Teknik Konseling

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Konseling adalah suatu kegiatan bertemu dan berdiskusinya seseorang yang
membutuhkan (klien) dan seseorang yang memberikan (konselor) dukungan
dan dorongan sedemikian rupa sehingga klien memperoleh keyakinan akan
kemampuannya dalam pemecahan masalah (Binfar, 2006)

- Meningkatkan keberhasilan terapi

- Memaksimalkan efek terapi
- Meminimalkan resiko efek samping
- Meningkatkan cost effectiveness
(Kemenkes, 2008).
Tujuan Khusus Konseling

●
Meningkatkan hubungan kepercayaan antara apoteker
dengan pasien
●
Menunjukkan perhatian dan kepedulian terhadap pasien

●
Meningkatkan kepatuhan pasien dalam menjalani
pengobatan
●
Mencegah dan meminimalkan DRP

●
Membimbing dan mendidik pasien dalam menggunakan
obat sehingga dapat mencapai tujuan pengobatan dan
meningkatkan mutu pengobatan pasien
 Manfaat Konseling

1.Bagi Pasien
- Menjamin keamanan dan efektifitas pengobatan
- Menurunkan kesalahan penggunaan obat
- Menghindari reaksi obat yang tidak diinginkan
- Meningkatkan efektifitas dan efisiensi biaya kesehatan
2. Bagi Apoteker
-Menjaga citra profesi sebagai bagian dari tim yankes
-Mewujudkan bentuk pelayanan asuhan kefarmasian sebagai tanggung jawab profesi
apoteker

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 Konseling vs informasi obat

Verbal vs non-verbal

Memahami vs menghakimi

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 Mengapa farmasis ber-konseling?

Provision and documentation of

patient education and counseling
are standards of pharmacy practice

Standard 2: Verify that patients

understand their medications and
appropriate outcomes of their drug

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• Pharmacists can contribute to positive outcomes by
educating and counseling patients to prepare and
motivate them to follow their pharmacotherapeutic
regimens and monitoring plans (ASHP, 2011).
• The pharmacy profession has accepted
responsibility for providing patient education and
counseling in the context of pharmaceutical care to
improve patient adherence and reduce medication-
related problems.

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• Tujuan konseling >>

Meningkatkan outcome terapi

dengan memaksimalkan
penggunaan obat secara tepat

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 3 aspek pendukung konseling

Pengetahuan
dan skills

Lingkungan Komunikasi

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 Pengetahuan dan skills
• Mengapa perlu??
– Informasi yang disampaikan benar
– Menumbuhkan ke-PeDe-an
– Pengakuan profesi (bagi masyarakat dan tenaga kesehatan)
– Kepuasan pasien
• Pengetahuan dan skills tentang apa?
– Keilmuan farmasi (farmakoterapi, farmakologi, toksikologi,
farmakokinetik, farmakodinamik, dll)
– Psikologi pasien
– Berkomunikasi

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 Kenali pasien Anda
• Karakteristik pasien (pola pikir terhadap
kesehatan dan penyakitnya; sikap; gaya hidup)
• Kemampuan pasien (kognitif; gaya belajar; status
fisik dan fungsi indera)
– Mengerti dengan mendengarkan
– Mengerti dengan melihat diagram, gambar atau model
– Mengerti dengan simulasi (obat atau alat)
• Apakah telah paham, mampu dan akan
menggunakan obatnya?

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 Lingkungan
• Ciptakan suasana kondusif
– Comfortable
– Confidential
– Safe
• Pasien dapat bercerita dengan nyaman tanpa
faktor pengganggu dari luar
• Farmasis dapat memberikan informasi sejelas
mungkin kepada pasien

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 Komunikasi konseling >> efektif dan efisien

• Verbal
– pilihan diksi : memahami bukan menghakimi
– pilihan informasi : sesuaikan kebutuhan pasien
• Nonverbal
– eye contact
– facial expressions
– body movements
– vocal characteristics

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 Skills communication
• Effective verbal communication skills
• Use an interactive approach to assessing and
verifying patient understanding through the
use of open-ended questions
• Effective nonverbal communication
• Use language the patient will be able to
understand
• Demonstrate effective counseling techniques

