The Need For

Patient Counseling
Dr. Ahmad Al-Rusasi

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 Objectives
• To understand the need for patient counseling.
• To Understand Why Pharmacists Need to Become skillful
in Patient Counseling
• To learn about Communication Skills
• To be familiar with the patient centered consultation
• To Be Able to Describe and Define Patient Counseling
• To Describe How People Feel About Being Ill and Using
Medication
• To Demonstrate the Use of Techniques Involved in Patient
Counseling
• To Identify and Deal with Special Situations
• To Be Able to Provide Counseling in Everyday Practice

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Real Cases resulted from no counseling
1. Calamine lotion case.
2. A 36-year-old man was prescribed a
fentanyl® patch to treat pain resulting from a
back injury. He was not informed that heat
could make the patch unsafe to use. He fell
asleep with a heating pad and died. The level
of fentanyl® in his bloodstream was found to
be 100 times the level it should have been.

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Real Cases resulted from no counseling
3. A patient prescribed Normodyne®(Labetalol)
for hypertension was dispensed Norpramin®
(Desipramine). She experienced numerous
side effects including blurred vision and hand
tremors. Since she knew that she was
supposed to be taking the medication to
treat hypertension, even minimal
communication between the pharmacist and
patient about the therapy would have
prevented this medication error (ISMP, 2004).
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Real Cases resulted from no counseling
4. A patient being seen in an anticoagulation clinic mentioned
to the pharmacist that he had developed several bruises on
his hands and legs. The pharmacist immediately checked the
patient's computer records and found a recent INR value of
6, which was well above his targeted 2-3 range. The
pharmacist asked whether the patient had changed his diet,
lifestyle, or drug regimen. The patient said no, but that he
was given another medication during his last clinic visit. The
pharmacist then went back to the profile and noticed that
the patient had been receiving 4 mg daily Coumadin® for
some time, but his dose was reduced to 3 mg during the last
visit to adjust his INR. The pharmacist suspected what the
issue might be and asked the patient, "Did you stop taking
the 4 mg tablet?" The patient replied, "No, nobody told me
to, so I have been following instructions and taking both
tablets!!" Thus, he was taking 7 mg per day rather than the
intended 3 mg.
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Real Cases resulted from no counseling
5. A young woman suffering from vaginal
candidiasis was given the usual 15 nystatin®
vaginal tablets and was told by the
pharmacist to "use one tablet daily for two
weeks." She returned to the pharmacy after
two weeks in severe discomfort with a
complaint that "those nystatin® tablets taste
terrible!"

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Real Cases resulted from no counseling
6. A patient returned to the pharmacy
complaining of side effects apparently caused
by his medication. The patient's records
indicated he was given 30 nitroglycerin
patches. Both the pharmacist and the
physician told him to "apply one daily" The
patient opened his shirt to reveal 27
nitroglycerin patches firmly adhered to his
chest!!
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 The concept of pharmaceutical care
As A Caregiver Pharmacist Must ensure Drug delivery,
medication safety and the concepts of pharmaceutical care

1. Right Medication
2. Right Dose
3. Right Time
4. Right Route
5. Right Patient
6. Right To Counsel and education
7. Right To Refuse
8. Right History and Assessment
9. Right DRP Evaluation
10. Right Documentation
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Why Patient Counseling in Daily
Pharmacy Practice

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 Objectives
• After completing this module, the trainee should
be able to:
1. describe the potential benefits of patient counseling
to the patient.
2. describe the potential benefits of patient counseling
to the pharmacist.
3. discuss how patient counseling may be seen as a
service to the public and private.
4. describe how patient counseling fits in with the
pharmaceutical care model.
5. discuss the challenges faced by pharmacists in
patient counseling

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 The Role of Patient Counseling in
Pharmacy
• 1922 to 1969 pharmacists were prohibited from discussing therapies
with their patients
• 1998 The Pharmacist Practice Activity Classification (PPAC) developed
in by the APhA describes pharmacists' activities:
– patient interaction: interviewing, educating &counseling the
patient, obtaining patient information, providing verbal and
written information, discussing, demonstrating, face-to-face
patient contact.
• Philosophy of Pharmaceutical care: pharmacists are responsible
directly to the patients they serve.
• From the Patient-centered view: patient counseling improves patient
care
• From the pharmacist's point of view: it is integral to providing
competitive and professional pharmacy services
• patient counseling and (patient—pharmacist interaction )are key to
the pharmacist's role today
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 PATIENT COUNSELING TO IMPROVE
PATIENT CARE
• studies:
– Between 30 and 50% of patients do not take their medicines as
intended.
– As few as 16 percent of patients prescribed a new medicine take
it as prescribed, experience no problems and receive as much
information as they need
– 50% of patients will use their medications incorrectly
– 48% of the US population, and 55% of the elderly no-adherent
– 32% of patients who were instructed by their doctors to have
their prescriptions refilled failed to do so
– 25% of patients will use a medication in a way that poses a
threat to their health.
– 5.5% of hospital admissions can be attributed to drug therapy
nonadherence.

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 PATIENT COUNSELING TO IMPROVE
PATIENT CARE
• Studies:
– 1999 that as many as 100,000 Americans die in
hospitals annually from adverse event (more than car
accidents, breast cancer, or AIDS).
– 45% of those were due to medication errors.
– the annual cost of drug-related morbidity and
mortality in the United States was estimated in 1995
is $45.6 billion.
– the cost of preventable adverse events was estimated
to be between $17 billion and $19 billion including
lost income.

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 Why Counseling
1. Reduces errors in using medication
2. Reduces nonadherence
3. Reduces adverse drug reactions
4. Improves outcomes
5. Increases satisfaction with care
6. Assists with self-care
7. Can provide referral for assistance
8. Reduces health care costs
9. Is an integral part of providing Pharmaceutical care
10. Increases revenue through payment for counseling
services and reduces loss resulting from unfilled or un-
refilled prescriptions
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Theoretical basis and guidelines for pharmacist –
patient communication process
USP Patient Counselling Guidelines:
1. The patient will recognize why the medication is helpful for
maintaining or promoting wellbeing.
2. The patient will accept the support from the HCP and
consultation.
3. The patient will develop the ability to make more appropriate
medication-related decisions concerning adherence to his/her
medication regimen.
4. The patient will improve coping strategies to deal with adverse
effects and interactions.
5. The patient will become a more informed, efficient, active
participant in disease treatment and self-care management.
6. The patient will show motivation toward taking medications to
improve his/her health status.
 PATIENT COUNSELING AND
PHARMACEUTICAL CARE
• Each step in the pharmaceutical care process requires
pt-phst interaction:
1. Establishing the phst—pt relationship.
2. collecting and interpreting patient information
3. listing and ranking drug-related problems (DRP)
4. determining desired pharmacotherapeutic goals
5. determining feasible alternatives
6. Selecting the most appropriate treatment regimen
7. designing a drug-monitoring plan
8. implementing the decisions about drug use
9. designing a monitoring plan to achieve desired goals
10. following up to determine the success of treatment

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CHALLENGES IN PATIENT COUNSELING
Will be mentioned later on:
1. System challenges
2. Pharmacy environment:
3. Patient challenges:
4. Pharmacist challenges:
5. The challenge of change:

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