Counseling

Patient counseling at the pharmacy counter is an acquired skill. Yes, filling prescriptions accurately and expeditiously is paramount to the community pharmacy profession; however, assuring that the patient understands the therapy is just as critical.

Without a discussion with the pharmacist, the patient leaves the pharmacy with nothing more than the directions on the label and the consumer medication information flyer that may or may not make it into the patient's prescription bag.

I realize that patients have the alternative to "opt-out" of a counseling session with their pharmacist; however, it is my opinion that this practice should be strongly discouraged by the pharmacist filling the prescriptions.

Throughout my years as a practicing pharmacist, I have worked with many different pharmacists and it seems that they all have their own ways of addressing medication counseling at the pharmacy counter. I am not saying that 1 method is completely correct or that another is completely wrong; however, it would do us all some good to revisit our patient counseling technique now and again.

One resource that provides an excellent guide to patient counseling is the ASHP Guidelines on Pharmacist-Conducted Patient Education and Counseling. This document was developed specifically to help pharmacists provide effective patient education and counseling.

Initially, as I approach the pharmacy counseling counter, I ask patients whether they are familiar with the medication their doctor has prescribed, how they are going to take it, and what it is being used for specifically. This is an important step in order to assess the patient's current knowledge of the therapy.

I have developed a simple acronym that helps keep me focused while providing a patient medication counseling session. We all need some sort of tool to help us remember to cover all of the important medication counseling aspects of the specific drug. The acronym I use is DRUG, and it goes as follows:

Dosage: I discuss the dose of the medication, how it should be taken, any specific dosage timing issues, and what to do if the patient misses a dose.

Results: What should the patient expect while taking this medication? How is the drug working in the body, and how can the patient tell if the medication is working? It is also important for the patient to understand the consequences of nonadherence.

Underlying Issues: I present potential issues that the patient needs to be aware of when taking the medication, including:

Does this medication have any Black Box Warnings?

Is the patient allergic to this medication?

Is the patient taking any other medications that may interact with this medication?

Does this medication have any specific alcohol, grapefruit, or sun sensitivity warnings?

Does this medication have an effect on any other disease states that the patient may have?

Are there any special precautions with the elderly, young, pregnant, or breast feeding patients?

Are there any other medication specific cautions or precautions that should be discussed?

General information: Assess the patient's understanding of the above information. Discuss how to properly store the medication, what to do about refills, how to dispose of unused meds, and assure that the patient knows who to call for questions.

Speaking as a community pharmacist, many patients rely on us for medication information and education. Therefore, we need to stay current on our understanding of the important counseling topics with each and every medication we dispense, and it is our duty to maintain our skills as patient educators so that we may convey such information in an appropriate manner to our patients.