Effective and/or Efficient Ways to Counsel Patients

[PharmDstudent]

If I go into retail pharmacy, which is still a possibility, how can I counsel the majority of patients? I've been thinking about using different bins for scripts that need counseling, stamps, stickers, notes to remind myself, etc.
Your hints and suggestions would be greatly appreciated. If I can't figure this out before I graduate, I'll probably drop the idea of becoming a retail pharmacist altogether, because I can't stomach the idea of scrutinizing pills day in and day out all day long for eternity.

Thanks y'all.

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[RxWildcat]

Have you worked retail before? Usually you will place a sticker or marker with the filled rx that states the pt has to have mandatory counseling before the rx is sold to them.

 

[PharmDstudent]

Have you worked retail before?

Yes. Roughly three years so far.


Let me clarify my problem: retail environments are super busy and sometimes it doesn't seem possible to counsel patients. (I don't want to make things worse by being the "slow" pharmacist who can't work efficiently, because I'm too worried about counseling patients, which could lead to a mismanagement of other parts of the pharmacy.)

The way that they teach patient counseling in school is how I would like to do it, even though it seems idealistic. There are so many easy ways to give out drug information, but the pharmacists that I've worked with so far seem to have an aversion to it.

Maybe I could stamp something like --> "Take with a full glass of water", "Avoid antacids", "May cause drowsiness", or "Take on an empty stomach" on the front of the leaflet in bold letters, highlight information in the leaflets, or well... I don't know what else I would do.

How are pharmacists accomplishing patient consultations while verifying scripts, answering phone calls, checking interactions, and messing around with insurance?

 

[MaseratiGT]

Yes. Roughly three years so far.


Let me clarify my problem: retail environments are super busy and sometimes it doesn't seem possible to counsel patients. (I don't want to make things worse by being the "slow" pharmacist who can't work efficiently, because I'm too worried about counseling patients, which could lead to a mismanagement of other parts of the pharmacy.)

The way that they teach patient counseling in school is how I would like to do it, even though it seems idealistic. There are so many easy ways to give out drug information, but the pharmacists that I've worked with so far seem to have an aversion to it.

Maybe I could stamp something like --> "Take with a full glass of water", "Avoid antacids", "May cause drowsiness", or "Take on an empty stomach" on the front of the leaflet in bold letters, highlight information in the leaflets, or well... I don't know what else I would do.

How are pharmacists accomplishing patient consultations while verifying scripts, answering phone calls, checking interactions, and messing around with insurance?

At the pharmacy I work at, we use little stickers that have that information printed on them. We also use these 'tags' that stick out of the bags that let the techs know that counseling is mandatory.

As for the phone and insurance...get seasoned CPhT's to help you out. A really well trained head CPhT can handle a lot of your day to day business that is required.

 

[bananaface]

Have you worked retail before? Usually you will place a sticker or marker with the filled rx that states the pt has to have mandatory counseling before the rx is sold to them.

I have worked for 6 different retail employers and only one had stores that used that sort of system.

 

[Pharmavixen]

Where I practise, pharmacists are legally required to counsel all new rxs. So pharmacy software programs print up something you can staple to the bag that provides a quick and easy place for the pharmacist to document the counselling, and afterwards you rip it off and toss it into a bin that the tech eventually files with the original rx.

We don't have to counsel on refills so we don't.

Often counselling consists of, "Have you taken Oxycontin before?"

"Of course!"

"Okay; you have a good day!"

 

[pharmdinfl]

I covered a shift at a store where the pharmacist had a great system worked out. At home, in his spare time, he typed out counseling points for things that require counseling often times such as warfarin. They are small strips of paper with important FYI material (i.e. "clinical pearls") and he has a bucket full of them filed according to the medication. He staples them to the fronts of the patient leaflets and that signifies to the techs that the patient requires counseling.

He'll then counsel the patient on the info that's on the paper strip b/c that way the person has an opportunity to ask questions that may arise, but what's great is that often times what you tell a patient goes in one ear and out the other (especially if it's just a care giver/family member picking up the RX) - but since he has the most important tips on the strips of paper, the patient will have it at home later to reflect on.

 

[PharmDstudent]

Where I practise, pharmacists are legally required to counsel all new rxs.
...
We don't have to counsel on refills so we don't.
Often counselling consists of, "Have you taken Oxycontin before?"
"Of course!"
"Okay; you have a good day!"

