Pharmacist patient counselling is one of the key roles of the community pharmacist. It is a one-to-one interaction where the pharmacist provides medication information and advice to the patient or their representative. The aim is to improve quality use of medicine through greater awareness of a range of factors including side effects, correct use, adherence, storage and lifestyle factors. This example of excellent pharmacy patient counselling shows a Master of Pharmacy student in a simulated counselling session. The student provides information to a patient on adherence and correct technique for asthma medication. Practice-based feedback is given by leading community pharmacist John Bell, and theoretical feedback is given by pharmacy practice academic Dr Victoria Garcia-Cardenas. This type of simulation is integrated throughout the UTS Master of Pharmacy course.
Hello welcome to part pharmacy course here yes what you’re about to see is one of the simulated counseling sessions which form part of the professional services and also the primary healthcare sections of our course we believe it’s so important to develop these practice skills early on so that when you become fully qualified registered pharmacists you really know
What it’s all about i hope you’ll enjoy it more importantly i hope you’ll be a part of it in the not-too-distant future good afternoon michael how are you today danny i got a bit of a cough coughing now the doctors give me a prescription okay so it’s a thing called right i forgive me tourism yeah that’s actually the same thing i’ll think of the brand name yeah you
Shouldn’t might help a bit sure no worries well i’ll get that sorted for you good i’ve just heard so that scripts ready for you michael has the doctor told you what this is for you mentioned a cough yeah we described the cough for me well i’ve just an irritating do you think it’s more prevalent at any particular time of the day not really okay maybe it not but
Perhaps i notice it more at night okay sure forget other medications i’ve noticed you’ve got asthma is that right yeah well that’s what the doctor says it is a few years ago now he diagnosed me with this aspect i was getting really short of breath a bit wheezy and so we had a couple of puffers seems to be okay coughs annoying yeah sure i can understand that and
The cops’ll heights quite irritating and so we certainly hope that we can get that sorted for you with your asthma medication is still taking them regularly you’re having any concerns with any of those medications the other one i haven’t been using it i’ll write it because to be honest i’m feeling okay you know the louise is fine and they consist of people under
Control and the doctor keep telling me it was sterile yes sure that’s exactly right i’m a bit worried about that to be honest i’m i thought too many steroids cannot be doing me that’s good so and because the other the other person to do control sure okay so you’re saying that your estimate is well controlled and that sounds it sounds from what you’re describing
That it might actually not be i cannot send your concerns with the corticosteroid that’s completely understandable and sometimes some of the drug these drugs can be a bit worrying you however i just remind you that the corticosteroid is inhaled so it actually means that you’re unlikely to get a lot of side effects from the medication because it’s not entering the
Blood directly so the side effects actually quite the fact of them is a different type of medication and it’s not designed to provide long-term relief for your asthma and what can actually happen is that if you keep using this medication you’ll suffer some side effects like tremors in your hands and also your sma actually get worse because it’s not controlling
The a smart itself it’s only controlling the symptoms we noticed any side effects recently i usually everyday it is actually you shouldn’t be using your ventolin inhaler more than a couple of times a week at very most yes okay so how often would you say that you’re using your pulmicort inhaler probably a few weeks since i’ve used it and even when i was using that
Again captive chums a week really yeah i can understand why you think that but i think it’s really important that you start taking this medication regularly because it will actually assist in controlling your estimate better and they actually get rid of your cough that you’re experiencing okay and yeah make sure that he doesn’t think this pulmicort might help river
Cough it may because uncontrolled asthma can sometimes result in a cough that you experience at night which is exactly the symptoms that you described okay okay so is that something you think you’d be able to start doing yeah i guess i mean if you think that southern fiction are going to be a problem oh man the doctor did tell me initially to use it twice a day
But on the exact clothes that i thought the symptoms are okay yeah and just keep in mind with this medication too that you may not notice any changes in your symptoms if your symptom asthma is well controlled that’s showing that the medication is working and doesn’t indicate that you should stop taking the medication okay yeah once you start using that medication
More regularly you shouldn’t be using the ventolin often at all and that should make things a lot easier for you now you’re confident with your inhaler technique would you like me to demonstrate who might be a little bit different it is it’s a completely different device so it might be a bit helpful for a reminder it’ll just give you this written information it
Summarizes the points of having used device and i didn’t demonstrate it for you now sure okay so this is the device familiar to you unscrew the top and it needs track of the dose in this number here so that’s showing that there’s plenty left you want to keep it upright at all times and to initiate the dose you just twist it and you’ll hear a click to hear that
Click view yeah then to inhale you breathe away from the device hold the device vertical there any inhale take the device away hold your breath for as long as you can a few seconds at least yep and then breathe away from the device okay and then just put the cap back on and that’s when you’re confident in doing that that’s great well michael i hope that’s been
Helpful for you that yeah as i say keep taking that pulmicort and have that will help with your are smart okay i think initiative in that worries i’m cadet thank you i guess thanks so now what i’m going to do is i’m going to provide daniel with some useful feedback on how to address medication non-adherence from a more theoretical perspective so we are going to
Cover some of the theoretical models that we have been covering in class and how to apply to change patient behavior so daniel now we are going to go through some of the session that she just had with john i think that was really really good so i’m going to give you a bit of feedback on especially and the application of the theoretical models but i’ll start from
The beginning so when you were assessing medication adherence you went straight up heading to the asthma medications probably you forgot to ask questions about the other medications that the patients are taking and you should also consider assessing other barriers that the patient might have for medication suffered some sort you can address or you can assess
If the patient forgets the communication sometimes if he’s feeling worse sometimes that he stopped taking the medication as when so you know a more holistic assessment on the barriers because as you know there are like 100 of medication i really like your conscience is minor comment would be that at the beginning when you were expressing that empathy which is
Really important when you are using motivational interviewing somebody look at his eyes because you were saying yes i am yeah you were looking down with a driver okay so remember the time to do that but apart from that i thought that was very good when you are playing the theoretical mothers even if you use the necessity and concerns or they believe model over the
Motivational information strategy remember to cover all the elements that the theoretical model explains so i think i draw at the health belief model below yeah some elements yes so for example i you need to assess happy they perceive separately and susceptibility to disease when the patient is not taking the medication so for example asking the thing you are at a
Higher risk of suffering from an asthma attack and taking this medication to have it gathering a bit more information and about the perceived severity of the condition that the patient had might be a very good point then when you are who you are concealing on the inhaler technique i think you forgot to tell a patient to move insist mouth so that’s a really important
Point as you know to avoid any possible side effects of using corticosteroids and also don’t forget to ask is if the patient has an asthma action apart from that was very good do you have any questions yes i do actually a couple of them i know that developing discrepancies yeah important part of this counseling session yeah can you explain how might have been
Able to integrate that yes in fact that’s a really good point because it as you know it’s are really important a limit of motivational interviewing so you can say i look my calendar on one hand you are telling me that not having this cough or controlling the rasmus an important thing for you but on at the same time you are not taking these medications that would
Help you prevent list of future asthma attacks she cites highlighting like contradictorily behavior yeah yeah so my other question was when do you think i could have bought the asthma action plan into the counseling session i realized i forgot to include that as well yes daniel i think after ssinnim addressing inhaler technique to be active point reversal you know
Can just ask the patient directly as an asthma action plan and if not i refer him to his gp sure okay well thank you for that feedback okay thank you
Transcribed from video
Pharmacist patient counselling demonstration By University of Technology Sydney
