Lack of Patient Counseling

Assignment

LACK OF PATIENT COUNSELING

A research proposal submitted in partial fulfillment of

requirement for degree of

Bachelor of Business Administration,

Submitted to:

Prof. Sir Farhan Sarver

Submitted by: Abdullah Aslam

Roll Number BSF1704186

BBA (Evening) Semester 8th Session: 2017-2021

UNIVERSITY OF EDUCATION Lack of Patient Counseling

LACK OF PATIENT COUNSELING
Abstract
Patient understanding regarding the illness plays a very important role in management of
chronic illness. Effective patient counseling makes the patient understand his/her illness,
necessary lifestyle modifications and pharmacotherapy in a better way and thus enhance
patient compliance. The pharmacist has immense responsibility in counseling the patients with
chronic illness. The counseling pharmacist should possess adequate knowledge and should be
an effective communicator, making use of the verbal and non-verbal communication skills.The
aim and objective of our research is to highlight the lack of counseling program people are
facing in our country which leads to drug abuse and miss use. There is survay based research
in which questioner is mentioned and filled from people who recently visited any hospital or
pharmacy. The outcomes we have after our survay are showing that there is big lack in
counseling program of our health system as i already had observe and i also mentioned some
previous researches on this topic but still these is behavioral lack in our health workers. As a
health worker either a doctor or pharmacist our first priority should have patient satifaction which
only overcome through proper guidance and counsel the patient
.
Introduction

Patient counseling may be defined as providing medication information orally or in written form
to the patients or their representative or providing proper directions of use, advice on side
effects, storage, diet and life style modifications. It involves a one-to-one interaction between a
pharmacist and a patient and/or a care giver. It is interactive in nature. The effective counseling
should encompass all the parameters to make the patient/party understand his/her disease,
medications and life style modification required .
Patient counselling provides an opportunity to elicit the necessary information from a patient,
and to enable safe and effective use of medicines. Patients have the right to expect that the
pharmacist will counsel them privately about their medicines. Counselling is also the final
checking process to ensure the correct medicine is supplied to the correct patient.
The availability of and rational use of medicines are critical for a successful therapeutic
outcome. Though rapid developments in science and technology have led to easy
understanding of etiology and pathophysiological basis of various diseases and development of
new molecules, many times clinicians fail to achieve the desired therapeutic goals. One of the
major reasons for this can be the patient non-compliance or partial compliance towards the
prescribed treatmentstanding of how the medicine is to be used, as well as a positive behavior
in which the patient is motivated sufficiently to use the prescribed treatment in the manner
intended because of a perceived self-benefit and a positive outcome (e.g. enhanced quality of
life and well being). Non- compliance can lead to various consequences including underuse,
overuse, misuse, abuse etc. The most common factors associated with non-compliance are the
nature of the disease, multiple drug therapy, frequency of drug administration, duration of drug
therapy, adverse events, cost of medications, administration technique, taste of medication etc.
patients unsatisfy and leads to medicine abuse and miss use because they dont even know that
how to use Lack of Patient Counseling and when to stop. The only making change in behavior
of health workers make patient confident about his recovery make patient educate about his
disease and preventions he has to follow on. The diet he has to use and tge other possible
ways of treatment. 80 percent patient mentally recover when doctor counsel him properly.
Patient counseling refers to the process of providing vital information, advice and assistance to
help you with your medications and to ensure you take them properly. This also includes
important information about the patient's illness and lifestyle. A patient is advised on whether
medications should be taken with or without food, at bed time or in morning, with water, juice or
milk, swallow whole or chew the tablet, time between each doses. All of this information results
in the proper use and best therapeutic action of the medications.
When we are called to the counseling area we get access to a new situation at hand which
should be properly studied in order to provide effective information. As we approach the counter
we have to observe the patient’s non-verbal cues for any barriers that need to be overcome
while communicating with the patient. There comes various barriers faced by a pharmacist in a
clinical setting to perform his counseling service . Some barriers are patient-centered such as
counseling the caregiver instead of the patient, low level of education and physical condition of
the patient which is difficult to overcome. Whereas some are institution-centered like delay of
discharge order, lack of privacy etc. which can be counteracted by strict implementation of
policies. To provide a framework for ensuring medication adherence and the optimum
therapeutic efficacy it is mandatory to counteract the barriers faced by a pharmacist in
communication with the patient . The difference in having a positive or negative
pharmacotherapeutic outcome purely depends on an effective pharmacist consultation.
Although individual pharmacist has their own way of counseling a client, they must follow certain
key features like introducing themselves, identifying the right patient using patient details,
providing comfort ensuring privacy to the patient and also solving their queries .