Since CII medications are always new prescriptions in the US, they will always require counseling in Louisiana (even though some patients will be on certain types of narcotics forever, like Adderall or Fentanyl patches). "Have you taken _____ (CII medication) before?" sounds like a very useful question that I could see myself asking.
+1

 

[PharmDstudent]

I covered a shift at a store where the pharmacist had a great system worked out. At home, in his spare time, he typed out counseling points for things that require counseling often times such as warfarin. They are small strips of paper with important FYI material (i.e. "clinical pearls") and he has a bucket full of them filed according to the medication. He staples them to the fronts of the patient leaflets and that signifies to the techs that the patient requires counseling.

He'll then counsel the patient on the info that's on the paper strip b/c that way the person has an opportunity to ask questions that may arise, but what's great is that often times what you tell a patient goes in one ear and out the other (especially if it's just a care giver/family member picking up the RX) - but since he has the most important tips on the strips of paper, the patient will have it at home later to reflect on.

Thanks pharmdinfl! That sounds doable. It also seems like a more accurate way of counseling, because the information is specific to that medication (instead of a few general tidbits specific to a class of drugs) and written out. I have a knack for organization, so that kind of system is right up my alley.
+1

Now... Can you tell me a little bit about practicing pharmacy in Florida??? I plan on moving to Florida after I graduate in 2010.

 

[pharmdinfl]

Thanks pharmdinfl! That sounds doable. It also seems like a more accurate way of counseling, because the information is specific to that medication (instead of a few general tidbits specific to a class of drugs) and written out. I have a knack for organization, so that kind of system is right up my alley.
+1

Now... Can you tell me a little bit about practicing pharmacy in Florida??? I plan on moving to Florida after I graduate in 2010.

You're welcome. I was very impressed with his method because I could tell he really spent a lot of time working on the information sheets and he adds new info based on interactions with patients.

I would be happy to talk to you about practicing pharmacy in FL; do you have any questions in particular?

 

[PharmDstudent]

You're welcome. I was very impressed with his method because I could tell he really spent a lot of time working on the information sheets and he adds new info based on interactions with patients.

I would be happy to talk to you about practicing pharmacy in FL; do you have any questions in particular?

Yes.

I have a few questions in fact, which include: How do you like practicing pharmacy in Florida?, Which companies would you recommend working for? (retail, hospital, etc.), Do you see any potential for opening an independent pharmacy or a pharmacy-related business?, Where would you recommend living while working as a pharmacist?, and What would you do if your area has a hurricane warning?

Thanks.

 

[pharmdinfl]

Yes.

I have a few questions in fact, which include: How do you like practicing pharmacy in Florida?, Which companies would you recommend working for? (retail, hospital, etc.), Do you see any potential for opening an independent pharmacy or a pharmacy-related business?, Where would you recommend living while working as a pharmacist?, and What would you do if your area has a hurricane warning?

Thanks.

I work in the community pharmacy setting. As far as which company goes, I highly recommend checking out the companies in the summers in between pharmacy school. That will give you a chance to see first hand what you might like/dislike about the particular companies. That goes for both the community or hospital setting. In particular with community pharmacy, here are just a few factors I compared when choosing the company:

1. Hours - I was not interested in working more than 10 hour shifts. Any longer than that and I think I would be cross-eyed.
2. How efficient the computer system is
3. How much technician help would be available
4. Benefits in terms of vacation time, 401k, etc.

I really can't discuss independent pharmacy with you because I don't work in that environment. However, my husband is also a pharmacist and a good friend of his owns a VERY successful compounding pharmacy. He happens to be a very good businessman though who has no problems evolving as the profession changes directions.

I have only practiced pharmacy in FL so I can't really compare to anywhere else - but I haven't had any problems thus far. We do have hurricane season between June-November each year. Some years are more active than others. The pharmacies do get a lot busier when there is a threat of a hurricane. If they declare a state of emergency, what changes is according to FL law, we are allowed to give a 30-day emergency supply of medication. Other than that, it is business as usual....just a LOT more busier because everyone panics about not having access to meds.

I hope that information helps you at least some what.

 

[PharmDstudent]

pharmdinfl, What about location??? I wouldn't want to live too far south, but that's all that I can come up with right now.

 

[pharmdinfl]

pharmdinfl, What about location??? I wouldn't want to live too far south, but that's all that I can come up with right now.

I live in central FL (Brevard County area). It's MUCH less congested where I live than it is in south FL. There are still lots of pharmacies in my area as there are all over FL because we have a large population of elderly people who obviously take more medications in general than younger population.

