PATIENT COUNSELING PROGRAM

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PATIENT COUNSELING PROGRAM

• Yasser I. Al-Obaida M.Sci., CPHQ, MLC

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IN THIS PRSENTATION

• Introduction
• Compliance and non-compliance
• Pharmacist patient care responsibilities
• Patient counseling models
• Pharmacy visit
• Patient discharge counseling
• Out-patient counseling

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IN THIS PRESENTATION

• Barriers to effective counseling
• ways to improve your counseling skills
• How to be better listener
• Conclusion

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INTRODUCTION

• Next to drug dispensing
• Patient counseling (PC) defined as one-on-one,
  interactive session designed to modify patient
  knowledge or behavior
• Also refers to the process whereby a pharmacist
  listens to patients concern about his/her drug
  therapy and offers education appropriate to the
  patients needs

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Reported Errors in Health Care

• 44,000 - 98,000 Americans die in hospitals each
  year2.
• exceed the death attributed to Motor Vehicle
  Accidents (43,458), Breast Cancer (42,297) or
  AIDS (16,516).
• Every 6 months, death at US hospitals are more
  than who died in the Vietnam War
• Some have compared the rate to 3 fully Jumbo Jets
  crashing every other day.

1.IOM report 1999 2.JAMA 2001
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Reported Errors in Health Care (Contd)

• New York 1984 and Colorado using 1992.
• Injuries caused by medical management, were 3.7
  and 2.9 respectively.
• Preventable adverse events 58 in NY and 53 in
  Colorado1.
• National Patient Safety Foundation
• 42 of respondent had been affected by medical
  error
• 32 of the respondents indicated that the errors
  had a permanent negative effect on the patients
  health.

JAMA 2001 BMJ 1999
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Reported Errors in Health Care (Contd)

• American Society of Health System Pharmacist
  reported that, American is concerned about
• The wrong medicine (61)
• Two or more medications that interact in negative
  way (58)
• Possible Solutions
• 75 keep health professionals with bad track
  records from providing care.
• 69 thought the problem could be solved through
  better training of health care professional.

JASHP 2001
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Reported Errors in Health Care (Contd)

• In Britain the medical errors come in the third
  ranks after the cancer and heart disease.
• Are top causes of death of more than 70 thousands
  persons annually
• 280 thousands persons. Ministry of Health
  allotted special budget with setting-up practical
  mechanisms.

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Reported Errors in Health Care (Contd)

• In Switzerland, the Swiss Institute for Poisoning
  Control.
• increase in poisoning rates among the patients to
  8,380 cases out of 23,000 registered cases due to
  error in medication prescription or in dose
  volume. Whereas.
• These error had cause the death of 10 persons
  and developed serious complication to other 556
  patients.

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Reported Errors in Health Care (Contd)

• Local Level No accurate statistics on the
  medical errors.
• Scientific Forum in Riyadh under the title
  Ethics and Medical Errors highlighted that, 80
  of medical errors were found to be a result of
  medication errors.
• College of Pharmacy KSU (not published), 1996
  found 20 of the hospital admissions are due to
  drug related problem(2).
• 70 of these drug related hospital admission are
  avoidable.

KSU College of Pharmacy
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COMPLIANCE

• Compliance definite as the degree which the
  patients behavior correspond with directions from
  health care provider
• The benefits from patient compliance
• improve patient disease and clinical symptoms,
• it reduces the cost of medical treatment

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NON-COMPLIANCE

• The costs of non-compliance
• Hospitalization.
• Additional diagnostic procedures and medication
  to treat complications.
• Physician visits.
• The best solution of this problem

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REASONS OF NON-COMPLIANCE

• Patient factors
• Patient cant remember to take the medication
• Patient stops medication because of early
  symptomatic relief
• Asymptomatic disease
• Patient doses not understand instructions
• Patient doses not understand the importance of
  the compliance

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REASONS OF NON-COMPLIANCE

• Product factors
• complexity of drug regime
• inconvenience of dosage forms
• disagreeable taste
• cost
• side effect
• abuse potential

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REASONS OF NON-COMPLIANCE

• Pharmacy Factors
• lack of counseling
• attitude about the products importance
• Pharmacy physical appearance
• lack of time
• shortage of staff

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PHARMACIST ROLE

• Pharmacist can improve patient compliance by
  patient counseling
• In one the studies PC by pharmacist can reduce
  60 of high rate of deviation
• Pharmacist is the logical resource to provide
  information
• PC the most important pharmacist responsibilities