Review of literature

The results of several studies suggest that up to 10% of hospital admissions and 23% of
nursing-home admissions are related to non-compliance . A review of published studies of drug-
related hospital admissions reported that 22.7% of adverse drug reaction hospitalizations were
induced by non-compliance . With significant growth and development over the past 30 years,
the profession of pharmacy has evolved a new concept called pharmaceutical care; the
responsible provision of drug therapy for the purpose of achieving definite outcomes that
improve the patients’ quality of life. These outcomes are cure of disease, elimination or
reduction of symptoms, arresting or slowing of disease progressions, or preventing a disease or
symptomology. One of the important aspects of pharmaceutical care is counseling patients
concerning medications. It has been the responsibility of pharmacists to counsel the patient’s
before dispensing the medication . Counseling not only enhances compliance, but also reduces
complications resulting from non adherence to treatment.
significant positive correlation between subspecialty and concerns about adherence (r = −0.160,
P < 0.01), on the other hand, significant negative correlation was found between years of
experience and concerns about adherence (r = −0.246, P < 0.01). Lack of Patient Counseling
Using random sampling technique, pharmacies were approached to take part in this
questionnaire-based research. All the collected data were analysed using PASW® 18.0.
Correlations were studied using Pearson's correlation. Key findings: From the 714 community
pharmacies that were approached, 374 pharmacists were responded to the survey 52.4%. The
majority of pharmacies provided patient counselling for long-term conditions and weight
management (72.5%, n = 271 and 70.3%, n = 263 respectively). Lack of patient interest was
the main barrier for not providing pharmaceutical services according to 50.8% of pharmacists.
Three-quarters of the pharmacists preferred to be given incentives for providing pharmaceutical
services by government (73.3%, n = 274). There were significant correlations between providing
community pharmacy services and subspecialty of the responding pharmacists (r = 0.142, P <
0.01), experience (r = 0.150, P < 0.01). Concerns regarding patient adherence to medications
were raised by 88% of pharmacists. There was a significant positive correlation between
subspecialty and concerns about adherence (r = −0.160, P < 0.01), on the other hand,
significant negative correlation was found between years of experience and concerns about
adherence (r = −0.246, P < 0.01). Conclusions: This study provides baseline data for
policymakers on what pharmaceutical services are currently available across community
pharmacies in Jordan and what barriers to these services may exist. These data also give an
insight into how to improve the delivery of professional services that could result in better health
outcomes.
There are several previous researches on patient counseling to prove the lacks present in this
system that very few pharmacies and hospitals leads on patient counseling program but
majority not. This topic is rarely discused but if we elaborate it, patient counseling is one the
basic term leads to patient's recovery when we properly attend the patient, listen him
understand him and make sure him that he will be fine soon by the medication and other
therapy process than he believes on that firstly when we educate him about the contradictions
about the precautions his diet plan and other ways like therapies and other possible ways than
he become satisfy when we acknowledge him about the meducation6he is going to start that
how and when to take than we prevent him from miss use and abuse otherwise people done
even know that how to take medicine before meal or after meal once in a day or twice they use
the medicine according to their sense, other hand they stop taking medicine due to lack of
guidance or may taking medicine daily if find any kind of relief these all are miss use and
abuse which is directly because of lack of counseling.There are previous researches which
showing that there is big lack in patient counseling program either lack from health workers or
patient side.
Research is increasingly finding that the type of therapy used is not a important to outcomes as
are specific counselor behaviors such as (1) Enthusiasm, (2) Confidence, (3) Belief in the
patient’s ability to change. Although there is nothing which will ensure change, it would appear
that clients are more likely to achieve their goals when a good and positive relationship exists
between them and their therapist. In essence the counselor’s interactions with the client are a
powerful tool in the helping relationship.Attending - orienting oneself physically to the patient
(pt) to indicate one is aware of the patient, and, in fact, that the client has your full, undivided
attention and that you care. Methods include eye contact; nods; not moving around, being
distracted, eye contact, encouraging verbalizations; mirroring body postures and language;
leaning forward, etc. Researchers estimate that about 80 percent of communication takes place
non-verbally. Listening/observing - capturing and understanding the verbal and nonverbal
information communicated by that pt.Showing the Empathy the ability to perceive another's
experience and then to communicate that perception back to the individual to clarify and amplify
 their own experiencing and meaning.REFLECTING PT'S FEELINGS- Affective reflection in an
open-ended, respectful manner of what the client is communicating verbally and nonverbally,
both directly through words and nonverbal behaviors as well as reasonable inferences about