I would recommend either central or northern FL just because it's less populated - but that's just me; I'm not into big cities and traffic.

 

[PharmDstudent]

I live in central FL (Brevard County area). It's MUCH less congested where I live than it is in south FL. There are still lots of pharmacies in my area as there are all over FL because we have a large population of elderly people who obviously take more medications in general than younger population.

I would recommend either central or northern FL just because it's less populated - but that's just me; I'm not into big cities and traffic.

I was thinking about central or northern FL too. I've been reading about FL on city-data.com, and someone was really disappointed with Lee county, so I'll have to find out more about the places that people like.

One last question. I promise! How can a young person like me avoid retirement communities? I like going to the VFW with my grandpa, but I wouldn't chose that sort of thing on my own. Everyone that I talk to says that I need to travel more so that I can get an idea of what I like and don't like, but there's no way that I could travel that much before I graduate. Is there anything that sticks out like a sore thumb in a retirement community? Are there any specific clues?
Thanks. *sigh of relief*

 

[pharmdinfl]

I was thinking about central or northern FL too. I've been reading about FL on city-data.com, and someone was really disappointed with Lee county, so I'll have to find out more about the places that people like.

One last question. I promise! How can a young person like me avoid retirement communities? I like going to the VFW with my grandpa, but I wouldn't chose that sort of thing on my own. Everyone that I talk to says that I need to travel more so that I can get an idea of what I like and don't like, but there's no way that I could travel that much before I graduate. Is there anything that sticks out like a sore thumb in a retirement community? Are there any specific clues?
Thanks. *sigh of relief*

Well, one thing that might stick out is the number of pharmacies in a particular area ....the more there are, chances are there are more elderly people in that area. The bigger cities in FL tend to have less seasonal residents just because the cost of living is higher - one of the big reasons we have a lot of elderly people here is we have no state tax and the homes in general were historically lower than the northeast.

That city-data website is pretty nice. There are forums on there that could be helpful as far as finding people to ask questions to that live in particular cities that stick out for you.

Good luck to you.

 

[PharmDstudent]

Thanks pharmdinfl!

 

[Old Timer]

How to counsel patients:

• Be brief
• Be concise
• Speak in a vocabulary your patient's will understand.

Place some kind on written note on the prescription bag indicating you wish to speak to the patient in those situations where counseling is not legally required but is required in your clinical opinion.

For example, when explaining that medication may cause drowsiness, I start with "NO drinking, NO driving and NO operating farm equipment". That usually breaks the ice for the conversation to start. Since I live in a city, most people get a chuckle and you develop a rapport that allows you to give them the information they need in a way they can assimilate it.

 

[PharmDstudent]

How to counsel patients:

• Be brief
• Be concise
• Speak in a vocabulary your patient's will understand.

Place some kind on written note on the prescription bag indicating you wish to speak to the patient in those situations where counseling is not legally required but is required in your clinical opinion.

For example, when explaining that medication may cause drowsiness, I start with "NO drinking, NO driving and NO operating farm equipment". That usually breaks the ice for the conversation to start. Since I live in a city, most people get a chuckle and you develop a rapport that allows you to give them the information they need in a way they can assimilate it.

I like that approach. I would never want to "lecture" someone about their medication.

I've developed a few different methods so far:
I try to figure things out before I talk to patients (mostly insurance stuff at this point). It's easier to answer questions when I know what I'm talking about.

Approach is very important to me. Depending on the patient, a little comedy can go a long way. Wittiness is useful too, because patients know that I'm engaging with them on a personal level when I don't use generic phrases. Old ladies usually want us to be sweet to them, so I'll use a softer tone if I think it will help.

I look at people when I talk to them even though I'm shy. It's not natural for me, but I let my guard down at work. Also, I can't always hear people due to music and other types of background noise, so if it's necessary, I'll rest my upper body on the counter when I speak to them. I would rather do that than yell.



My only problem, potential problem is more like it, is the pushy customers that are in too much of a hurry to wait in line behind someone who's being counseled. I can feel their pressure, and I don't like it. I doubt I'll have to worry about that too much if I'm the boss, but I would rather do it right and counsel the patient the first time than have someone call about diarrhea, rashes, nausea, etc.

 

[Me_Gusta_Drugs]

Good advice. I need advice not on HOW to counsel patients....but on WHAT to counsel patients. I have little retail experience, am a 3rd year student, and it seems like a good guide to follow, is the information packet that is printed up w/ each prescription. However there is too much information. So how do you take that information, and be concise and brief with it. How do you judge what is important, what to emphasize, what to leave out.

