Patient Education

• Patient education is a planned learning experience

using a combination of methods such as teaching,
counseling and behaviour modification techniques
that influence patients knowledge and health
behaviour.

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 Patient Counselling

• Patient counselling refers to the process of

providing information, advise and assistance to help
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patient to use their medication appropriately.

• Patient counselling 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 lifestyle modifications.

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 Patient Counselling

• To provide accurate advice and information, the

pharmacist should be familiar with the
pathophysiology and therapeutics of the disease.

• Patient counselling is one of the major duty of a

pharmacist other then dispensing of drug.

• It enhances the problem-solving skill of patient for

the purpose to improve or maintain the quality of
health and life.
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 Principles of patient counseling

1. Patient should recognize the importance of

medication.
2.
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A working relationship and a foundation for
continuous interaction and consultation should
be established.
3. Patient’s understanding of strategy to deal
with medication side effects and drug
interactions should be improved.

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• To provide information directed at
encouraging safe & appropriate use of
medication, thereby enhancing therapeutic
outcomes.

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• Good communication skill – which is required to gain
patient confidence and to help motivate the patient
to adhere to the recommended regimen.
• Better patient understanding- their illness and role of
medication.
• Improve medication adherence.
• More effective drug treatment.

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• Reduce incidence of adverse drug effect and
unnecessary healthcare cost.
• Improve quality of life for patient.
• Better coping strategies to deal with medication
related adverse effect.
• The communication skills includes both verbal and non-
verbal communication skills.

VERBAL:
1. Language: simple and in which the patient
understands and avoid unnecessary medical
terminology.
2. Tone: pitch of the tone should be changed according to
the need. The tone of the voice should be caring and
reassuring.
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1. Volume: counseling should be conducted in a
quiet and private setting and audible.
2. Speed: The clarity of communication depends
on rate of speech. Should be such that the patient
is able to understand and should be in logical
sequence.
Non-verbal communication:
● This includes body language such as the movement
and position of the head, limbs and body, and other
aspects such as whether the pharmacist is dressed in a
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professional manner.

● Includes body language, dressing, eye contact,

proximity distance, facial expression, etc.,
 1. Proximity distance:
● Refers to the distance that people maintain
themselves during the counseling, this has been
classified into four zones: intimate (45 cm or
less), personal (45 cm to 1.2 m), social (1.2–3.6
m) and public (>3.6 m).

● Generally, counsellors and healthcare

professionals use intimate or personal
proximities.
 2. Eye contact:
● Direct eye contact help build confidence in
patients.

3. Facial expression:
● Should be according to the sex, age and condition
of the patient.
● These can be used during counselling to
demonstrate empathy towards the patient.
● Head movements such as nodding, hand gestures
and body posture also can be used to advantage.
• Pharmacist should counsel patients on all new and refill
prescriptions.
• If the pharmacist cannot counsel to this extent, it
should be defined which patient types, or which
medications pharmacists will routinely counsel
patients.
• Patients receiving more than a specified number of
medications.
• Patients known to have visual, hearing or literacy
problems.
• Paediatric patients and Patients on anticoagulants.
• Confused patients, and their caregivers.
• Patients whose profile shows a change in medications or
dosing.
• New patients, or those receiving a medication for the first
time (transfer prescription).
• For children receiving medication, parents should be
counselled.
• Patients receiving medication with special storage
requirements, complicated directions.
• Asthmatic, COPD patients.
• Diabetic, hypertension patients.
• Patients taking 4 or more prescribed medications.
• Patients who are mentally ill.
• Patients using appliances.
• Epileptic patients.
• Patients with skin complaints.
• Patients misusing drugs.
• Patients who are terminally ill.
• The medication’s trade name, generic name,
common name or synonym.
• The medication’s use and expected benefit and
action.
• The medication’s expected onset of action.
• The medication’s route, dosage form and
administration schedule.
• Direction for preparing and using medication.
• Action to be taken in case of missed dose.
• Precaution to be taken.
• Common Drug Adverse Effect.
• Drug-Food or Drug-Drug Interaction.
• Proper storage of medication.
• Proper disposal of contaminated medication.
• Any information unique to individual patient.
Effective patients counseling aims to produce the
following results:
Better patients understanding of their illness and the role
of medication in its treatment.
Improved medication adherence.
More effective drug treatment.
Reduced incidence of adverse effects and unnecessary
healthcare costs.

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Improved quality of life for the patient.
Better coping strategies to deal with medication related adverse
effects.
Improved professional rapport between the patient and
pharmacist.

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 Be a good listener.
Be flexible.
Be empathetic.
Be Non-judgemental.
Be tolerant.
Communicate
confidently.

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• Review the patient's record.
• Introduce your self.
• Explain purpose of counseling.
• Obtain drug related information such as allergies, use of herbals etc.
• Assess the patients understanding of the reasons for therapy.
• Assess any actual and/or potential concerns or problems of
importance to the patient.
• Use language that the patient understands.
• Use appropriate counseling aids.
• Present facts and concepts in simple words and in logical order.
• Use open ended questions.
• Verify the patient's understanding by means of feedback.
• Summarize by emphasizing key points.
• Give an opportunity to the patient to put forward any concerns.
• Help the patient to plan follow-up.
 Steps of Patient Counselling

• The pharmacist must possess not only a sound

knowledge of the drugs and appliances being
dispensed or sold, but also excellent
communication skills.

• The counseling should be an interactive process and

should not be a monologue by the pharmacist.

• It includes four steps as follows.

 STEP 1: Preparing for the
session

• The following points should be considered before

starting the session.
• Authentic knowledge regarding the disease and its
management.

• Medication history of the patient.