what the client might be experiencing emotionally It is important for the helper to think carefully
about which words he/she chooses to communicate these feelings back to the client. The skill
lies in choosing words which use different words that convey the same or similar. Lack of Patient
Counseling
For example, if a poorly skilled helper reflected to the client that he/she was “very angry and
depressed,” when the client had only said they were irritated by a certain event, and had felt
very sad over the death of a family pet, the result could be counterproductive to the process of
change. showing Genuiness Ability of counselor to be freely themselves. Includes congruence
between outer words/behaviors and inner feelings; nondefensiveness; non-role-playing; and
being unpretentious. For example, if the helper claims that they are comfortable helping a client
explore a drug or sexual issue, but their behavior (verbally and nonverbally) shows signs of
discomfort with the topic this will become an obstacle to progress and often lead to client
confusion about and mistrust of the helper.Unconditional positive regard An expression of
caring and nurturance as well as acceptance.Includes conveying warmth through: Also
conveying acceptance by responding to the pt's messages (verbal and nonverbal) with
nonjudgmental or noncritical verbal & nonverbal reactions. Respect - ability to communicate to
the pt the counselor's sincere belief that every person possesses the inherent strength and
capacity to make it in life, and that each person has the right to choose his own alternatives and
make his own decisions.Concreteness Keeping communications specific -- focused on facts
and feelings of relevant concerns, while avoiding tangents, generalizations, abstract
discussions, or talking about counselor rather then the client. Includes the following functions:
Assisting client to identify and work on a specific problem from the various ones presented.
Reminding the client of the task and redescribing intent and structure of the session. Using
questions and suggestions to help the client clarify facts, terms, feelings, and goals. Use a here-
and-now focus to emphasize process and content occurring in current session, which may of
help to elucidate the problem being worked on or improving the problem-solving
process.OpenQuestions -- A questioning process to assist the client in clarifying or exploring
thoughts or feelings. Counselor id not requesting specific information and not purposively
limiting the nature of the response to only a yes or no, or very brief answer. Goal is to facilitate
exploration – not needed if the client is already doing this.Counselor Self-Disclosure The
counselor shares personal feelings, experiences, or reactions to the client. Should include
relevant content intended to help them. As a rule, it is better to not self-disclose unless there is a
pressing clinical need which cannot be met in any other way. Remember empathy is not sharing
similar experiences but conveying in a caring and understanding manner what the client is
feeling and thinking. Interpretation Any statement to the client which goes beyond what they
have said or are aware of. In interpretation the counselor is providing new meaning, reason, or
explanation for behaviors, thoughts, or feelings so that pt can see problems in a new way.
Interpretations can help the client make connections between seemingly isolated statements of
events, can point out themes or patterns, or can offer a new framework for understanding. An
interpretation may be used to help a pt focus on a specific aspect of their problem, or provide a
goal. Keep interpretations short, concrete (see concreteness), and deliver them tentatively and
with empathy. Use interpretations sparingly and do not assume a pt's rejection of your insight
means they are resistant or that you are right.Information Giving and Removing Obstacles to
Change Supplying data, opinions, facts, resources or answers to questions. Explore with client
possible problems which may delay or prevent their change process. In collaboration with the
client identify possible solutions and alternatives.
Several techniques can be adopted for effective counseling. Some of them include providing
written information to the patient and the use of audiovisual materials. The use of various
compliance aids include labeling, medication calendars, drug reminder chart and providing
special medication containers and caps can also be adopted. The United States
Pharmacopoeia medication counseling behavior guidelines divide medication counseling into
the following four stages .Stage I: Medication information transfer, during which there is a
monologue by the pharmacist providing basic, brief information about the safe and proper use of
medicine.Medication information exchange, during which the pharmacist answers questions and
provides detailed information adapted to the patients’ situation. Stage III: Medication education,
during which the pharmacist provides comprehensive information regarding the proper use of
medicines in a collaborative, interactive learning experience. Stage IV: Medication counseling,
during which the pharmacist and patient have a detailed discussion intending to give the patient
guidance that enhances problem-solving skills and assists with proper management of medical
conditions and effective use of medication. Lack of Patient Counseling
Communication is the exchange of information, ideas, thoughts and feelings. It involves not
just the spoken words, but also what is conveyed through inflexion, vocal quality, facial
expression, body posture and other behavioral processes. Effective communication with
patients depends greatly on the degree of empathy demonstrated in the course of conversation.
