5 PHASES OF PATIENT COUNSELING
1. Opening Discussion
2. Discussion to gather information and identify
needs
3. Developing a care plan
4. Discussion to provide information and
educate
5. Closing Discussion
OPENING DISCUSSION
New Rx​-introduce counseling and its purpose
-Px are unprepared to discuss personal
information
-if Px is in hurry, set another time
Refill Rx- explain follow-up drug
DISCUSSION TO GATHER INFORMATION AND
IDENTIFY NEEDS
New Px​ – gather basic information (name,
telephone, address, etc.)
Returning Px​- RPh’s confirm if there are changes
such new conditions or medications
New Prescription
a) A previous use
b) Knowledge about medication purpose and
condition
c) Knowledge of medication regime
d) Treatment goal
e) Potential problems
Refill Rx
a) Details of medication use
b) Effectiveness of medication
c) Presence of abuse effects
Self-Care Px
DEVELOPING A CARE PLAN
New Px-​ if real and potential problems are
identified, inform the Px
-pharmacotherapeutic outcomes for
each Px must be established
-if outcomes will be altered, RPh must
identify alternatives
-Px may be involved a choice of drug,
dosage, formulation and regime.
-document any changes
-keep track
Refill Px​- document any changes in the
treatment plan, success of plan
-difficult to implement if Px does not
always frequent the same pharmacy
DISCUSSION TO PROVIDE INFORMATION AND
EDUCATE
-RPh’s should decide how much
information should be given to Px
-RPh’s must consider Px’s rights and
preferences
New Rx
Refill Rx
CLOSING DISCUSSION-GIVE NEEDED
INFORMATION
-allow the Px the opportunity to
consider the information he/she has received
-ask the Px to repeat the most
important information, such as directions for
use.
-assure the Px to feel free to ask
questions
-reiterate and emphasize the most
important points
HEALTH CARE
Factors that influence Self-Care and
Self-Medication
1. Consumer’s attitude and beliefs
2. Consumer’s education or sophistication
3. Demographic characteristics
4. Accessibility and availability consideration
5. Product
6. Economy
7. Alternate approaches to health
03-11-19
DIFFICULT ISSUES/ SITUATIONS
1. Patient characteristics
2. Cultural issues
3. Medication incidence
4. Involvement of patient care and
nontherapeutic situation
● Patient characteristic
For elderly:
1. High drug use
2. High incidence of illness
-low immune system in elderly and children-
3. Increase risk of drug related problems
and inappropriate drug use
4. Increase limitation and disabilities
5. Decline and cognitive functioning
6. Difficulties adhering to medication
regimen
7. Attitudinal barriers of communication
8. Literacy and cultural issues
-low levels of education
9. Access and affordability to health care
services
● Cultural issues
-​effects of culture to individual patients:
1. HEALTH BELIEF
a. Biomedical- believe in scientific
explanation. Dominant health belief
system in north America focuses on obj.
diagnosis and scientific explanation.
Illness believed to be a result in the
abnormality in body functioning.
-deity, ghost, evil spirit, witch, sorcerer
Effects in health care:
- Aims to create at relationship to
entities that causes disease
- Prepare treatment to physical ward
off
c. Naturalistic-belief that disease is an
imbalance among elements in the body,
mind and environment
● Ex. Asian believed the balance
between yin and yang
● Mexicans and Puerto Ricans believe
in the need to balance four body
humors
- Blood- should be hot and wet
- Yellow bile- should be hot and dry
- Phlegm- should be cold and wet
- Back bile- should be cold and dry
● Africans, Asians Jamaicans and
native Americans believed that
illness is caused by disharmony
between nature
● Native Americans believe that
illness as a fate to be accepted like
birth and death
Treatment: restoring balance, foods and herbs
restore balance by treating cold illness with hot
remedy, and hot illness with cold remedy.
Prevention involved the balance of illness
d. Religion
e. Family – pregnancy, depression

