Patient Counseling

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Patient Counselling India

PATIENT COUNSELING

Anantha Naik Nagappa and Uday Venkat Mateti

Manipal College of Pharmaceutical Sciences, Manipal University, Manipal-576104

Why the patients need Patient counseling?

The information on using drugs is technical and needs to be understood by the patients before using it. The patients are unaware regarding precautions and tips to prevent harmful effects of the drugs and at the same time good outcomes due to medicines. This can only happen by a personalized professional counseling in the matters of drug, disease and life style. It is also important to make and respond to the instructions in the prescription, so that he/she understands and behaves responsibly like an informed patient.

What are the basic skills required in patient counseling?

When the patient arises at the counter of pharmacy for collecting the dispensed medications. The first encounter should be impressive and emphatic. The pharmacist at the counter should present him/her self that the patient feel encouraged and confident. The pharmacists while dispensing should estimate the patient needs by friendly gestures and inviting him/her to ask questions while answering questions the patients need to verify the correctness of information given to the patients. If the patients requires elaborate discussion should be invited to come to patient counseling room where in patients privacy is ensured. The pharmacists should not ask too many questions which embarrass the patient. The pharmacist should listen patiently, the problems and difficulties of patients. In case of any strange things in prescriptions comes to notice of pharmacist, he should not criticize or comment on prescription or prescriber. He should directly contact the doctor and draw his/her attention to the flaw in the prescription and correct without knowledge of the patients.

What are the advantages of patient counseling over written instructions?

The dialogue mode of patient counseling is a direct personalized one to one discussion. In this model patient can reveal his/her difficulties due to disease and medications. Patients get motivated by direct interaction by a pharmacist. The written instructions are passive and difficult to understand by mere reading.

What is the benefit for the pharmacist by providing patient counseling?

The pharmacist gets recognized and his/her involvement in the drug information gets sharpened due to involvement and reference. The pharmacist drives a professional satisfaction and in the sense of fulfillment due to acknowledgement of gratitude by the patients. It has been proved that the patient counseling improves quality of outcomes. The fee can be collected for providing services of patient counseling.

What are the etiquettes and manners required for successful patient counseling?

When the patient arrives at the pharmacy the pharmacist should present himself as professional distinct from assistant or pharmacy aid. The patients' needs are to be gauged and an offer voluntary help should make patient comfortable and at ease. The patient should never get the feeling of getting neglected or ignored due to rush more of customers. The due diligence should be imbibed should never express unhappiness due to excess work pressure. This is important as the patient himself under the spell of disease is under stress and should not get depressed due to negative expressions of gestures of pharmacist.

What is the impact of patient counseling on pharmaceutical care?

Patient counseling is the gateway for pharmaceutical care and practice. The personal dialogue and listening patiently to the greenness of the patients is the first step towards insuring the patient's confidence and acceptance as a reliable professional. Further the pharmaceutical care can be built on the rapport built by patient counseling.

Why the patient should demand patient counseling services?

The patient requires practical information after he gets the prescription medicines at pharmacy. The out patients and ambulatory patients are likely to develop confusion regarding usage of medicines after reaching home. In an eventuality he is likely to face dilemmas regarding whether the drug should be taken before or after food, regarding the time gap between the doses, any special precautions like drowsiness etc., the likely change in body condition and food-drug interactions etc.,

How to charge service fee for patient counseling?

The system of awarding for patient counseling services is based on the idea to prevent any hazards while using medicines. The patient counseling is a professional service for which the pharmacist gets paid. For example USA and Canada in a stand-alone pharmacy charge the patient directly. In retail chain pharmacies gets additional incentive for providing the patient counseling. Some of the insurance companies also cover the pharmacist patient counseling expenses. In UK where the major healthcare provider is government the community pharmacists are paid extra for the patient counseling and pharmaceutical care services. In Australia and New Zealand community pharmacists gets reimbursement in addition to salary for patient counseling by government.

Is patient counseling should be free of cost?

The patient counseling is a professional activity which should be encouraged and rewarded because the medicines are sold in a pre-packed ready to use formulations. Currently the income of pharmacy depends on retail margins provided by pharmaceutical industry. In case the expertise of pharmacist to be nurtured and developed there is a need for motivation of the pharmacist.

What are the advantages and limitations of providing free patient counseling?

The advantages of free patient counseling are making the expenditure of medicine for a patient and third party co-payers. The limitations are the patient counseling may not be done properly and it is not possible to demand accountability for no patient counseling and substandard counseling. The money spent on medicines can be realized if the medicines deliver the expected outcomes and does not cause harm to the patients. Hence it is very important to give proper instructions and guidelines for using the prescribed medicines.

How to fix the accountability of patient counseling services?

The documentation of services can be done using CCTV which can be used as data for reinforcement of services in case they render services fall short of expected standards. Further the TV footages of CC camera is possible if the patient counseling is carried out. The performance of the pharmacist can be assessed on cumulative scale and periodic review. This type of scheme makes the pharmacist alert and understands the skill areas in which the pharmacist need to improve for delivering quality services for the patients.

What is the importance of confidentiality in patient counseling?

