Psychosis: Counseling the Hallucinating or Delusional Patient
9.13.21 Patient Counseling Lecture
Transcript of 9.13.21 Patient Counseling Lecture
![Page 1: 9.13.21 Patient Counseling Lecture](https://reader030.fdocuments.in/reader030/viewer/2022012716/61aeeb0741a15f4134021593/html5/thumbnails/1.jpg)
1
Pharmacist Patient Care Process and Introduction
to Patient Counseling
Dr. Hindu Rao, PharmD, APh, BCACP
Dr. Neeloufar Fakourfar, PharmD, APh, BCACP
![Page 2: 9.13.21 Patient Counseling Lecture](https://reader030.fdocuments.in/reader030/viewer/2022012716/61aeeb0741a15f4134021593/html5/thumbnails/2.jpg)
Learning Objectives
1. Describe the Pharmacist Patient Care Process (PPCP)
2. Review the goals and steps for effective patient counseling
3. Review effective ways to navigate challenging patient encounters
4. Practice patient counseling with peers
![Page 3: 9.13.21 Patient Counseling Lecture](https://reader030.fdocuments.in/reader030/viewer/2022012716/61aeeb0741a15f4134021593/html5/thumbnails/3.jpg)
![Page 4: 9.13.21 Patient Counseling Lecture](https://reader030.fdocuments.in/reader030/viewer/2022012716/61aeeb0741a15f4134021593/html5/thumbnails/4.jpg)
The Pharmacist Patient Care Process
1. Process for consistent delivery of patient care across the profession
2. Applicable to any practice setting where pharmacists provide patient care and for any patient care service provided by pharmacist
3. Patient centered approach, in collaboration with other providers on the health care team, to optimize patient health and medication outcomes
4. Uses principles of evidence based practice
5. SOAP note is a tool used to guide through the process of working up patients
![Page 5: 9.13.21 Patient Counseling Lecture](https://reader030.fdocuments.in/reader030/viewer/2022012716/61aeeb0741a15f4134021593/html5/thumbnails/5.jpg)
Patient Counseling
“The pharmacy profession has accepted responsibility for providing patient education and counseling in the context of pharmaceutical care to improve patient adherence and reduce medication-related problems.” - ASHP Guidelines on Pharmacist-Conducted
Patient Education and Counseling
https://www.ashp.org/-/media/assets/policy-guidelines/docs/guidelines/pharmacist-conducted-patient-education-counseling.ashx
![Page 6: 9.13.21 Patient Counseling Lecture](https://reader030.fdocuments.in/reader030/viewer/2022012716/61aeeb0741a15f4134021593/html5/thumbnails/6.jpg)
Steps to Patient Counseling
Modified Calgary-Cambridge Approach
Build patient relationship
Develop rapport
Involve the patient
Use appropriate non-verbal cues
1. Initiate the interview (preparation, opening discussion)
2. Collect information
3. Assess
4. Plan and implement
5. Close encounter: monitor and follow up
![Page 7: 9.13.21 Patient Counseling Lecture](https://reader030.fdocuments.in/reader030/viewer/2022012716/61aeeb0741a15f4134021593/html5/thumbnails/7.jpg)
Goals for Patient Counseling
Effective patient interviewing and counseling is a core clinical skill
Goals:
• Collect accurate health history from a patient
• Come up with an assessment and plan
• Implement: provide successful consultation
• Include instructions for follow up
To be successful at the goals above, you must develop a good patient relationship using effective communication skills
![Page 8: 9.13.21 Patient Counseling Lecture](https://reader030.fdocuments.in/reader030/viewer/2022012716/61aeeb0741a15f4134021593/html5/thumbnails/8.jpg)
Steps to Patient Interview
Modified Calgary-Cambridge Approach
Build patient relationship
Develop rapport
Involve the patient
Use appropriate non-verbal cues
1. Initiate the interview (preparation, opening discussion)
2. Collect information
3. Assess
4. Plan and implement
5. Close encounter: monitor and follow up
![Page 9: 9.13.21 Patient Counseling Lecture](https://reader030.fdocuments.in/reader030/viewer/2022012716/61aeeb0741a15f4134021593/html5/thumbnails/9.jpg)
Initiate the Interview
Understand your setting
• Pharmacy counter, pharmacy aisle, clinic, hospital, blood pressure screening, immunization delivery
Establish initial rapport
• Greet the patient, identify and confirm the patient’s name, check how the patient prefers to be called.