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 Patient Interaction
• Communicate to the patient why the counseling
session and included information is important
• Systematically think through problems and
present medication information in a logical order
• Display confidence and the ability to control and
direct the counseling session
• Manage time during the session effectively
• Work efficiently with their team member

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 Yang dihindari
• Berargumentasi
• Interupsi
• Memberikan pengertian yang tidak diminta
• Memberikan pemecahan masalah yang sulit
• Membebani pasien dengan pengalaman
• Berbasa-basi bercerita tentang moral
• Banyak bicara
• Sok bossy
• Instruksi
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 Metode konseling

Three prime Final Show and

question verification tell

Open-ended question
Active listening
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 Open-ended question
• Menggali informasi pasien
• Pertanyaan yang tidak dapat dijawab dengan
ya atau tidak
– Apa yang dirasakan?
– Bagaimana Anda menggunakan obat?
– Kapan Anda lupa minum obat?
– Pada bagian mana Anda merasakan sakit?

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 Three prime question
Bagaimana penjelasan dokter tentang :
• obat Anda?
• cara pakai obat Anda?
• efek yang diharapkan setelah menggunakan
obat?

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 Final verification
• Meminta pasien untuk mengulang instruksi
• Dilakukan untuk meyakinkan bahwa pesan
tidak ada yang terlewat
• Koreksi bila ada mis-informasi

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 Show and tell
• Untuk obat yang pernah dipakai
• Untuk memastikan pemahaman pasien

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 Process Steps of Counseling

Relationships

Verify patients’ Patient’s

understanding knowledge

Information

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 (1) Relationship
• Establish caring relationships with patients as
appropriate to the practice setting and stage in
the patient’s health care management.
• Introduce yourself as a pharmacist, explain the
purpose and expected length of the sessions,
and obtain the patient’s agreement to
participate.
• Determine the patient’s primary spoken
language.
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 (2) Patient’s knowledge
• Assess the patient’s knowledge about his or her health
problems and medications, physical and mental capability to
use the medications appropriately, and attitude toward the
health problems and medications.
• Ask open-ended questions about each medication’s purpose
and what the patient expects, and ask the patient to describe
or show how he or she will use the medication.
• Patients returning for refill medications should be asked to
describe or show how they have been using their medications.
• They should also be asked to describe any problems, concerns,
or uncertainties they are experiencing with their medications.

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 (3) Information
• Provide information orally and use visual aids or demonstrations to fill
patients’ gaps in knowledge and understanding.
• Open the medication containers to show patients the colors, sizes, shapes, and
markings on oral solids.
• For oral liquids and injectables, show patients the dosage marks on measuring
devices.
• Demonstrate the assembly and use of administration devices such as nasal and
oral inhalers.
• As a supplement to face-to-face oral communication, provide written
handouts to help the patient recall the information.
• If a patient is experiencing problems with his or her medications, gather
appropriate data and assess the problems.
Then adjust the pharmacotherapeutic regimens according to protocols or
notify the prescribers.

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 (4) Verify patients’ understanding
• Verify patients’ knowledge and understanding
of medication use.
• Ask patients to describe or show how they will
use their medications and identify their effects.
• Observe patients’ medication-use capability
and accuracy and attitudes toward following
their pharmacotherapeutic regimens and
monitoring plans.

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 Content of Counseling

Drug’s Administeri
description ng drug

Refill Self
prescription monitoring

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 Contents of counseling (1)
• The medication’s trade name, generic name, common
synonym, or other descriptive name(s) and, when
appropriate, its therapeutic class and efficacy.
• The medication’s use and expected benefits and action.
This may include whether the medication is intended to cure
a disease, eliminate or reduce symptoms, arrest or slow the
disease process, or prevent the disease or a symptom.
• The medication’s expected onset of action and what to do if
the action does not occur.
• The medication’s route, dosage form, dosage, and
administration schedule (including duration of therapy).

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 Contents of counseling (2)
• Directions for preparing and using or administering the
medication.
• Action to be taken in case of a missed dose.
• Precautions to be observed during the medication’s use
or administration and the medication’s potential risks in
relation to benefits.
• Potential common and severe adverse effects that may
occur, actions to prevent or minimize their occurrence,
and actions to take if they occur, including notifying the
prescriber, pharmacist, or other health care provider.

