INTRODUCTION:

Linked requirements have been present all across the world for the past four decades. A concerted effort has been made to change the perception of patient counseling as a component of pharmaceutical therapy. From its initial concentration on medicine supply in India, the pharmacy profession has shifted to patient care. As a developing country with over a thousand modern pharmaceutical practices, India holds a significant obligation to ensure suitable care for many lakh people. The country is confronted with numerous innovative and safe medication therapies that are both cost-effective and socially challenging in terms of disease burden and limited commitment¹. The distinction between a positive and bad pharmacotherapeutics². Patient counseling and patient-pharmacist interaction are clearly regarded as important aspects of the pharmacist's profession nowadays. The most important job of patient counseling is seen as improving patients' quality of life and delivering great care. The patient's understanding of the therapy, including correct use and adverse effects of the medicine, is assessed; patient compliance is enhanced, and the patient is motivated to take an active role in health management, all as goals of patient counseling. It has been shown in studies that patient counseling improves patient care in a variety of ways³.

COUNSELLING FOR PATEINT’S GOAL:

The significance of medication in the patient's overall health must be understood. A professional connection that allows for ongoing engagement and consultation must be built. A better understanding of how to deal with prescription side effects and drug interactions is important for patients. During disease treatment and self-care management, the patient is made an informed, efficient, and active participant. Medication interactions and hazardous drug reactions should be avoided, and the pharmacist should be seen as a professional who provides pharmaceutical care⁴.

Potential Pharmacist Benefits:

In the eyes of patients and other healthcare providers, higher professional status is held by you. A vital component of patient care that cannot be replaced by technicians or technology is created. Job satisfaction is improved because of better patient outcomes. A service that adds value to the patient's experience is provided. Payment for counseling services generates revenue, which is currently minimal but expanding.

The patient should be able to:

Recognize why a prescription drug is helpful for sustaining or boosting well-being because of a properly executed counseling contact.

Accept the healthcare professional's help in building a working connection and laying the groundwork for ongoing engagement and consultation.

Develop the ability to make more informed decisions about medication compliance and adherence.Improve coping methods for dealing with stress.⁵

Pharmacist Characteristics:

Listen attentively: Counselling is seen as a collaborative effort. Close attention must be paid by the pharmacist to the patient, with both verbal and nonverbal communication being tracked. This behavior allows the pharmacist to assess the patient's understanding of their ailment and drugs.

Be adaptable: The pharmacist should be adaptable, with advice and information being provided that is customized to the specific requirements and capabilities of each patient.

Show empathy: The patient's personal suffering and situation should be tried to be understood by the pharmacist, as if it were their own problem.

Be non-judgmental: A patient's behavior should not be criticized based on their ailment or the group to which they belong.

Be compassionate: Patients may become irritated, irrational, or aggressive during counseling sessions. The patient's feelings should be recognized and tolerated by the pharmacist.

Speak with assurance: Assurance should be spoken by the pharmacist, as this will increase the patient's acceptance of the pharmacist's recommendations.⁶

CONSULTATION WITH THE PATIENT:

A. Patient Counselling While Prescribing:

Figure 1-Patient Counselling

The consultation is an important part of the prescribing process, and awareness of its significance and effective use in improving practice should be maintained by the prescriber. A wide range of practical abilities is required during the consultation.

Interpersonal skills are defined as the capacity to communicate with patients and establish relationships with them.

Reasoning abilities are described as the ability to obtain relevant information, interpret it, and apply it to diagnosis and treatment.

Practical abilities include the capability to conduct physical examinations and use clinical instruments.⁷

B. Disseminating Information About Treatment Risks and Benefits

When it comes to drugs, communicating the dangers and advantages of treatment is crucial. This is because many drugs are used over long periods to treat or prevent chronic diseases, but it is known that they are not always taken as prescribed. For example, medicines used to treat hypertension do not always appear to have a substantial therapeutic effect on patients' symptoms.

A well-informed patient is more likely to adhere to therapy, leading to a reduction in wasted healthcare resources, such as professional time and dispensed but unused medications. Communicating risk is not easy, as many diverse aspects and inherent uncertainties must be taken into account. Patients' risk assessments are primarily influenced by emotions, opinions, and values rather than facts.