• Introduce yourself, clarify your role, if appropriate give the patient an outline of what you intend
• Engage the patient, use open ended questions, assess their understanding
![Page 10: 9.13.21 Patient Counseling Lecture](https://reader030.fdocuments.in/reader030/viewer/2022012716/61aeeb0741a15f4134021593/html5/thumbnails/10.jpg)
Steps to Patient Interview
Modified Calgary-Cambridge Approach
Build patient relationship
Develop rapport
Involve the patient
Use appropriate non-verbal cues
1. Initiate the interview (preparation, opening discussion)
2. Collect information
3. Assess
4. Plan and implement
5. Close encounter: monitor and follow up
![Page 11: 9.13.21 Patient Counseling Lecture](https://reader030.fdocuments.in/reader030/viewer/2022012716/61aeeb0741a15f4134021593/html5/thumbnails/11.jpg)
Collect Information
Identify the problem or problems (s)
Consider all aspects of the patient’s illness experience
• Social, psychological, biomedical
It is important to have an organized approach on how to gather information
If you collect information through an organized and comprehensive approach, the rest of the encounter will be smoother
![Page 12: 9.13.21 Patient Counseling Lecture](https://reader030.fdocuments.in/reader030/viewer/2022012716/61aeeb0741a15f4134021593/html5/thumbnails/12.jpg)
Key Components of Health History
• Identification of the Problem(s)/Chief Complaint (CC)
• History of Present Illness (HPI)
• Past Medical History (PMH)
• Current Medications/Medication History
• Allergies
• Family History (FH)
• Social History (SH)
• Review of Systems (ROS)/Physical Exam Findings
• Laboratories/Studies
![Page 13: 9.13.21 Patient Counseling Lecture](https://reader030.fdocuments.in/reader030/viewer/2022012716/61aeeb0741a15f4134021593/html5/thumbnails/13.jpg)
Steps to Patient Interview
Modified Calgary-Cambridge Approach
Build patient relationship
Develop rapport
Involve the patient
Use appropriate non-verbal cues
1. Initiate the interview (preparation, opening discussion)
2. Collect information
3. Assess
4. Plan and implement
5. Close encounter: monitor and follow up
![Page 14: 9.13.21 Patient Counseling Lecture](https://reader030.fdocuments.in/reader030/viewer/2022012716/61aeeb0741a15f4134021593/html5/thumbnails/14.jpg)
Assess
Use information gathered to evaluate the patient’s needs
• What medications are they currently taking?
• Are they starting a new medication?
• Are there specific patient needs that are unmet?
• How are the current conditions being managed?
![Page 15: 9.13.21 Patient Counseling Lecture](https://reader030.fdocuments.in/reader030/viewer/2022012716/61aeeb0741a15f4134021593/html5/thumbnails/15.jpg)
Steps to Patient Interview
Modified Calgary-Cambridge Approach
Build patient relationship
Develop rapport
Involve the patient
Use appropriate non-verbal cues
1. Initiate the interview (preparation, opening discussion)
2. Collect information
3. Assess
4. Plan and implement
5. Close encounter: monitor and follow up
![Page 16: 9.13.21 Patient Counseling Lecture](https://reader030.fdocuments.in/reader030/viewer/2022012716/61aeeb0741a15f4134021593/html5/thumbnails/16.jpg)
Plan and Implement
• Determine a course of action
• Focus on resolving task at hand (e.g. new medication being counseled on, screening patient for health condition, educating and answering patient’s questions)
• Highlight any other important health needs
• Explain to the patient course of action
• If counseling on a medication, focus on providing key topics for your drug (directions for use, highlighting potential side effects, managing side effects when possible, etc)
• Make sure to answer patient questions and engage them
![Page 17: 9.13.21 Patient Counseling Lecture](https://reader030.fdocuments.in/reader030/viewer/2022012716/61aeeb0741a15f4134021593/html5/thumbnails/17.jpg)
If patient is picking up a new prescription medication, use the 3 PRIME QUESTIONS to direct your counseling session
