Patient Counseling FINAL first half!
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. What would you like to do?
what does pharmaceutical care meant to you?
what are the components of pharmaceutical care?
- taking care of patients and being able to counsel the patient
- acting in the interest of the patient
- accuracy and making sure to look for interactions between drugs
- trying to figure out what the optimal medical therapy would be, other than what was prescribed
what are the essential aspects of pharmaceutical care?
- 1. patient counseling: pharmacists take responsibility for preventing and solving drug related problems; we aid in diagnosing of a patient
- 2. needs to be specific for the patient in front of you
- 3. we need to monitor: drug interactions, allergies, side, effects, and adherence
- 4. we need to follow-up with patient
- 5. dispensing
4 things needed in order to provide pharmaceutical care?
- 1. knowledge: we have to know what we're talking about
- 2. understand the health care and drug distribution system: we have to know what our role is and where we come into play
- 3. develop a relationship with the patient: professional relationship
- 4. willingness to provide pharmaceutical care
definition: "the responsible provision of drug therapy for the purpose of achieving definite outcomes that improve a patient's quality of life"
- definition of pharmaceutical care
- defined by Hepler and Strand
what percentage of patients actually want the full slate of pharmaceutical care?
- 10% want it
- 90% don't really care
why do patients not really care for pharmaceutical care?
- 1. not enough time: high volume, understaffing, insurance
- 2. lack of confidence or no desire
- 3. barriers (explained later)
- 4. we don't get extra money for providing it
- 5. patients don't appreciate it
to produce optimum drug therapy outcomes, patients must:
- 1. show interest in their condition
- 2. they have to understand their condition
- 3. they have to correctly assess the impact of their diagnosis
- 4. patients have to take the drug
- 5. they have to be honest with themselves on how healthy they want to be
what are the goals of effective communication?
- 1. to be understood
- 2. to accomplish a task or communicate a task
- 3. to be accepted, we want to be right
importance of relationships: how do we see patients?
- 1. we see patients as objects, basically as just the prescriptions they bring in
- 2. we see patients as people (choose this one)
what are the benefits of a positive relationship?
- patients are more forgiving, more compassionate, etc.
- when no relationship exist, we view them more as objects and not people
importance of relationships: what are the 4 basic rules about people?
- 1. people behave in order to get their needs met
- 2. feelings are real
- 3. although patients ultimately have the responsibility for their own medication taking behavior, pharmacists may have substantial influence on this behavior
- 4. unrealistic expectations can drive you and your patients crazy
defined as "one to one" communication
what is the communication model? (4 aspects)
- 1. SENDER: provides the information; has the responsibility to be accurate, clear and be in understandable terms
- 2. MESSAGE: words, emotions, thoughts, ideas
- 3. RECEIVER: person who decodes it, interprets what the sender says
- 4. FEEDBACK: receiver communicating back to sender
what are the barriers to effective communication?
- failure to listen ... person can't hear
- bypassing ... hearing the 1st part of something and assuming the rest
- physical environment ... noisy, busy or not private
- personal appearance ... patients value professional attire
- verbal ... different languages, use of medical terminology
definition: interpretation of a message by a receiver based upon their biases and their observations of the sender
what influences a person's perception?
- a. perception of the meaning of the message
- b. perception of the sender
are non verbals important?
- examples of bad non verbals: body turned away, poor posture, rolling eyes
- always reflect what the patient is doing and don't talk across a barrier
perception: what are our INFERENCES?
- make sure to check your assumptions: are they valid?