The ability to convey risks and benefits to patients in a way that allows them to understand the risks as fully as possible is required of healthcare practitioners. It is also advisable to inform patients that nearly all treatments involve some degree of risk and that a trade-off between benefit and risk is almost always present.

When risks and benefits are described to patients, the following guidelines should be considered: Patients' risk assessments are largely influenced by emotions rather than facts. The trade-off between benefits and drawbacks should be explained. The use of solely descriptive risk phrases, such as "low risk," should be avoided.

C. Procedures for Conducting a Medication Interview with a Patient:

1. Greetings and the Interview’s Purpose:

The patient should be greeted, and introductions should be made by the pharmacist. Small talk should be used to help the patient feel at ease. The purpose of the session, along with the benefits for the patient, should be stated. Assurance should be given to the patient that the information obtained will be kept confidential.

2. Gathering Basic Information:

Basic information, including full name, address, phone number, birth date, all regular healthcare providers, insurance details, and occupation, should be gathered.

3. Health History of the Patient:

All current and past medical issues, including symptoms and the duration of the illness, should be discussed with the patient. If the patient is a woman of childbearing age, questions about pregnancy or lactation should be asked. It is important to determine whether any allergies exist and what type of reaction occurred upon exposure to the drug⁷.

4. Use of Prescription Medications:

Each of the medical conditions listed above should be addressed individually. The patient should be asked to provide a list of all current medications being taken, including the name, strength, prescriber, dosage form, route of administration, and dosing schedule. Additionally, information should be gathered on how well the prescribed regimen is followed, the patient's perception of the medication's effectiveness, any adverse effects experienced, and the steps taken to manage them.

5. Non-prescription Medicine Use:

The patient should be asked to provide details on the use of all nonprescription products, including over-the-counter medications, nutritional supplements, and herbal remedies. Since patients often have difficulty recalling these products and their usage, prompters may be used by the pharmacist, such as asking about major product categories individually.

6. Life-Style Questions:

It is best to reserve questions regarding lifestyle habits and recreational drug use for the conclusion of the interview, once the patient has become familiar with the pharmacist and the process. An explanation should be provided that the use of these products can influence drug therapy and that a clear understanding of their extent is essential for delivering the best possible care. The patient should be reassured that this information will be kept confidential. The option to decline providing this type of information should be made available to the patient. Questions should be asked about the patient's use of tobacco, alcohol, and recreational substances.

7. Closing the Interview:

Once the systematic collection of information has been completed by the pharmacist, the patient should be given the opportunity to provide any additional information or ask questions. It should be emphasized that all gathered information will remain confidential unless sharing it with another healthcare practitioner is necessary for patient care. Time will be needed to analyze the data and develop any recommendations for the patient. A follow-up appointment should be arranged for this purpose. The patient should be thanked for taking the time to complete the questionnaire.^8,9

D. Advise Patients on the Use of Prescription Refills:

Whether the patient is starting a new drug or refilling an existing prescription, the core elements of a patient counselling session remain the same. During a counselling session for a refill, however, the focus of the talk is different. The following three areas should be addressed at a refill counselling session:

It should be verified that the correct drug is being taken by the patient and that the indications are understood. The drug should be shown to the patient to ensure that there has been no mix-up with another prescription. The patient's medication usage should be inquired about, which will reveal whether the prescribed treatment plan has been followed. Drug profile information should be reviewed to provide additional evidence of the patient's compliance. It should be confirmed whether the patient has returned for a refill at the correct time and whether the patient is certain about how the medication has been taken. Appropriate medicine use should be praised, and support should be provided to help the patient overcome any concerns that have hindered adherence to the regimen.

The patient's response to the drug should be inquired about. The benefits of taking the drug should be identified, and any issues arising from the medication should be discussed. It should be determined how the patient has dealt with these issues. Viable solutions should be provided for any problems that have not been addressed. The patient should be reminded of the advantages of continuing the medication, and the proper follow-up procedures for monitoring the patient's condition should be confirmed. ¹⁰

E. Counselling Techniques for Patients with Barriers:

There are two types of patient barriers: functional and emotional.

Functional barriers occur when a patient has difficulties receiving and understanding the pharmacist's communication. Examples of this type of barrier include low literacy, hearing or vision disabilities, and non-English-speaking patients. Functional barriers can be divided into four subcategories:

1. Sensory impairments, such as vision and hearing loss.

2. Disparities in language, including low literacy and non-English speakers.

3. Problems with comprehension, such as psychiatric disorders, mental retardation, and dementia

4. Cultural barriers to communication, which were explored earlier in the chapter under alternative health ideas.

To improve counselling, the following suggestions should be considered:

Rephrase or carefully repeat information when necessary; speak slowly and face the patient.