1. What did your health care provider tell you the medication was for?
2. How did your health care provider tell you to take the medication?
3. What did your health care provider tell you to expect?
![Page 18: 9.13.21 Patient Counseling Lecture](https://reader030.fdocuments.in/reader030/viewer/2022012716/61aeeb0741a15f4134021593/html5/thumbnails/18.jpg)
“Fill in the Gaps”
Using an open-ended question-and-answer process, the pharmacist must address specific points:
• Name/class/purpose of medication
• Open vial/pour in lid
• Directions for use
• Side effects and precautions
• Duration of use/refill info
• Storage
• Missed dose instructions
![Page 19: 9.13.21 Patient Counseling Lecture](https://reader030.fdocuments.in/reader030/viewer/2022012716/61aeeb0741a15f4134021593/html5/thumbnails/19.jpg)
Steps to Patient Interview
Modified Calgary-Cambridge Approach
Build patient relationship
Develop rapport
Involve the patient
Use appropriate non-verbal cues
1. Initiate the interview (preparation, opening discussion)
2. Collect information
3. Assess
4. Plan and implement
5. Close encounter: monitor and follow up
![Page 20: 9.13.21 Patient Counseling Lecture](https://reader030.fdocuments.in/reader030/viewer/2022012716/61aeeb0741a15f4134021593/html5/thumbnails/20.jpg)
Final Verification of Patient Understanding
• “I want to make sure I explained everything clearly. Please summarize for me how you will take this medication.”
• “When you get home, how will you check your blood sugar?”
• “What side effects are you going to look for when taking this medication?”
![Page 21: 9.13.21 Patient Counseling Lecture](https://reader030.fdocuments.in/reader030/viewer/2022012716/61aeeb0741a15f4134021593/html5/thumbnails/21.jpg)
Closing Discussion
• Provides the patient an opportunity to consider the information discussed during the session
• Time for patients to ask questions
• “What questions do you have for me?”
• Consider asking patient to repeat the most important information
• Reiterate and emphasize the most important counseling points as well as your contact information
• Thank patient for their time
![Page 22: 9.13.21 Patient Counseling Lecture](https://reader030.fdocuments.in/reader030/viewer/2022012716/61aeeb0741a15f4134021593/html5/thumbnails/22.jpg)
Closing Discussion
• Provide patient the opportunity to voice any additional concerns and questions
• Provide patient with follow-up information• Follow-up with you
• Follow-up with another provider
• Appointment or time-frame for another visit
• Use written information to support counseling when appropriate• Written information has been shown to reinforce verbal instruction
• Don’t give before you start speaking because either you or the patient will start reading the paper during the verbal portion of the session
![Page 23: 9.13.21 Patient Counseling Lecture](https://reader030.fdocuments.in/reader030/viewer/2022012716/61aeeb0741a15f4134021593/html5/thumbnails/23.jpg)
23
Patient Counseling Resources:1. “Communication Skills for
Pharmacists” by Bruce Berger2. ASHP Guidelines on
Pharmacist-Conducted Patient Education and Counseling
![Page 24: 9.13.21 Patient Counseling Lecture](https://reader030.fdocuments.in/reader030/viewer/2022012716/61aeeb0741a15f4134021593/html5/thumbnails/24.jpg)
24
Example Counseling Video: https://youtu.be/_4iQOKRQrwA
![Page 25: 9.13.21 Patient Counseling Lecture](https://reader030.fdocuments.in/reader030/viewer/2022012716/61aeeb0741a15f4134021593/html5/thumbnails/25.jpg)
25
Example Counseling Video:https://www.youtube.com/watc
h?v=TBqfu-uaRpU
![Page 26: 9.13.21 Patient Counseling Lecture](https://reader030.fdocuments.in/reader030/viewer/2022012716/61aeeb0741a15f4134021593/html5/thumbnails/26.jpg)
Patient Case #1 - Information for Student Playing the Pharmacist
A patient presents to your community pharmacy to pick up a new prescription and needs counseling. The patient informed the technician they are hoping they do not need to take the medication long-term.
