As articulated by the World Health Organisation (2019), community pharmacists are the health professionals who are most accessible to the public. Integral to the pharmacy profession is a commitment to promoting health awareness in the community.

Pharmacists can directly influence positive outcomes for patients by educating and counselling them to assist their compliance to their pharmacotherapeutic regimens and monitoring plans (ASHP 2011).

To provide effective pharmaceutical care, a pharmacist needs to acknowledge the responsibility they have in a patient’s pharmacotherapeutic outcomes.

- ‘Patient counselling … provides an opportunity to elicit the necessary information from a patient, and to enable safe and effective use of medicines. Patients have the right to expect that the pharmacist will counsel them privately about their medicines. Counselling is also the final checking process to ensure the correct medicine is supplied to the correct patient.’

(Pharmacy Board of Australia 2015)

Providing counselling and information for safe and effective medication management is directly tied to Domain 3: Medicines Management and Patient Care of the National Competency Standards Framework for Pharmacists in Australia.

Medication Non-Compliance in Numbers

An American study in 2018 found that misuse of medicines is responsible for approximately 275,000 deaths every year in the US (Watanabe et al. 2018).

Furthermore, about 50% of patients living with chronic conditions in developed countries do not adhere to treatment recommendations (Usherwood 2017).

According to an Australia study, the cost of medication non-adherence is $10.4 billion for hypertension, dyslipidaemia and depression alone (UTS 2019).

The Role of the Pharmacist

The role of the pharmacist is constantly growing and being redefined. Pharmacists are essential in verifying that patients have sufficient understanding, knowledge and skill to follow their pharmacotherapeutic regimens (ASHP 2011).

In addition to this, pharmacists should also seek ways to encourage patients to learn about their treatment and to be involved as active partners in their care (ASHP 2011).

Pharmacists play a central role in ensuring medication safety and compliance across the continuum of care. The complexity of the medication prescribing and delivery processes can make it hard to prove the positive effect that pharmacists have on adverse outcomes directly.

This challenge aside, studies have shown that pharmacist involvement has the potential to:

• Reduce errors
• Improve prescribing practices
• Enhance patient monitoring across different settings.

(PSNet 2019)

Lack of sufficient knowledge about their health problems and medicines is a leading cause of patients’ non-adherence to treatment plans (ASHP 2011).

It’s an issue to be taken very seriously. Medicine non-compliance not only creates problems for health professionals overseeing treatment, but also has the potential to cause death. For example, a patient with congestive heart failure who does not take diuretics correctly on a regular basis will likely end up in hospital repeatedly (Fung 2012).

Patient Counselling

Patient counselling at the pharmacy counter is a practised skill. Arguably, assuring that the patient understands the treatment is as critical to the role as filling prescriptions accurately.

If a medicine is not properly discussed with a pharmacist, the patient leaves the pharmacy with only the directions on the medication label and an information pamphlet.

What is Required to Provide Effective Counselling?

Allocating appropriate time for each patient is crucial to effective counselling. Each and every patient should understand why they are taking a medicine and exactly how it should be taken (Pathickal et al. 2016).

With a community setting that has largely become like a business, pharmacists must do what they can to try to make themselves available to their patients (Pathickal et al. 2016).

Open-ended questioning and active listening are essential skills for sharing information with patients, and obtaining information from them as well.

Pharmacists may need to adapt medicine counselling to suit patients’ language skills and primary languages. This can be achieved through the use of teaching aids, interpreters or cultural guides if necessary.

Pharmacists also need to observe and interpret the nonverbal messages (e.g. eye contact, facial expressions, body language, vocal characteristics) that patients give during counselling (ASHP 2011).

The Essential Components of Patient Counselling (DRUG)

Leuck (2015) endorses the DRUG acronym to assist pharmacists in remembering the vital components of patient counselling.

• The dose of the medicine and how often it should be taken
• Potential timing issues associated with dosage
• What to do if a dose is missed.

• What the person can expect while taking the medicine
• How the drug works in the body
• How the person can tell if the medicine is working
• The potential consequences of non-adherence.

• Does the medicine have a Boxed Warning?
• Is the person allergic to this medicine?
• Is the person taking other medicines that could interact with this medicine?
• Does this medicine react to alcohol, particular foods or sunlight?
• Are there specific precautions for older, young, pregnant or breastfeeding persons?
• Any other medicine-specific cautions or precautions.

• Assess the person’s understanding of the above
• Discuss how to properly store this medicine
• Discuss information regarding refills
• How to dispose of unused medicines
• Who they can call if they have any questions.

(Leuck 2015)

An active counselling role not only facilitates a clearer understanding of medicines but also plays an important role in emphasising the necessity of medication adherence (Pathickal et al. 2016), which could have a positive life-long influence on the patient.

It is vital for both the community and pharmacists themselves to understand and appreciate the role pharmacists play in managing a patient’s health (Pathickal et al. 2016).

References