- avoid self-fulfilling prophacies
listening is an ____ process while hearing is a ______ process
- listening = active; you have to work and concentrate
- hearing = passive; as long as hearing is functional, don't really have to think about it
describe the process of listening
- 1. act of will; you have to want to listen
- 2. give complete and undivided attention
- 3. don't automatically correct others (don't judge, just listen)
- don't try to fix the problems or emotions expressed
- listening and empathetic responding offer hope because most of the time when the person tells us about their problem, the patient usually feels alone ... understanding their problem, gives them empowerment
definition: the ability to see the world as another person sees it; to perceive their feelings and to respond in a proper manner; means "FEELING WITH" and not feeling sorry for them
definition: feeling sorry for someone, automatically assuming
- different from empathy? empathy is trying to understand the person's feelings but keep your feelings out of it
do you need to have the same type of experience to be able to empathize with a person?
- if you experience it, might actually be a barrier because you automatically assume that they feel how you have felt
- no two people undergo the same process the same way
what are the 3 components of empathy?
- 1. facilitating
- 2. perceiving
- 3. responding
definition: the act of establishing a safe non threatening atmosphere where people can express important ideas and feelings; can't do this if you're distracted or interrupted; primarily non verbal; may occur unconsciously; mimic their facial expression, body position
definition: ability to identify the feelings and meanings people express and to understand it from their point of view, not yours; no only what you say but also the underlying meaning
definition: communicating to others your understanding of them and your willingness to listen; maybe called reflection or feeling; as for clarification and make sure it's genuine responding
what are the 3 questions you ask yourself working with patients?
- 1. what is this person really saying?
- 2. what can't they bring themselves to say?
- 3. what they hinting at?
what are the benefits of empathy?
- improves patient adherence to their medication regiment
- better satisfaction with relationships
- patients are more likely to carry out a treatment plan and ask for help
- builds trust and rapport
- patients have a better understanding of themselves
- patient's problem solving abilities improve
if not empathy, what then? what are the other types of responses to patients?
- 1. paraphrasing
- 2. advising
- 3. reassuring
- 4. generalizing
- 5. probing
- 6. distracting
definition: conveying back to the patient what was said; focus on content and superficial opinions; when patient provides you a lot of information, just cut through the details; differs from sympathy because empathy is a reflection of patient's feelings ... when we do this, we judge what is truly important
definition: providing solicited or unsolicited advice; differs from empathy because we assume we know enough about the situation and that we know more about the patient; always gives a list of choices; best not to make it seem dictatorial, don't be authoritative
definition: providing assurance with the goal of trying to get a patient to stop feeling upset or change the patient's feeling, we can give false information; we have a natural tendency to say: "I'm sure they'll be okay" but we can't do this
definition: telling patients that you or others have had the same experience; saying that you know just how they feel; problem with this: takes the focus away from the patient
definition: asking questions when patient has expressed a feeling; we want to understand patient's feelings but we don't want to do this because it can be disturbing to a patient and can lead to false expectation
definition: changing the subject
patient counseling: open ended vs closed questions?
- open ended
- start with who, what, where, and when
what are some general techniques we need to remember during patient counseling? (8 techniques)
- present material in logical order
- provide accurate information
- use patient friendly language
- display effective non verbal behaviors
- address any concerns or problems that the patient may have
- use empathetic responses
- maintain control of the session
patient counseling checklist:
- 1. introduce yourself
- 2. identify the patient
- 3. ask the patient if this is a good time to review his/her medications
- 4. explain the purpose of the session
- 5. ensure and maintain confidentiality
- 6. assess the patients understanding of therapy (BIG 3: what did the doctor tell you this medication was for? how did the doctor tell you to take this medication? what did the doctor tell you to expect from this medication?)
- 7. assess: medical conditions, current medication use (prescription and non), social history, adherence
- 8. provide complete info on the med
- 9. verify patient understanding
- 10. summarize key points
- 11. allow for opportunity to follow up
- 12. provide closure
definition: the extent to which a person's behavior (in terms of taking medications, following diets or executing lifestyle changes) coincides with medical or health advice; can be intentional or unintentional
- defined by hippocrates in 400BC
non adherence rate? average non adherence?
- 15-90% non adherence
- average of 50%
- so ... large problem!!
what is the range of non adherence?