b. Personalistic- held by Asians

Vietnamese, Laotians
-Believed that disease or illness is caused by 2.Adressing multicultural issues
supernatural or non-human beliefs
 a. Be aware of personal attitudes and
perceptions and multicultural issues
b. Make concessions to cultural
preferences and customs where
possible
c. As much possible communicate in an
understandable language
d. Be aware of nonverbal language
e. Be emphatic
f. Be assertive
g. Encourage feedback and use teach-back
h. Recognize poor literacy
i. Teach each patient as an individual
j. Be alert to atypical drug responses or
poor response to treatment
k. Involve family as needed but focus on
the patient
Vital points family must remember:
● Don’t assume patients had info from
doctor
● Don’t assume patients understand all
information given
● Don’t assume patients have resources
to comply
● Don’t assume patients don’t care or are
stupid
● Don’t assume patients will comply if
they understand
● Don’t assume others will monitor or
follow-up
● Don’t assume patients will voluntarily
seek help or inform if there are
problems
03-25-19
MEDICATION INCIDENCE/ MEDICATION ERROR
- medication incidence is more known to us as
medication error. It has been reported that a
large percentage of adverse events suffered by
patients, many of which are preventable,
involve medication incidence.
Rates of medication incidence vary from ​missed
doses​, ​near misses​, and ​wrong time​. But in the
Philippines, ​the most common medication error
pharmacists encounter is ​wrong dispensing.​
Medication incidence happens when
pharmacist is in ​hurry or not in focus of what he
is doing. T​ here are several reasons​ w
​ hy he is
not focused on what is being dispensed. It may
be that the pharmacist did not hear clearly what
the costumer said and was able to clarify the
drug before he dispensed it, or the pharmacist
has something else on his mind and is bothered
by it. Bat whatever reasons the pharmacist has
to result to this unbecoming circumstance, he
or she must face the problem.
When a medication incident occurs, it is
important that actions should be taken to deal
with the outcome with the patient. In addition,
an investigation should be undertaken to
discover what happened., and why, and action
taken to prevent future incident.
According to Rantucci, a protocol for handling
medication incidents in the pharmacy (even in
the hospital) should be followed so that all
persons involved know what needs to be done.
What to do:
2 types:
● Patients report incidence
● Incident identified in the pharmacy
1. Patients report incidence
a. Verify incident
b. Go to private area
2. Incident identified in the pharmacy
a. Contact patient
b. Go to private area
As a pharmacist ​Go to private area​ and:
-offer a sincere apology
-establish if drug was taken
-Establish risk if taken
If ingested:
High risk: ​refer to physician or hospital
Low risk:​ reassure patient
- Assure patient that an investigation will
be made
- Complete incident report
- Develops strategies to prevent future
incidents
- Discuss with staff and all involved in
causes
- Advise patient and physician of actions
taken
Appropriate communication is a critical part of
handling a medication incident, including
communication with patient, family of patient
and the physician. when medication incidents
are mishandled, they are more likely to result in
complaint to a pharmacy regulatory body or
legal action. Hoe things are said- are all
important to an outcome that id satisfying to
the patient and pharmacists.
The following are recommendations and
techniques for handling medication incidents:
1. All involved should be honest and open
2. The pharmacist should deal with the
situation
3. The pharmacist should communicate
directly with the patient
4. The pharmacist and anyone else
involved should give a sincere apology
5. The welfare of the patient should be
assured
6. The patient should be assured that an
investigation should be conducted
7. Discussion should take place in private
area
8. The pharmacist should be properly
prepared
9. The pharmacist needs to deal with
personal emotions
10. Words should be chosen carefully
11. The focus should be on the patient’s
issue
12. The pharmacist should show empathy
to the patient
13. There should be never blaming or
making excuses
14. The physician should be informed if
necessary
15. The pharmacist follow-up with all
involved
D. involvement of primary care and
non-therapeutic situations
Although pharmacists deal with patients
primarily in the area of medication
counseling, they are also generally
considered to be the most available
professionals in the community. This is the
reason why pharmacist have much more
involvement to the community than other
health care providers especially in
promoting primary care and illness
prevention activities.
Involvement in primary care and prevention
involves promoting health maintenance in
individual patients by providing counseling
and education on topics such as smoking,
alcohol use, nutrition and exercise.
There are also times that social issues are part
of pharmacist’s scope in providing primary
care to the patients. ​These social issues may
include,​ ​alcoholism, legal or illegal drug
abuse, family planning, unwanted
pregnancy, child abuse, or family violence
and suicidal thoughts.
When confronted with social issues although
unprepared to provide specialized
counseling, pharmacists can deal with
patient compassionately and appropriately
as follows:
 1. Listen to patient in unbiased and
nonjudgmental manner
2. Provide privacy
3. Ensure confidentiality
4. Encourage patients seek their own
solutions
5. Refer patients to appropriate
resources
6. Provide follow-up

There are also times that patients have

emotional outbursts. ​Techniques dealing with
these conflicts and emotional situations are
the following:

1. Remain in control of your own personal

emotions
2. Provide privacy
3. Let the patient vent his or her own
feelings
4. Express empathy to the patient
5. Probe to clarify the issue
6. Provide explanations and suggestion
7. Be assertive
8. Provide positive messages to the
patient
9. End the situation on the positive note