The patients are sensitive to their privacy of health and are likely to hide their health condition to the public as there are multiple influences on opportunities and impression regarding the personality of patient. The patient has approached the pharmacist with a confidence that his disease condition shall not be revealed to other people in the community. The disclosure of patient information in the public is unprofessional and unethical

What is the difference between patient education and patient counseling?

The patient education is set of instructions and classified information explained to the patient with a hope of that a patient understands vital information for a particular disease of the patient. Patient education is an impersonal communication addressed to presumed needs of a drug therapy. Whereas the patient counseling is an active model of appeal to the patients instructing regarding the disease and drugs used by them with an intention of motivation.

How to ensure privacy for patient counseling?

The privacy of patient counseling is possible when a patient and pharmacist are allowed to interact in a closed room designated as patient counseling cabin. The pharmacist should not address the patient in the dispensing area where the other patients are also there for buying medicines. The pharmacist should invite the patient or his close relative to a patient counseling room and discuss the maters of health, disease and drugs. There should be security built in that classified information of patients does not get leaked in the public media.

What are the bottlenecks hindering the patients to voluntaries to avail patient counseling?

The psychological and social inhibitions of the patient's discourage them to open up and disclose their personal information of health. However the service of the pharmacist mainly depends upon patient's history which can be obtained with skillful interview and interactions. Once the patient feels confident and opens-up then the patient disclosed the information. Based on the disclosed information pharmacist can plan a personalized patient counseling plan.

How to optimize the pharmacy profits versus patient welfare by patient counseling?

The pharmacist is a trusted professional by patients who want to submit their apprehensions and fears in order to get clarifications and confirmations regarding drug, disease and life style. The pharmacist being projected as an expert in the matters of medicine. The patients are likely to consult which takes considerable amount of time for the pharmacist. The pharmacist can charge the patients on time slat or question wise. The most of the reimbursement for the pharmacy patient counseling services are by insurance claim, government subsidy and rarely by out of pocket by the patients.

What is contribution of m-health and e-health in patient counseling delivery?

The mobile health is a technology platform utilizing the communication technologies and e-health is also technology based healthcare delivery solution which aims at machine based patient education modules. This can become high impact in case a human inter phase is introduced at the delivery point. These technologies can be highly successful as a customized patient counseling module with enough patient confidentiality.

What is the difference in objectives of services of patient counseling and pharmaceutical care?

The patient counseling is a one to one verbal instructions regarding comprehensive pharmaceutical care delivered in an interactive session. Whereas pharmaceutical care is an active model of service where the pharmacist motivates the patient to comprehensive pharmaceutical care direct supervision.

Whether patient counseling should be interactive or directive?

The interactive session gives an opportunity for the patients to clarify his/her doubts with the pharmacist whereas the instructive module is a pre thought process in which patients have less scope to learn and understand the directions given by pharmacist. It also understands that pharmacist has an approach to motivate the patient and get the feedback from the patient regarding the knowledge, attitude and practice by the patient.

References

ASHP Guidelines on Pharmacist-Conducted Patient Education and Counseling. Available from: http://www.ashp.org/DocLibrary/BestPractices/OrgGdlPtEduc.aspx

Pharmacist-patient consultation program, unit II: counseling patients in challenging situations. New York: Pfizer Inc.; 1993.

Innovative education for Pharmacists-Counseling, Concordance and Communication. Available from:http://www.fip.org/files/fip/PI/Counselling,%20Concordance,%20and%20Comm...

Pharmaceutical Care-Policies and Practices for a Safer, More Responsible and Cost-effective Health System, 2012. Available from: https://www.edqm.eu/site/policies_and_practices_for_a_safer_more_responsiblpdf-en-31003-2.html.

About the Author

Anantha Naik Nagappa's picture

I am professor, intrested in developing the community pharmacy services in India, We have an association called ASSOCIATION OF COMMUNITY PHARMACISITS OF iNDIA. CHECK AT www.acpi.in for further detials

Comments

Albert Ana-Maria's picture

Is this good? To counseling the pacient? What is the doctor job then ?

Anantha Naik Nagappa's picture

Patient counseling is the responsibility of all the healthcare service providers in the areas of expertise making the patient feel at ease and relief his/her tensions becomes the primary requirements of all treatments. Pharmacists can speak on medications and doctors can speak on disease and other apprehensiveness regarding the sufferings of the diseases. Nursing professionals can make the patients feel comfortable by providing nursing care and listening to the patients grievances. It is also true that the doctors and nurses are usually busy on patients load.

Prof Anantha Naik Nagappa

My Page : http://www.pharmainfo.net/ananthanaik

Srinivas's picture

why should patient counselling be charged separately when it is part of duties or responsibilities of the pharmacist?

will the patient be willing to spend an extra amount for patient counselling along with already burdensome health care costs?

Anantha Naik Nagappa's picture

The reward for the healthcare service is a must because the pharmacist or any other person wont take interest unless incentives are there. In India the earnings of retail pharmacies solely depend upon the volume of sales as a result of it no pharmacist is taking an active interest in patient education. Where as an Australia Pharmacists are reimbursed for counseling time. It is successfully done we all know without patient counseling treatment is incomplete and the results in poor outcomes along issues on patient safety and increased cost of treament

Prof Anantha Naik Nagappa

My Page : http://www.pharmainfo.net/ananthanaik

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