- 1/3 of patient take their meds (improperly)
- 1/3 take some
- 1/3 don't take meds at all
- 20% not filled
- specific example: % of 3rd refill of statins not picked up = 40%!!!
what are the most common causes of non adherence?
- 1. not getting the drug filled
- 2. cost
- 3. taking an incorrect dose
- 4. taking it the wrong time
- 5. forgetting one or more doses
- 6. stopping the medication too soon
- 7. lack of understanding, unsure how or why they're taking the med
other causes of non adherence?
- 1. complexity of a treatment regiment
- 2. any more than 2 doses a day ... almost insurance for a lack of adherence
- 3. any patient with 4 or more doses ... almost a guarantee for non adherence
- 4. work and schedule issues
results of non adherence?
- 1. not getting the full effect of the drug
- 2. antibiotic resistance
- 3. morbidity, mortality, illness or death
- 4. medication misadventure leads to 1/3 of all hospital issues
what are some false assumptions about patient understanding?
- do not assume that the physician has already discussed the med with the patient
- do not assume that the patient understand all the info given
- do not assume that, if patients understand what is required, that they will have all the tools necessary to comply
- do not assume when communication breaks down that the patient "doesn't care" or "isn't motivated" or "lacks intelligence" of "can't remember"
- do not assume that once a patient understands how to comply with a medication regiment, that adherence will occur
- do not assume that physicians routinely monitor the patient's use of meds and if there are med problems, that the prescriber knows them and is addressing them
- do not assume that, if patients are having problems, they will ask direct questions or volunteer information
how do we detect non adherence?
- through computers ... see refill records and patient records
- EFFICACY ... monitor if the condition has improved!!
- side effects
- ask them if taking med
how do we assess non adherence?
- assess frequency, degree, duration of non adherence
- assess the effects of patient's current med use on therapeutic outcome
resolution of non adherence
- 1. identify the desired outcome of the intervention (receiver right med, right dose, and side effects should be removed)
- 2. develop a plan (goals? what does the patient want? individualize!)
- 3. select strategies to motivate the patient
- 4. select various techniques or tools (pill boxes, reminder calls, calenders, therapy)
- 5. follow up to ensure desired outcome
10 tips and tactics that will help improve patient adherence: COMPLIANCE
- C - correct misconceptions by identifying the patient's understanding, attitudes, beliefs and experience about the condition and med
- O - open the package or vial to show the patient the actual med
- M - make time for the patient to be included in any decision making regarding the med regiment, especially if the decision is to revolve around life events
- P - provide reinforcement and positive rewards for compliant behavior
- L - leave written patient info leaflets only in combination with face to face dialogue
- I - inform the patient of the risks of non adherence and outcome
- A - assure the patient that you share in the treatment goals and confidentiality is respected; that you might collaborate with other prof, esp if there'll be a need to change therapy to avoid side effects
- N - never assume that the patient can remain adherent alone; suggest family/friends to be involved
- C - congratulate the patient for being adherent
- E - evaluate adherence behavior by contacting patients who missed refills
definition: a "summary", refers to a list of accomplishments and achievements whose purpose is to get the reader interested no more than 1 page
definition: a short account of a person's career and personal qualifications; may be used in place of an initial interview; used in a non professional type
- CV curriculum vitae
- resumes are used for jobs with lots of positions
% of employers that remove resumes from the pool if they have typos or errors?
what are the key elements to a resume?
- 1. contact info
- 2. career objective (optional)
- 3. education
- 4. experience
- 5. membership and service
- 6. awards and honors
what are the key elements of a CV?
- 1. contact info
- 2. education
- 3. professional training
- 4. work experience
- 5. professional activities/memberships
- 6. organizational activities
- 7. awards and honors
- 8. presentations
- 9. publications
- 10. grants or research
- 11. volunteer activities
What would you like to do?
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