Reassure the patient as needed.

Ask for feedback from the patient to assess their level of understanding.

Keep the communication simple and avoid jargon.

Prioritize the information to be given, stressing the most important points, and break the information into small segments.

Use associations to daily activities whenever possible, and engage in a conversation.

F. Children and Adolescents Counselling:

Ten guiding principles for teaching children and adolescents about medicines were produced by the USP Paediatrics Advisory Panel and its Ad Hoc Advisory Panel on Children and Medicines. These principles promote activities that enable children and adolescents to take an active role in their own health, particularly regarding medication use.

Ten Guidelines for Teaching Children and Teenagers about Medicines

1. A right to adequate information about their medicines that matches their health situation, capacities, and culture as users of medicines should be afforded to children.

2. Children's drugs should be discussed directly with healthcare providers and educators, as children are curious.

3. The interest of children in drugs should be encouraged, and they should be taught how to ask questions about medicines and other therapies to healthcare practitioners, parents, and other caregivers.

4. Proper medication use should be modeled for children by parents and other caregivers, as children learn by observing their elders.

5. A progressive transfer of responsibility for medication use, taking into consideration parental responsibilities as well as the child's health and skills, should be seen by children, their parents, and their healthcare providers.

6. Medical education for children should include both what children need to know about drugs and what health professionals believe they should know.

7. As part of their school health education, the fundamentals of medicine and how to use them properly should be learned by children.

8. Information about the general use and misuse of medicines, as well as the specific medicines the child is taking, should be included in children's medicine education.

9. Information that will help children avoid becoming poisoned due to medication usage should be provided to children.

10. Adequate information should be received by children invited to participate in clinical trials (with their parents' permission) to help them understand what they are doing. ¹¹

PATIENT COUNSELLING OBSTACLES:

A. Emotional Considerations:

Patients with a changed state of mind due to fear of illness, out-of-pocket expenses, work and business interruptions, and so on should be considered. Other factors, such as uncertainty about what to expect with a new illness or symptom, reliance on providers to offer the best treatment, and dependence on family to assist with day-to-day tasks, should also be acknowledged. Fear of change and death, pain and discomfort, lack of privacy during physical examinations, and loss of identity as a healthy person (which may sound strange but is largely true) should be taken into account. Social support is likely to lead to greater trust or more favorable responses toward another individual. ¹²

B. The Pharmacy Setting:

Many community pharmacies do not have a dedicated room for private counselling and discussion between the pharmacist and the patient. In addition to the lack of privacy, other obstacles to meaningful engagement with patients are frequently faced by pharmacists, such as:

A lack of supportive people.

A significant workload and backlog.

People waiting for their medicines to be filled or for pharmacist assistance.

Incoming phone calls and coworker requests for information or assistance.

Interns and other employees.

Inadequate computer hardware, software, and services.¹³

BARRIERS TO COMMUNICATION AMONG PHARMACISTS:

Nervous movements or "fidgeting," crossed arms or legs, turning or leaning away from the patient, failure to maintain eye contact, and obvious distractedness are examples of inappropriate nonverbal behaviours that may be exhibited by pharmacists who are uncomfortable interacting with patients or who have had little training in patient interaction. The following impediments to successful communication have also been mentioned by pharmacists:

1. Lack of time.

2. Financial concerns.

3. Poor communication skills or a lack of confidence in those skills.

4. Lack of information about current drugs or medical history, as well as the patient's failure to value the counselling session or pharmacist expertise.