![Page 27: 9.13.21 Patient Counseling Lecture](https://reader030.fdocuments.in/reader030/viewer/2022012716/61aeeb0741a15f4134021593/html5/thumbnails/27.jpg)
Patient Case #1 - Information for Student Playing the Pharmacist
https://www.urmc.rochester.edu/medialibraries/urmcmedia/medicine/general-medicine/patientcare/documents/Lisinopril_Brochure_URMC.pdf
![Page 28: 9.13.21 Patient Counseling Lecture](https://reader030.fdocuments.in/reader030/viewer/2022012716/61aeeb0741a15f4134021593/html5/thumbnails/28.jpg)
You, Blake Anderson, are a new patient to this pharmacy. You were told to pick up a new prescription after being informed you have high blood pressure.
No known drug allergies
PMH: Seasonal allergies, newly diagnosed hypertension
Other medications: Claritin 10 mg once daily
Demeanor: Calm, curious
Question to ask pharmacist: Do I have to take this medication long-term?
Patient Case #1 - Information for Student Playing the Patient
![Page 29: 9.13.21 Patient Counseling Lecture](https://reader030.fdocuments.in/reader030/viewer/2022012716/61aeeb0741a15f4134021593/html5/thumbnails/29.jpg)
29
Let’s practice!Do not advance to next slide without practicing!
![Page 30: 9.13.21 Patient Counseling Lecture](https://reader030.fdocuments.in/reader030/viewer/2022012716/61aeeb0741a15f4134021593/html5/thumbnails/30.jpg)
![Page 31: 9.13.21 Patient Counseling Lecture](https://reader030.fdocuments.in/reader030/viewer/2022012716/61aeeb0741a15f4134021593/html5/thumbnails/31.jpg)
Modified Calgary-Cambridge Approach
1. Initiate the interview (preparation, opening discussion)2. Collect information3. Assess4. Plan and implement5. Close encounter: monitor and follow up
Patient Case #1
![Page 32: 9.13.21 Patient Counseling Lecture](https://reader030.fdocuments.in/reader030/viewer/2022012716/61aeeb0741a15f4134021593/html5/thumbnails/32.jpg)
Patient Case #1
![Page 33: 9.13.21 Patient Counseling Lecture](https://reader030.fdocuments.in/reader030/viewer/2022012716/61aeeb0741a15f4134021593/html5/thumbnails/33.jpg)
Navigating Challenging Patient Cases
Adopted with permission from: Heidi Eukel, PharmD School of Pharmacy, College of Health Professions, North Dakota State University
![Page 34: 9.13.21 Patient Counseling Lecture](https://reader030.fdocuments.in/reader030/viewer/2022012716/61aeeb0741a15f4134021593/html5/thumbnails/34.jpg)
![Page 35: 9.13.21 Patient Counseling Lecture](https://reader030.fdocuments.in/reader030/viewer/2022012716/61aeeb0741a15f4134021593/html5/thumbnails/35.jpg)
• The patient• The provider• The disease state• The system
What can cause interactions to be challenging?
![Page 36: 9.13.21 Patient Counseling Lecture](https://reader030.fdocuments.in/reader030/viewer/2022012716/61aeeb0741a15f4134021593/html5/thumbnails/36.jpg)
• Convey respect and non judgmental attitude towards patients• Listen to and engage with the patient• Use patient friendly language • Display appropriate body language and eye contact• Address patient’s concerns in a thoughtful and caring manner• Stay calm and professional at all times• Try your best to meet the patient’s needs• Set boundaries
Navigating Challenging Patient Cases
![Page 37: 9.13.21 Patient Counseling Lecture](https://reader030.fdocuments.in/reader030/viewer/2022012716/61aeeb0741a15f4134021593/html5/thumbnails/37.jpg)
B.G., a 55 year old male, is picking up a new prescription for metformin, a medication for diabetes. He is overwhelmed that he has been recently diagnosed with diabetes. He feels that his health is changing rapidly at a young age and worries about his ability to take the medication every day at the same time.