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 Contents of counseling (3)
• Techniques for self-monitoring of the pharmacotherapy
• Potential drug–drug (including nonprescription), drug–food, and
drug–disease interactions or contraindications.
• The medication’s relationships to radiologic and laboratory
procedures (e.g., timing of doses and potential interferences with
interpretation of results).
• Prescription refill authorizations and the process for obtaining refills.
• Instructions for 24-hour access to a pharmacist.
• Proper storage of the medication.
• Proper disposal of contaminated or discontinued medications and
used administration devices.
• Any other information unique to an individual patient or medication.

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 Documentation
• (1) that counseling was offered and was accepted and
provided or refused
• (2) the pharmacist’s perceived level of the patient’s
understanding.

• As appropriate, the content should be documented

(eg.counseling about food–drug interactions).
• All documentation should be safeguarded to respect
patient confidentiality and privacy and to comply with
applicable state and federal laws.
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 Evaluasi konseling

SETTING THE CONSULTATION

CLOSURE
STAGE PROCESS

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• Sumber: Indian Health Servise Interactive
Patient Counseling Technique Evaluation Form

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• Video konseling

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 Kasus (1)
• Seorang wanita (30th) datang ke apotek
membawa resep berikut:
R/ Captopril 12,5 tab XX
S2dd

• Ia mengatakan baru pertama mendapat obat

tersebut
• Bagaimana Apoteker memberikan konseling?
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 Kasus (2)
• Seorang pasien laki – laki (60th) datang ke
apotek untuk membeli obat flu sebab selama
3 hari ia merasa tidak nyaman dengan
sakitnya.
• Apa yang dilakukan Apoteker?

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 Kasus (3)
• Pasien wanita (50th) mengalami diabetes dan
gagal ginjal kronik stage 3. Saat ini ia
menggunakan metformin 500mg 3x sehari dan
insulin long acting digunakan malam hari. Ia
mengeluh terkadang berkeringat dingin di
malam hari.
• Apakah ada problem pengobatan pada pasien?
• Bagaimana anda melakukan konseling?

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 Kasus (4)
• Tn. Hr (42th) datang ke apotek dan
mengeluhkan nyeri dada beberapa waktu yang
lalu. Pasien meminta Anda memilihkan obat
yang manjur untuk sakitnya.
• Apa yang dilakukan Apoteker?

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 Kasus (5)
• Ny An (35th) menderita hipertensi dan diabetes
tipe-2 sejak 3 tahun yang lalu. Saat ini ia sedang
hamil 2 bulan. Karena kehamilan tersebut tidak
diketahui klinisi maka pengobatan hipertensi dan
DM tetap dilanjutkan seperti semula yakni Catopril
25mg 2xsehari dan Metformin 500mg 3xsehari.
• Apa yang dilakukan Apoteker?
• Bagaimana Anda mengkomunikasikan kepada
dokter dan pasien?

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 Kasus (6)
• Tn XL (63th) mendapatkan obat hipertensi
golongan beta bloker
• Informasi konseling apa yang disampaikan
Apoteker?

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 Kasus (7)
• Ny Mg (37th) mendapatkan gemfibrozil untuk
menurunkan kolesterolnya
• Informasi penting apa yang harus disampaikan
Apoteker?

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• Konseling adalah jatidiri farmasis
• Kita belum ber-profesi jika belum beraksi
untuk melakukannya
• Konseling merupakan tanggung jawab profesi
agar pengobatan pasien aman dan optimal

00000;  ;00000

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• Terima kasih..

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 Daftar pustaka
• ASHP Guidelines on Pharmacist-Conducted Patient Education
and Counseling.
• Harlina, K., 2005, Counseling Technique, MFK UGM.
• Herrier R. Case Studies in Patient Communication. In:
Schwinghammer T, Koehler J, eds. Pharmacotherapy Casebook:
A Patient-Focused Approach. New York, NY: McGraw-Hills;
2009:11-19, in Patient Counseling, www.snpha.org
• McDonough R, Bennett M. Improving Communication Skills of
Pharmacy Students Through Effective Precepting. Am J Pharm
Educ. 2006; 70(3):58. in Patient Counseling, www.snpha.org
• Pharmacist consultations : Indian Health Servise Interactive
Patient Counseling Technique Evaluation Form.
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