Lack of time and financial constraints in patient counselling can be overcome by the expansion of technical employees' roles to relieve pharmacists of dispensing responsibilities, allowing more time to be spent with patients. The patient's lack of appreciation for the usefulness of a pharmacist consultation can be addressed by publicizing the service and personally offering the consultation to each patient, along with a brief discussion on the importance of the process in enhancing patient medication therapy outcomes.¹⁴

TACTICS OR OVER COMING BARRIERS:

The following strategies can be used to overcome patient-based barriers through the use of a variety of materials:

1. Pictograms, which are symbols used to represent something.

2. Adherence aids.

3. Oral and written information.

4. Schedules for follow-up.

5. Tapes with audio and video.

^6.Prescription instructions that are created to be unique to the patient.¹⁵

Counselling Approaches:

A variety of techniques can be used to provide good counseling. Some of these techniques include the giving of written information to the patient and the use of customized materials. Labeling, medicine, a drug reminder chart, and the provision of customized medication containers and closures are some of the compliance aids that might be used. The following four stages of medication counseling are defined by behavior standards for medication counseling:

Stage 1: Medication information transfer, in which basic, brief information about the safe and proper administration of medicine is offered through a pharmacist's monologue.

Stage 2: Medication information exchange, during which questions are responded to by the pharmacist and specific information tailored to the patient's needs is provided.

Stage 3: Medication education, which is a collaborative, interactive learning experience in which complete information about the proper use of medicines is given by the pharmacist.

Stage 4: Drug counseling, in which a thorough discussion is held between the pharmacist and the patient, with the goal of providing advice that improves problem-solving abilities and aids in the proper management of medical problems and medication use.¹⁶

Patients who should be Counselled at all Times:

1. Patients and their caregivers who are perplexed

2. Patients who are deaf or hard of hearing.

3. Patients who are illiterate.

4. Patients with a medication change in their profile.

5. Patients receiving medication that requires special storage or has difficult administration.

6. Medication given to both children and parents.

7. Patients who are new to a medicine or who are receiving it for the first time.

Patients that need to be Counselled at Regular Periods Include:

Prescription and monitoring with the goal of increasing drug efficiency, reducing drug toxicity, and increasing cost-effectiveness are carried out.

Drugs with a narrow therapeutic index are therapeutically monitored.

Drug information is provided by the provider.

Customer service is delivered.^17,18

PHARMACIST’S ROLE:

Prescriptions and monitoring are done with the goal of increasing drug efficiency, reducing drug toxicity, and increasing cost-effectiveness.

Drugs with a narrow therapeutic index are subjected to therapeutic drug monitoring.

Drug information service is provided.

Service is provided to patients for collecting historical medical history to improve patient compliance. ^19,
20

SOME COMMON DISEASE COUNSELING ²³

Coronary Heart Disease ²¹:

The goal of treatment, as with other chronic diseases, is to reduce mortality, morbidity, and the associated decline in quality of life. The management of this chronic illness can be assisted in various ways by a pharmacist. The key points for drug counseling in coronary heart disease are outlined below.

Beta Blockers:

Hypotension, dizziness, headache, and bradycardia should be monitored. Information regarding the risk of nocturnal dreams and CNS issues should be provided to the patient. Before discontinuation of the drug, the necessity of tapering the dose should be explained.

Nitrates:

The sublingual route of administration should be followed, and sublingual tablets should not be chewed or crushed. Transdermal patches should be used correctly, and patients should be advised not to stand up suddenly after taking the medication. Signs of bluish lips, fingernails, or palms should be carefully observed²².

Aspirin:

The patient should be encouraged to take the medication with a meal. Symptoms such as abdominal pain, tarry stools, fever, and blood spitting should be monitored. If the pills are enteric-coated, patients should be advised not to crush or chew them²³.

Asthma:

Asthma is a chronic illness that requires lifelong medication use. Self-monitoring of drug therapy, lifestyle modifications, and proper medication use should be supported by the pharmacist.

The use of metered-dose inhalers, dry powder inhalers, spacers, and other customized dosage forms should be explained.

Non-Pharmacological Interventions:

Travel safety, prophylactic medicine use before exercise, avoidance of allergies, and smoking cessation should be emphasized. Education on nutrition, smoking, and exercise should be provided, and patients should be encouraged to maintain a journal of their anginal attacks, pain symptoms, and other related symptoms.

Pharmacological Interventions:

The involvement of patients in asthma management is considered critical. Drug therapy advice should be focused on three areas: pharmaceuticals used to relieve symptoms, drugs prescribed to prevent asthma attacks, and medications administered solely as a last resort for severe episodes. One of the most significant duties of the counselling pharmacist is to ensure that training on the proper use of metered-dose inhalers is provided.

The following is a list of some pharmaceutical measures that should be considered when counselling these patients. One of the most essential responsibilities of pharmacists is to ensure that patients are educated on the use of nitrates during an acute angina episode. The following is a list of some of the most important pharmacological metrics to be considered.