Pharmacist should use proper verbal and non-verbal communication skills during the counseling
session. Studies repeatedly show that effective patient counseling can significantly reduce
patient non-adherence, treatment failure, and wasted health resources. To be good
communicators, pharmacist must be attuned to the types of questions asked, the manners in
which questions are asked,
These all above mentioned aspects are the complete counseling ethical manners which are not
used properly to counsel the patient and this is huge gap we have in our health system. I've
choosed that topic of research because previously it is not soo much used but seem major
issue facing every patient mostly. These all points should be followed by doctors pharmacists
and frobt line heath workers while treating their patients. I have not soo much research on this
problem previously but the topic is enough important to to think on it. This is also not
technology based topic that will replaced in future with any other mechanical devise this is
ethical behavioral and patients satisfaction that is directly based on behavior and the way of
attending and listening them.
My research area is significant enough as i mentioned the problems facing people in our
society these are the problems leads to psychological un satisfaction when a patient is not
satisfy from his doctor or pharmacist than how and why he starts the proper medication even he
thinks that the problem he has us incurable and leads to anxiety and depression like problems.
It is very important to look after that issue to raise this issue for patient satisfaction first. When
tha patient get satisfy than je trusted his doctor and take medicine proper. I will go with full
fledge research program which not only includes my own observations but also I'll took people
observations their experiences about dovtor or pharmacist behavior to them. All most every
one visited doctor or pharmacist in our life so every common people have his own opinion and
experience which is mandatory in our research. I am going to make Google forms withsome
simple and specific questions in it and make it fill from common people or specially the people
wo has recently visited any hospital or pharmacy. So that they can share their experience which
they have faced about counseling program. Every single person's opinion is important for us
than i will compile the results of every one experience about counseling and make the authentic
research program which most importantly includes the people suggestions in it and not only
based on mine.
There are also lacks from patient side that people even dont how that pharmacists can
counsel so they never ask any questions to them and gender or language difference may also
inhibit patients from asking the pharmacist about medication use information.
Aims and objective
I have choosed this topic of research with the aim that this is one of the major problem been
neglected but everyone faced. I also observe this in my nearest people when they were not
counseled properly they were not satisfy and than they have lacks in taking medicine. My aim of
research is firstly to take the opinion and experience of people on patient counseling and to
highlight this problem so that health system prioritize the patient satisfaction which is most
important to treat the patient. When patient satisfy, when he has good communication with his
consultant than he become confident on his recovery. In our country, government hospitals and
centers have big lack in counseling program they just give prescription without properly
attending the patient and this makes gap in his recovery. If doctors and pharmacists and all front
line health workers follow the proper counseling procedure than patients have move belive on
their recoveries and on health system of our country. Satisfaction is the term which is more
important in recovery when a patient satisfies than he start the proper diet and medication.
Counseling also includes patient education, when patient have knowledge about his disease
about possible ways to treat and about the medication he is taking than he prevent himself from
false believes.
The lack in counseling is also through the system our system our government not making the
counseling mandatory legal requirement and officially pharmacists are not entitled to charge for
Lack of Patient Counseling
counseling or information provider. Lack of privacy in busy pharmacies and hospitals are also a
problem.
The aim of our research is to highlight one of the very basic issue facing by almost every
single person in our society. Somehow we all have interaction to any clinic pharmacy hospital or
health care professionals. In government sectors (hospitals, clinics, centers) it is very common
that doct/ physician/ technician/pharmacist only listen and give the prescription back to the
patient without making any communication relationship without making him confident and satisfy
about the medication written on without attending him or her properly or without educating him
about his disease and medication he has to follow on. This behavior from health workers make
patients unsatisfy and leads to medicine abuse and miss use because they dont even know that
how to use and when to stop. The only making change in behavior of health workers make
patient confident about his recovery make patient educate about his disease and preventions he
has to follow on. The diet he has to use and tge other possible ways of treatment. 80 percent
patient mentally recover when doctor counsel him properly.
I'm making specific research questions about the research plan and their answers are main
objective to prove the lack in counseling system that people are facing.

