Chapter 1 & 2: Community Pharmacy and Patient Counseling

CHAPTER 01 COMMUNITY PHARMACY Definition Community Pharmacy “A community pharmacy is a pharmacy that deals directly with people in the local area / Locally owned pharmacy. It has responsibilities including compounding, counseling, checking and dispensing of prescription drugs to the patients with c...

CHAPTER 01 COMMUNITY PHARMACY Definition Community Pharmacy “A community pharmacy is a pharmacy that deals directly with people in the local area / Locally owned pharmacy. It has responsibilities including compounding, counseling, checking and dispensing of prescription drugs to the patients with care, accuracy, and legality.  A community pharmacy has appropriate procurement, storage, dispensing and documentation of medicines. It is an important branch of the pharmacy profession and involves a registered pharmacist with the education, skills and competence to deliver the professional service to the community”. OR  “Community pharmacy includes all of those establishments that are privately owned and whose function, in varying degree, is to serve societies need for both drug products and the pharmaceutical services”.  What is the scope of Community pharmacy ?  In processing prescriptions- The pharmacist verifies the legality, safety and appropriateness of the prescription order, checks the patient medication record before dispensing the prescription (when such records are kept in the pharmacy), ensures that the quantities of medication are dispensed accurately, and decides whether the medication should be handed to the patient, with appropriate counseling, by a pharmacist  Clinical pharmacy- The pharmacist seeks to collect and integrate information about the patient’s drug history, dosage regimen Patient care- patient drug history, mode of administration, precautions, advices Drug monitoring- as practice research projects, and schemes to analyze prescriptions for the monitoring of adverse drug reactions  Extemporaneous preparation- pharmacists engage in the small-scale manufacture of medicines, which must accord with good manufacturing and distribution practice guidelines.  Alternative medicines- In some countries, pharmacists supply traditional medicines and dispense homoeopathic prescriptions  Checking symptoms of minor aliments- pharmacist can supply a non-prescription medicine, with advice to consult a medical practitioner if the symptoms persist for more than a few days. Alternatively, the pharmacist may give advice without supplying medicine.  Health care professionals- provide the information as necessary to other health care professionals and to patients, and use it in promoting the rational use of drugs, by providing advice and explanations to physicians and to members of the public.  Counselor- the pharmacist provides an advisory as well as a supply service to residential homes for the elderly, and other long-term patients. In some countries, policies are being developed under which pharmacists will visit certain categories of house-bound patients to provide the counseling service that the patients would have received had they been able to visit the pharmacy  In prophylaxis and health promotion- The pharmacist can take part in health promotion campaigns, locally and nationally, on a wide range of health- related topics, and particularly on drug-related topics (e.g., rational use of drugs, alcohol abuse, tobacco use, discouragement of drug use during pregnancy, organic solvent abuse, poison prevention) or topics concerned with other health problems (diarrheal diseases, tuberculosis, leprosy, HIV-infection/AIDS) and family planning. Role & responsibilities of community pharmacist 1.Dispensing prescriptions/ appropriate filling of prescriptions by Patient drug history. 2. Reviewing the prescription for correctly spell, label, interactions, right drugs etc. Dispensing prescriptions/ Appropriate filling of prescriptions Reviewing the prescription for correctly spell, label, interactions, right drugs etc. 3. Rational use of drugs–As common as common sense? “The irrational use of medicines is a major problem worldwide. WHO estimates that more than half of all medicines are prescribed, dispensed or sold inappropriately, and that half of all patients fail to take them correctly. The overuse, underuse or misuse of medicines results in wastage of resources and widespread health hazards.” CHAPTER 02 Patient Counseling The word PHARMACIST stands for P- Patience H- Honesty A-Alertness R-Research M- Motivator A-Administrator C- Courageous I-Intelligent S- Studious (spending lot of time on reading) T- Thinker Patient counseling Definition: Patient counseling is defined as providing medication information orally or in written form to the patients or their representatives on directions of use, advice on side effects, precautions, storage, diet and life style modifications.  Objectives of patient counseling 1.Patient should recognize the importance of medication for his well being. 2.A working relationship and a foundation for continuous interaction and consultation should be established. 3.Patient's understanding of strategies to deal with medication side effects and drug interactions should be improved. 4.Should ensure better patient compliance. 5.Patient becomes an informed, efficient and active participant in disease treatment and self care management. 6. The pharmacist should be perceived as a professional who offers pharmaceutical care. 7. Drug interactions and adverse drug reactions should be prevented.  Patient counseling consists of three stages : 1.Introduction 2.Process Content and Issues regarding manner 3.Conclusion Introduction 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. Issues regarding Manner 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. CONCLUSION 1. Verify the patient's understanding by means of feedback 2. Summarize by emphasizing key points 3. Give an opportunity to the patient to put forward any concerns. 4. Help the patient to plain follow-up Patients who should always be counseled - Confused patients, and their caregivers - Patients who are sight or hearing impaired - Patients with poor literacy - Patients whose profile shows a change in medications or dosing - New patients, or those receiving a medication for the first time (transfer prescription) - Children, and parents receiving medication - Patients receiving medication with special storage requirements, complicated directions, Patients who should be counseled at certain intervals - Asthmatic patients - Diabetic 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 Counseling area The patient should be counseled in a semi- private, or private, area away from other people and distractions, depending on the medication(s). The patient should perceive the counseling area as confidential, secure and conducive to learning. This helps ensure both parties are focused on the discussion, and minimizes interruptions and distractions. It provides an opportunity for patients to ask questions they may be hesitant to ask in public Communication skills for effective counselling: The counselling process uses verbal and non-verbal communication skills. Verbal communication skills are:- -Language -Tone -Volume -Speed Non-verbal communication skills are:- Proximity(Realtionship) Facial expression Steps during patient counselling: Counselling is a two-way communication process and interaction between the patient and the pharmacist is essential for counselling to be effective. 1.Preparing for the session. 2.Opening the session. Counselling content The counselling content is considered to be the heart of the counselling session.During this step the pharmacist explains to the patient about his or her medications and treatment regimen.Lifestyle changes such as diet or exercise may also be discussed.Topics commonly covered include: -name and strength of the medication. -reason why it has been prescribed or how it works - how to take the medication - expected duration of treatment. - expected benefits of treatment. - possible adverse effects. - possible medication or dietary interaction. - advice on correct storage. - minimum time duration required to show therapeutic benefit. - What to do if a dose is missed. - special monitoring requirements,e.g blood tests. - arrangements for obtaining further supplies.  conclusion  At last we can say that patient counselling is a part and parcel of good medication. A good counselling can provide a patient to take his medication. REFRENCE  A Text Book Of Hospital And Clinical Pharmacy by P.C. Dandiya and Mukul Mathur Fouth Edition 2005