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PHARMACIST ROLE

• Become more important in future for 5 reasons
• technicians or using some type of mechanized
• As the population ages more people will be taking
  drugs for chronic diseases and acute illnesses
• Many hospital admissions are the result of
  medication-related problem
• Intensive patient counseling education follow up,
  will reduce patient morbidity and mortality
• Pharmacists are the health care practitioners in
  the best position to focus on medication related
  problems

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PATIENT COUNSELONG MODELS

• The Indian Health Service
• which the most widely used and accepted in the
  pharmacy practice.
• Its based on opened-ended questions that help
  determine the patients knowledge of his or her
  disease and medications.
• An opened-ended question usually starts with one
  of the key words who, what, when, why, or how
  rather than with did, do, can, or well.

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PATIENT COUNSELONG MODELS

• At a minimum, the following points should be
  reviewed for each medication in the patient's
  drug regimen
• The medication's trademark name, generic name,
  common synonym, or other descriptive name.
• The intended use and expected action . what to do
  if the expected actions does not occur.
• The route, dosage form, dosage, and
  administration schedule (including duration of
  therapy ).
• Directions for preparation.
• Precautions to be observed during administration.

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PATIENT COUNSELONG MODELS

• Common adverse effects that may be encountered,
  including their avoidance Directions for
  administration.
• Techniques for self-monitoring of drug therapy.
• Proper storage.
• Potential drug -drug or drug-food interactions or
  contraindications.
• Issues related to radiological and laboratory
  procedures (e.g., timing of doses and potential
  interference with interpreting results).
• Prescription refill information.
• Action to be taken in the event of a missed dose
• Any other information peculiar to the specific
  patient or drug

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HEALTH COMMUNICATION MODEL

• The health communication model
• Notes the primary importance of the
  patient-provider relationship in ensuring
  compliance
• And provides strategies for enhancing patient
  comprehension and recall.

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HEALTH COMMUNICATION MODEL

• The seven strategies are
• Providing explicit directions (spelling out what
  the patient is supposed to do)
• Explaining the purpose or importance of the
  therapy
• Providing written information in combination with
  oral counseling.
• Explicit categorization.
• Repeating important points
• Simplifying instructions
• Providing consistent advice(between the visits
  and between the physician and the pharmacist)

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PHARMACY VISITS
Introduction
Profile assessment
Patient assessment
Clinical closure
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REMEMBER TO ASK PATIENT ABOUT

• The complaints that caused them to seek medical
  attention
• Allergies and /or idiosyncrasies.
• Other medication used.
• pregnancy status now and future (for female
  patient)
• Use of alcohol and smoking habits.

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PATIENT DISCHARGE COUNSELING

• Improve patient knowledge and compliance through
  educational and behavioral efforts.
• Provide a smoother and timely discharge process
  for patient.
• Create a more efficient process for preparing and
  dispensing discharge prescriptions and
• Enable pharmacists to gain experience in patient
  counseling and learn the importance of pharmacy
  participation in patient discharge process.

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TARGET POPULATION

• All patients OR
• Patients who take six or more medications
• Patients taking medication with a narrow
  therapeutic index.
• Medications with a high adverse effects profile.
• Patients over 55 years old
• OR specific patient population
• liver transplant patient
• renal transplant patient
• oncology patient
• pediatrics patient

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BARRIERS TO EFFECTIVE COUNSELING

• American foundation for pharmaceutical education
  repots 1187 barriers
• An important barrier to counseling
• insufficient time
• lack of privacy
• patient expectation of the pharmacist role

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WAYS TO IMPROVE YOUR PC SKILLS

• Does your patient know you by name and reason you
  are taking time to counsel him
• Are you able to express both verbally and
  non-verbally
• Do you find out about the patients problem before
  you counsel .
• What the language you would use with your patient

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HOW TO BE BETTER LISTENER

• Remove barriers
• Take time to listen and give full attention
• Focus on your goal
• Allow to tow-way communication
• Ask questions
• Restate what the patient says
• Look for and use nonverbal cues
• Touch
• Advise and judge

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CONSLUSION

• Pharmacist must pay attention to his role and
  responsibilities
• Pharmacist are the logical resource to provide
  information
• An effective PC program is a positive fore for
  pharmacists to enhance patient compliance