Specific objectives

1:Patient satisfaction is the main and specific objective which only we attain from proper
counseling.
2:To reduce the abuse and miss use of drug rate
3:To make patient confident and anthusiasm about his recovery
4:To educate the patient about the disease he has the medication he is going to take, the diet
and exercise he has to follow on, the precautions he has to take and other possible ways to
treat the problem and alternatives.
5:Using multimedia material and pictograms and by following up the schedule and audio visual
tapes or compliance aids

Research questions

Whenever you visited government hospital or clinic or center did your doctor or pharmacist
attend you properly with having his short introduction before listening you?
Did your doctor or pharmacist make effective communication with you?
Does he educate you about your disease, medication, diet you have to follow on?
When you asked question after question to your consultant does he satisfactory respond you
every time?
Does consultants share their personal experience to make you satisfy about your disease?
Does you get positive regard from your consultant?
Does he shoes Genuiness and respect your feelings after so many questions?
Does your consultant make you know about the adverse effects of medication is used
improperly? Lack of Patient Counseling
Methodology
The procedure I've used to achieve my objectives are just an effort i can do through my words
through my observations and socially through the survay which is filled by many of people. My
survay results shows the that the problem i have highlighted is mandatory. To properly achieve
my objectives there is need to change our health system aspects because as we see in our
research results although maximum people are facing this problem. The step i can do in this
problem is to compile the problem its all aspects which i have done in my research and also
attached people experience in my research by google form i have made and spread it into
people. I have made several questions about the patient's problem they are facing due to lack of
counseling and than spread it to people to fill them. My research is behavioral ethical and
medical care type in which patient's satifaction and confident is our goal to achieve by proper
counseling.
I have added the previous researches, my own observation, proper method of counseling, lack
of counseling and its effects on people mental satifaction and also in result of drug abuse and
miss use, collect the possible questions people are facing and took answers of these questions
from people to make our research more authentic by google form. This is survay based
research i have done to prove the lack of counseling program in our country.
Google survay form

https://docs.google.com/forms/d/e/1FAIpQLSe7-4yn2NgOkD4X-
ciFzN_09gO1GHQusJV7dJT13UrJ4iWw3A/viewform?usp=sf_link

Results Counseling Lack of Patient Counseling

my google Feb Feb March March April April
survay 1st to 15 15 to 28 1st to 15 15 to 31 1st to 15 15 to 30
results are
proving the
lack of
patient
counseling
in our
society.
Doctors or
pharmacist
s are not
attending
patients
properly
not guiding
them not
educating
them about
disease
and
medication
not giving
them
confidence
and these
all ate
shown in
red and
yellow
color in our
results.
Work
schedule
Identity research aeea
Formulate research questions
Formulate research strategy, research design and research method

Write research proposal 4th

Negotiate research
Literature review
Data collection
Data analysis
Write first draft
Write final draft
Dissertation due 26th

References
https://www.ausmed.com/cpd/articles/patient-medication-counselling
https://pubmed.ncbi.nlm.nih.gov/14617877/
https://pure.hud.ac.uk/en/publications/a-survey-study-to-measure-the-practice-of-patient-
counselling-and
https://scholar.google.com.pk/scholar?q=research+on+patient+counselling&hl=en&as_sdt=0&a
s_vis=1&oi=scholart#d=gs_qabs&u=%23p%3DNHrGtb6XhoQJ
https://www.coursehero.com/file/p4nbvkpo/3-Barriers-in-patient-counseling-Lack-of-time-was-
the-most-common-problem-faced