• The mental and the physical state of the patient.

 STEP 2: Opening the session

• The first phase of counseling is used for

collecting as much as information about the
patient.

• Patients understanding of the disease.

• Previous drug allergies, past history, personal

habits etc.

• Use open ended questions.

• Should avoid direct questions.

 STEP 3 : Counselling content:
• Considered to be the heart of the counselling session.
• In general, the following information should be given
to the patient.
1. Name and strength of the medication.
2. The reason why it has been prescribed, or how it
works.
3. How to take the medication (how much and how
often).
4. Expected duration of treatment.
5. Expected benefits of treatment.
6. Possible adverse effects.
1. Possible medication or dietary interactions.
2. Advice on correct storage.
3. Minimum duration required to show
therapeutic benefit.
4. What to do if a dose is missed.
5. Special monitoring requirements, for
example, blood tests.
6. Arrangements for obtaining further supplies.
 STEP 4: Closing the Session/Conclusion

• Before closing the session, it is the duty of the

pharmacist to ensure what that the patient has
understood from his entire counseling process.

• Ask feedback questions, any doubt patient having

in understanding or following the procedure.
• The next date patient must visit again.
 Some Important Aspects in
Counseling
1. Environment- The environment should be conducive
to proper interaction between patient and pharmacist.
There should be privacy and enough time for proper
interaction.

2. Benefits- patients get a lot of benefit by way of

information. Pharmacists get benefit by way of better
business.
 Barriers to patient counseling

➢ Pharmacy- related barriers

• Excessive workload.

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Lack of time and or staff.

• Physical lay out of pharmacy.

• Lack of privacy.

• Distractions (noise, telephone, interruptions).

➢ Pharmacist –related barriers

• Lack of education.

• Lack of experience in counseling.

• Lack of resources necessary to counsel patients.

• Lack of information about the patient.

➢ Patient –related barriers
• In a hurry
• Claim "I already know my drugs”
• Do not wish to be counseled for reason
• Not educated and is without a caretaker.

➢ Communication barriers
• Language
• Medical jargons
• Hearing/vision problems
 Strategies to overcome barriers
• Pharmacists can start by updating their knowledge
and counselling skills.
• Confidence can be developed by initially focusing
on one particular disease or group of drugs (for
example, antibiotics).
• A good approach is to ask patients ‘Have you
used this medication before?’ when they collect
their prescription.
• Encouraging individual patients to ask questions
about their medications or media campaigns will
also improve counselling opportunities.
 Key points in counseling

Name of the medication.

How to take the medication.
Warning about medication.
Storage of medication.
Sundry items.
Purpose and outcome of
treatment.

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 Satisfaction of having fulfilled his/her professional
duty.
Serving patients and their well being.
Improves patients compliance.
Pharmacy is seen as “Professional” or “Caring”
pharmacy.
Formation of trusting relationship with patients.

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 Aid’s to counseling

• Patient information leaflets (PIL)

e.g. ear drops, eye ointments, pessaries
etc.,
• Warning cards
e.g. anticoagulant therapy, lithium and
steroid treatment.
• Placebo devices
e.g. Inhalers, Epipens, patches, etc.,
 Case study

• Mrs Jackline, a 25 years old housewife, presented to her family

doctor with a two week history of frequent fever, productive
cough and weakness. Her fever frequency did not decrease
despite taking paracetamol 650 mg regularly. After examination,
her doctor ordered a sputum test for acid fast bacilli (AFB) and
the AFB test came back as positive. Her doctor prescribed the
following medications and asked her to see him after two months.
• AKT – 4 ® 1 Combipack a day for two months (Each combipack
contains 1 capsule of Rifampicin 450 mg + 2 tablets of
Pyrazinamide 750 mg + 1 tablet of Ethambutol 800 mg + 1 tablet
of Isoniazid 300 mg)
• Benadone ® 40 mg. One tablet every day for two months
Q. 1: How should Mrs PV be counselled?
•About the disease: TB is a serious lung infection caused by
bacteria that are generally transmitted from person to person by the
inhalation of cough droplets containing the bacteria. Symptoms
include high fever, night sweats, weight loss, cough with sputum and
chest pain. To treat the infection, she will need to take four different
antibiotics for two months followed by two antibiotics for the next
six months.

•About the combipack of AKT-4®: It contains four drugs.

•Isoniazid 300 mg one tablet per day.
•Rifampicin 450 mg one tablet per day.
•Pyrazinamide 750 mg two tablets per day.
•Ethambutol 800 mg per day.
•Tell her that she should take all four medications daily without fail
to treat the infection successfully. Completing the course is also very
important in the management of the disease.
Q. 2: How should Mrs PV be counselled about her drugs?
•Isoniazid: One isoniazid tablet should be taken each day on an
empty stomach for better absorption. If she experiences gastric
irritation, you advise her to take the medicine with food.

•Rifampicin: One rifampicin tablet should be taken each day.

This antibiotic should be taken one hour before or two hours
after a meal for maximum effect. You warn her that rifampicin
may change the colour of body fluids like urine, sweat and tears
to orange or red, and that she should not panic if this happens.
• Pyrizinamide: Two tablets of pyrazinamide should be taken
each day after food. Mrs PV should report to her doctor if
she experiences any unusual reactions.

• Ethambutol: One tablet of ethambutol should be taken

every morning after food. Mrs PV should report any changes
in her vision or eye sight to her doctor.
• Benadone®: Benadone® is a brand name of pyridoxine and
is used to prevent nerve pain which may be a side effect of
isoniazid.
• Dietary advice: Tell Mrs PV to eat liver, wholegrain cereals,
bananas and legumes in her diet.
Thanks you