With the advent of complex and sedentary life styles, morbidity rate has drastically increased and an all time huge rush of patients can be seen visiting hospitals, dispensaries, clinics and nursing homes thus leaving very little time for physicians to consult the patient, identify his disease and prescribe a suitable drug therapy and almost no time for him to inform and educate the patient about his disease state, alternative treatments and risk-benefit ratios of the prescribed drug therapy. Thus the patients remain dissatisfied, do not comply with the prescribed instructions resulting into a poor outcome of the drug regimen. Under these circumstances the job of counseling the patients at least on drug-related issues needs to be assigned to the second line of trained and competent personnel like qualified pharmacists.
Moreover if patients are not well informed about the medications and their usage, safe and effective drug therapy shall continue to remain a distant dream in this piece of forsaken land. It is only knowledgeable patients who exhibit increased adherence to physician’s instructions and compliance with drug regimens, leading to an improved therapeutic outcome. Physicians, well-qualified pharmacists and the nurses have to work in tandem to achieve this goal. All of them share a common responsibility of informing and educating the patients about the infesting disease, proposed treatment, possible risks and the pros and cons of prescribed drug therapy. Physician’s onus lies in informing the patient about his pathogenic state, nature of disease, possible treatment modalities available with their individual benefits and risks, other alternatives available etc. Pharmacist’s service can be availed in counseling the patients on following issues:
1) Generic and brand name of the medication
2) Intended use and expected action
3) Route, dosage form, dosage and administration schedule
4) Special directions for preparation, if any
5) Special directions for administration
6) Precautions to be observed during administration
7) Common side effects that may be encountered, including their avoidance and action required if they occur
8) Techniques for self-monitoring of drug therapy
9) Proper Storage
10) Potential drug-drug or drug-food interactions or other therapeutic contra-indications
11) Prescription refill information
12) Action to be taken in the event of a missed dose
13) Any other information peculiar to the specific patient or drug
These thirteen points have been approved by the Board of Directors of American Society of Hospital Pharmacists and are applicable to non-prescription drugs as well as those ordered by a physician or any other authorized prescriber. Further, pharmacists should counsel patients in the proper selection of non-prescription drugs and their use as well.
In essence, patient counseling is an amicable interactive session between a physician or a pharmacist and a patient designed to inform and educate the patient about the medication by providing him complete information about its usage and making an effort towards identifying and removing barriers to the most appropriate drug therapy. The main aim and objective behind conducting patient counseling sessions is to impart proper drug knowledge, ensure patient compliance to the prescription order and to improve therapeutic benefits.
A large number of educated patients often display inquisitiveness about the prescribed therapy and in the process try to seek information about the drugs being consumed by them from different sources like books, magazines, packaging inserts, leaflets, friends, relatives or healthcare professionals like medical and para-medical personnel. It is the prime duty of a pharmacist to assess the specific needs of individual patients in this regard, identify various means of delivering right knowledge to them and thereby tailor the educational approach to a particular patient. Other patients need to be made aware at first place about the potential benefits of counseling.
Majority of people in Kashmir harnesses certain conventional attitudes and beliefs towards health, drugs and disease, most of whom are simply illogical, irrational and baseless. A pharmacist has to first understand the patient’s approach and belief towards the prevailing disease condition and the prescribed drug therapy that shall go a long way in enhancing his existing rational knowledge base and alleviating his ill-conceived notions about the disease or the drug therapy. The pharmacist must recognize the complexity of counseling in order to come out with the most appropriate approach to make the patient realize the risk-benefit ratio of the drug regimen. Information must percolate in a very simple, lucid and lucrative manner so that it is easily understood, retained, recalled and applied by the patient during the course of his treatment. Patients should be inherently motivated to comply with the directions owing to their well-pronounced advantages.
Every hospital of the valley needs to chalk out proper patient counseling programs in a most strategic and scientifically designed fashion. Suitably qualified and trained pharmacists need to be engaged for the task in conjunction with other medical and para-medical staff. Keeping in view the heavy rush of patients in our hospitals, the maximum possible load of patient counseling needs to be shifted from physicians to pharmacists. However basic education about the disease and treatment modalities available needs to be imparted by the physician himself. Information relating to drug therapy and usage can most conveniently be handled by a well-trained and qualified pharmacist preferably a degree holder in Pharmaceutical Sciences.
A few guiding principles have to be kept in mind before conceiving and designing a patient-counseling program in any hospital. Firstly it should be relevant to the individual needs of the patients keeping in view their educational profile, knowledge base, beliefs, circumstances and prior experiences of the therapy. Accordingly the program has to be tailored to address their specific needs. During a counseling session there has to be adequate feedback from the patient in order to know his level of comprehension and understanding about the issues involved. Proper understanding and application of mind by the patient should be appropriately reinforced and appreciated by the counselor. All his queries must be acknowledged and answered patiently without losing temper or displaying any arrogance of behaviour. Another key to an effective counseling session is facilitation that includes using new means and methods to reduce barriers to a treatment regimen which, for instance, could be achieved by using special containers thereby reducing the cost of a prescription. All the above components of relevance, individualization, feedback, reinforcement and facilitation should be combined together and incorporated in a patient counseling program in order to yield the most optimum results.
Verbal, written or audio-visual techniques can be used to educate the patients. Verbal method involves a one-on-one interaction between a patient and the pharmacist wherein the counselor has to be formally dressed, maintaining an eye to eye contact with the patient, establish a rapport with him, exhibit clarity of speech and patience to accommodate patient’s queries or ignorance. At any point of time counselor should not lose track and a two-way traffic must be encouraged. Written information includes package inserts found inside drug containers, labels on cartons, booklets and other promotion material supplied by the pharmaceutical companies. Pharmacist can develop and devise his own written material too for the purpose on the basis of his personal knowledge and experience about the therapy. Audio-visual methods involve use of educational charts, audio, video cassettes and CDs, overhead projectors, slide projectors etc.
Certain obstacles could possibly emerge during the counseling session, which must be attended and overcome in order to have a successful session. For instance, gap existing between the counselor and the patient should be minimized by using a small sized prescription desk. No action on part of the counselor should hint at a lack of time available with him or suggest his inaccessibility. The openness and privacy of the counseling area must be suitably balanced. Other deterrents like noise disturbance, foul smell, unhygienic ambience, inadequate lighting and ventilation of the counseling area must be removed.
Counseling has to address three broad areas including knowledge about the nature, proper storage and use of medication. Besides the information relating to the dosing schedule, duration of therapy, directions for use, precautions to be taken, common side effects and shelf-life of the drug has to be imparted to the patient in sufficient quantum. Any further continuation of current practice of depriving the patients of the benefits of counseling shall mean denying them their basic right of information and education.
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