He is very openly worried when the pharmacist starts to counsel on the new medication
Facts:✔ The patient has never used this medication before✔ The patient is not confident that he will be able to take a medication every day without
forgetting✔ The patient is concerned about his quality of life now that he has a new diagnosis of diabetes
Patient Case #2
![Page 38: 9.13.21 Patient Counseling Lecture](https://reader030.fdocuments.in/reader030/viewer/2022012716/61aeeb0741a15f4134021593/html5/thumbnails/38.jpg)
38
Let’s practice!
![Page 39: 9.13.21 Patient Counseling Lecture](https://reader030.fdocuments.in/reader030/viewer/2022012716/61aeeb0741a15f4134021593/html5/thumbnails/39.jpg)
Adopted with permission from: Heidi Eukel, PharmD School of Pharmacy, College of Health Professions, North Dakota State University
Patient Case #2
• What attitude(s) is this individual demonstrating? How is it different than the individual in patient case #1?
• What went well in this encounter?• What are other strategies for working with individuals that
are demonstrating this attitude?
![Page 40: 9.13.21 Patient Counseling Lecture](https://reader030.fdocuments.in/reader030/viewer/2022012716/61aeeb0741a15f4134021593/html5/thumbnails/40.jpg)
J.B., a 16 year old female, is picking up 4 prescriptions – an oral contraceptive, a topical acne medication, an antibiotic for her newly-diagnosed gonorrhea, and an anti-anxiety medication. Her mother has called ahead and paid for her prescriptions so the pharmacist is asked to counsel the patient on all 4 new medications.
J.B. is extremely distracted by the use of her cell phone. She is talking on the phone, texting, and taking selfies constantly while waiting for the pharmacist. Prom is tonight so she has also picked out some condoms from the OTC area. She becomes very embarrassed when the pharmacist discusses the medication for her gonorrhea
Facts:✔ The patient has never used ANY medications before✔ There are 4 other patients in the pharmacy waiting for the pharmacist✔ The pharmacist has a call on hold on line 2
Adopted with permission from: Heidi Eukel, PharmD School of Pharmacy, College of Health Professions, North Dakota State University
Patient Case #3
![Page 41: 9.13.21 Patient Counseling Lecture](https://reader030.fdocuments.in/reader030/viewer/2022012716/61aeeb0741a15f4134021593/html5/thumbnails/41.jpg)
41
Let’s practice!
![Page 42: 9.13.21 Patient Counseling Lecture](https://reader030.fdocuments.in/reader030/viewer/2022012716/61aeeb0741a15f4134021593/html5/thumbnails/42.jpg)
Adopted with permission from: Heidi Eukel, PharmD School of Pharmacy, College of Health Professions, North Dakota State University
Patient Case #3
• What attitude(s) is this individual demonstrating?• What went well in this encounter?• What are other strategies for working with individuals that
are demonstrating this attitude?
![Page 43: 9.13.21 Patient Counseling Lecture](https://reader030.fdocuments.in/reader030/viewer/2022012716/61aeeb0741a15f4134021593/html5/thumbnails/43.jpg)
Summary
1. Introduce yourself and your role2. Build rapport with the patient3. Gather additional information and ask questions to help make
patient-specific recommendations 4. Listen to and engage with the patient respectfully5. Ask open ended questions throughout your conversation6. Keep counseling organized using your 3 prime questions7. Be mindful of the patient’s demeanor and respectful of their needs8. Convey appropriate body language and non judgmental attitude
towards the patient9. Wrap up by having them “teach back” what they learned. Ask specific
questions during “teach back”10. Answer patient’s questions
![Page 44: 9.13.21 Patient Counseling Lecture](https://reader030.fdocuments.in/reader030/viewer/2022012716/61aeeb0741a15f4134021593/html5/thumbnails/44.jpg)
44
Questions?