ROLE OF THE PHARMACIST IN THE DRUG CATEGORY:

Beta Receptor Agonists:

Short-acting medications in this category should primarily be used for symptom relief. Patients prescribed long-acting medications should be informed that the medication may take time to take effect.

Theophyllines:

Sustained-release medications should not be crushed or chewed.

Anticholinergics:

Symptoms such as dry throat, nausea, headache, impaired vision, and uncomfortable urination should be monitored.

Corticosteroids:

These medications should be used regularly and should not be stopped abruptly.

Mast Cell Stabilizers:

Patients should be informed that this drug is used for prevention. It does not relieve bronchospasm that has already started and does not prevent asthma attacks.

Diabetes:

It is recognized as a long-term condition that affects glucose, lipid, and protein metabolism. The quality of life of diabetic patients is known to be impacted by chronic diabetes complications. Various aspects, such as patient understanding of the disease, dietary control, and blood glucose self-monitoring, are considered important in diabetes management. Patient counseling and education have been shown to enhance the quality of life through both non-pharmacological and pharmacological interventions.²⁴

Non-pharmacological Approaches:

An overview of diabetes, stress, psychosocial adjustment, family engagement, social support, nutrition, exercise, and activity can be provided by the pharmacist. The relationship between nutrition, activity, medication, and blood glucose levels, as well as the monitoring and utilization of results, should be explained.

Pharmacological Interventions:

Studies have shown that tight glycemic control can prevent diabetic complications (The Diabetes Control and Complications Trial Study Group). Sulfonylureas should be taken half an hour before eating, and insulin therapy should be administered with caution to prevent hypoglycaemia. The main pharmacological measures that should be emphasized when counselling diabetes patients are outlined below.

ROLE OF THE PHARMACIST IN THE DRUG CATEGORY:

Methods for preventing, identifying, and treating hypoglycemia should be described.

Symptoms of jaundice should be monitored.

The administration time concerning food and the need for abstinence from alcohol should be discussed.

Insulin:

Hypoglycemia prevention, identification, and treatment should be explained.

Patients should be educated on improved insulin administration techniques and optimal insulin storage conditions.

Metformin:

Assistance should be provided to ensure that the medication is taken with or after food.

Symptoms such as muscle soreness, unexplained tiredness, nausea, stomach pain, and weight loss should be monitored.

Hypertension:²⁵

Though hypertension is not classified as a disease, it is recognized as a risk factor for various complications that can result in end-organ damage. If not controlled, a significant negative impact on quality of life can be observed. The management of hypertension requires both non-pharmacological and pharmacological approaches.

Non-pharmacological Measures:

In many cases, the control of hypertension can be achieved through nonpharmacological treatment. Patients can be advised by pharmacists on topics such as weight loss and regular exercise, sodium and calorie restriction, limiting saturated fat intake while increasing dietary fiber consumption, alcohol restriction, smoking cessation, caution when using cold remedies containing sympathomimetics, and blood pressure self-monitoring.

Pharmacological Measures:

Drug therapy is required for most patients. Hypertension is often misunderstood by those affected, as it typically does not cause major symptoms on its own. As a result, noncompliance has become increasingly common. Additionally, many antihypertensive medications are associated with significant adverse effects, such as cough caused by ACE inhibitors and bradycardia caused by beta blockers. In certain cases, drug dose adjustments are also crucial. Some of the pharmaceutical interventions that should be implemented during patient counselling are outlined below.

CONCLUSION:

Patient counselling is a vital component of healthcare that empowers individuals to take an active role in their health management. Through effective communication and education, pharmacists and healthcare professionals can significantly improve patient outcomes, adherence, and quality of life. By addressing individual needs, concerns, and barriers, patient counselling fosters a collaborative relationship between healthcare providers and patients. Ultimately, patient counselling is essential for optimizing medication therapy, preventing adverse events, and promoting overall well-being. By prioritizing patient counselling, we can create a more patient-centred, effective, and compassionate healthcare system."

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Received on 11.06.2025 Revised on 25.07.2025

Accepted on 01.09.2025 Published on 15.10.2025

Available online from October 30, 2025

Research J. Science and Tech. 2025; 17(4):279-287.

DOI: 10.52711/2349-2988.2025.00039

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