New approach to medication counseling

By David Stauth
It takes about one minute longer, but pharmacists who employ an unconventional, interactive patient counseling technique can more than double the chance that people will properly take, understand and manage their use of prescription drugs.
A new study published in the Journal of the American Pharmacists Association says this technique could improve the understanding of drug use and storage, possible side effects, what to expect from a medication and what to do if something isn’t working.
Historically, pharmacists use a “lecture format.” Robert Boyce, director of pharmacy services in the Student Health Center Pharmacy at Oregon State University, co-developed an alternative approach during a 21-year career with the Public Health Service pharmacy program of the Indian Health Service. It emphasizes a questioning of patients about the drug they have been prescribed, and answers questions about whatever they don’t understand. It’s a discussion, not a presentation.
The concept, Boyce said, was released in 1991 to every school and college of pharmacy, and is now gaining much wider acceptance across the nation. This study, which included a survey of 500 participants at four community pharmacies in Oregon, is the first of its type to confirm the value of the new approach.
In this approach, patients are asked three basic, open-ended questions, relating to the name and purpose of the medication; how to use and store it; and what possible side effects there might be, and what to do if they occur.
The study found that 71 percent of patients using the new approach answered all three questions correctly, compared to 33 percent of patients who were instructed with the conventional system.
With either approach, most people understood what medication they were taking and what it was for. However, with the new system, four times as many people understood how and when to take their medication, and also could answer basic questions about adverse effects.
According to this study, the average time it took pharmacists to use the new system was a little over two minutes, compared to 75 seconds for conventional counseling.
“For a busy pharmacist, some might suggest this is a significant additional amount of time,” Boyce said. “But when you compare that to the risks of something not going right when a patient does not understand what the specific directions are, or what to expect from their medication, the additional effort seems minimal.”
Patient counseling about medications, Boyce said, is still an evolving aspect of health care. Prior to federal legislation that became law in January, 1993, which mandated pharmacist counseling for Medicare patients receiving new prescriptions, pharmacist counseling was variable.
Since that time, all but three states in the country have enacted laws that require patient counseling on medication, or an offer to counsel, be made available.
“This new approach to counseling can find out what a patient does and doesn’t understand,” Boyce said. “It’s especially important when it comes to drug efficacy and side effects. If a medication isn’t working properly, patients learn what actions to take. If they experience side effects, they know better how to handle it and when to contact their doctor or pharmacist.”
People better remember what they heard and discussed, feel as if they are being listened to, and they appreciate the attention, Boyce said. Gaps in understanding are addressed before moving on to the next question.
Some common sense concerns can also be immediately identified with this format, which may be less obvious in conventional counseling. A patient may have hearing problems, language barriers or cognitive circumstances.
Previous research has shown that when people do not understand the proper use of their medications, adherence rates plummet. Also, studies show that patients are most interested in information on adverse effects, but that this topic historically was one of those least discussed.
The study outlined stages of improvement as pharmacists adapt to the new approach, become more comfortable with it and increase both their speed and communication effectiveness.