Clinical pharmacy practice is concerned with the promotion of effective, safe and economical drug therapy. Drug use is a complex process and there are many drug-related challenges at various levels, involving prescribers, pharmacists and patients. The patient load for prescribers is very high. A busy practitioner spends only around 5-7 minutes per patient. During a short time it is very difficult for the prescriber to give complete information about medication to the patient. Safe and effective drug therapy depends on patients being well informed about their medication.
Most pharmacists in community pharmacies and hospitals haven't been well trained for this purpose and have largely remained as dispensers. As a result patients in general do not get enough information about the use of the medication including how and when to take the medication, how long to take and what to do if side effects occur or a dose is missed specially in case of antibiotic therapy.
Lack of essential information leads to failure of the patient in taking the medication in correct way, which in turn results in therapeutic failure, adverse effects, and additional expenditure on investigation and treatment. Inappropriate use of antibiotics by individual patients leads to antibiotic resistance. In case actually an antibiotic is needed it may not be effective.
Patient counseling refers to the process of providing information, advice and assistance to help patients use their medications appropriately. It also includes information about the patient's illness and lifestyle modification. A patient is advised on whether drugs are to be taken before or after food, taken at bed time or in morning, with water or with juice/milk, swallow whole or chew the tablet, gap between each doses and monitor for any medication errors. All of these result in the rational use and best therapeutic action of the drugs. Lack of this information causes patient non-compliance towards medication.
Non-complaint behavior also encompasses failure to obey instructions on other aspects of healthcare, such as diet, exercise and smoking or drinking habits. Degree of non-compliance is expressed as a percentage of the ideal compliance.
% Compliance=NDP-NME / NDP
Where NDP = Number of doses prescribed and
NME = Number of medication errors
Any arbitrary value less than 90% indicates suboptimal use of the medication.
In 1999 the Institute of Medicine (IOM) released "To Err is Human: Building a Safer Health System". This report calls attention to the 98,000 Americans who may die each year because of medical errors. Mention errors alone were estimated to account for 7000 of these deaths. While medication misadventures can occur any where in the health care system from prescribers to dispensing to administration and finally to patient use, the simple truth is that many errors are preventable, and clinical pharmacists assume active role in better use of drugs.
A clinical pharmacist who is trained in patient counseling, having sound knowledge in pharmacology, pathophysiology and laboratory data interpretation. Clinical pharmacists are involved in specific information and counseling required in each patient care situation.
Counseling should be done using verbal, written or audio-visual communication techniques and methods. The following points should be consider during counseling-
- Name (trade or generic name or chemical name)
- Intended use and expected action of individual drug
- Route, dosage form, dosage and administration schedule of each item
- Special direction for preparation if any
- Special direction for administration
- Precaution to be taken during treatment
- Common side effects that may be encountered including their avoidance and action to be taken
- Proper storage condition of drugs
- Prescription refill information
- Action to be taken in the event of a missed dose
- Any other information peculiar to specific patient or drug
- Patient disease condition
- Life style modification in daily life routine
The patient should understand the information provided and it should be in understandable language. The feed back of the patients understanding must be ensure in order to eliminate confusions.
A study of 275 interviews, was conducted with 100 physicians, 75 nurses and 100 patients/customers in a tertiary care hospital. This exploratory study was basically a qualitative approach. Data was collected by face-to-face interviews. The prescriptions were also studied and it was found that, in a total of 250 prescriptions the average number of drugs or items per prescription was 4.2 with an average of 62.4% prescriptions with an antibiotic.
The subjects included in this study were both male and female. 92% of the physicians recommended clinical pharmacists for better services to patients and 100% of the nurses feel that clinical pharmacists can provide better use of medicines and counseling about life style modification.
There is a 100% improvement in understanding of prescription drugs use as compared to pre counseling. This studies shows that patient medication counseling is essential for better drug therapy & helps patients in better understanding of their medication and keep them adhere to treatment. As there is number of drugs prescribed which causes patients poor understanding and leads to confusion in remembering the dosage regimen. Patient counseling reduces such confusions, which in term gives patient better understanding about their medication.
This review study reveals that clinical pharmacist can contribute to achieving the highest possible standards of patients care. Comprehensive and accountable clinical pharmacy services are an essential component of contemporary health care practice. Therefore, an upliftment of clinical pharmacy services is needed to provide better health care by it service of patient counseling. Which achieves in improving patient non-compliance and helps society in better health care.
-- The authors Vijay Roy is a post-graduate student, while Basak S and Prasad G S are faculty members, Division of Pharmacy Practice, Dept. of Pharmacy, Annamalai University, Annamalainagar, Tamil Nadu