Does anyone have any websites, resources, documents to share on how to counsel patients in a retail setting. Some clinical pearls, or practical tips. And Im not talking those top 200 drug cards with patient counseling points, because using something like that isnt brief, concise, practical.....it is thorough

I think itd be great if there were a top 200 list for practical patient consultation points, emphasizing whats important for the patient, and what is just FYI

 

[Old Timer]

Good advice. I need advice not on HOW to counsel patients....but on WHAT to counsel patients. I have little retail experience, am a 3rd year student, and it seems like a good guide to follow, is the information packet that is printed up w/ each prescription. However there is too much information. So how do you take that information, and be concise and brief with it. How do you judge what is important, what to emphasize, what to leave out.

The patient is not going to remember everything you tell them, especially if you give them a doctoral dissertation. That's why it's important to give them written as well as oral information.

Give them the following:

The key facts about the medication.

• Antibiotics should be finished.
• Warfarin and drug interactions
• Storage information (Fridge vs Room Temperature)
• Dosage intervals (Does B.I.D. mean every 12 hours)
• Maximum dosage (Apap 4gm/day)
• Take with food or empty stomach.
• Things to avoid (Alcohol with Metronidazole or Sun and Tetracyclines)
• Common side effects.
• Need to continue chronic therapy.
• Read the insert and call with any questions.
• Review any drug interactions that do not require physician intervention, but patient awareness. (BC pills & certain antibiotics)

DO NOT go over the entire list of side effects. Know your patient. For example anti-muscarinic agents can cause prostate problems especially in older men. Warn of drowsiness with narcotics and older anti-histamines.

These are just some general guidelines. Unless your patient base is illiterate, you just highlight the key facts and point out the PPI and ask them to call with any questions.

 

[RxWildcat]

^^ And a surprising number of patients are illiterate!

 

[jpharmfarm]

My question is, how do we go about getting that bucket of information slips from that pharmacist you know?

 

[JJRAZ]

At school they taught us a method that is pretty fast and seems to work well to get the point across, it includes 3 basic questions.

1]What did the doctor tell you this is for?
-If they know move on to the next question, if not let the patient know

2]How did the doctor tell you do take this medication?
-If they know move on to next question, if not explain how to take

3]What did the doctor tell you to expect? (As far as side effects go as well as therapuetic outcomes)
-If they know great, counseling is finished.
-This is also the point in the counseling where you can throw in specific side effects of warnings you may want to advise the patient of.

I was certain this method would not go over well when I began to use this last fall, but it has proved to be very effective and efficient. Of course you can tweak the questions a bit so you don't sound like you are reading from a script.

 

[psurocks]

counseling is overrated, most pts dont care, all they care for is how much and how long

 

[RxWildcat]

counseling is overrated, most pts dont care, all they care for is how much and how long

Although this is true for some pts, it is still your duty to counsel the pt over important things about their medication.

 

[PharmDstudent]

At school they taught us a method that is pretty fast and seems to work well to get the point across, it includes 3 basic questions.

1]What did the doctor tell you this is for?
-If they know move on to the next question, if not let the patient know

2]How did the doctor tell you do take this medication?
-If they know move on to next question, if not explain how to take

3]What did the doctor tell you to expect? (As far as side effects go as well as therapuetic outcomes)
-If they know great, counseling is finished.
-This is also the point in the counseling where you can throw in specific side effects of warnings you may want to advise the patient of.

I was certain this method would not go over well when I began to use this last fall, but it has proved to be very effective and efficient. Of course you can tweak the questions a bit so you don't sound like you are reading from a script.

Yeah. We went over those too. Those are the "Three Prime Questions" from the Indian Health Services method.
http://www.pharmacytimes.com/issues/articles/2004-12_1755.asp

I think that method is too much for retail though. It could work in an outpatient clinic where time is not so much of an issue.

 

[pharmdinfl]

My question is, how do we go about getting that bucket of information slips from that pharmacist you know?

lol

 

[JJRAZ]

Yeah two of our teachers worked for IHS for 20+ years, and helped develop alot of those programs IHS uses today. I thought it was to much, I was used to seeing patients do the "brief lecture" method of counseling that was short and sweet, but surprisingly it does not take much longer and seems to work well, but might not work for everyone.

 

[Requiem]

Yeah two of our teachers worked for IHS for 20+ years, and helped develop alot of those programs IHS uses today. I thought it was to much, I was used to seeing patients do the "brief lecture" method of counseling that was short and sweet, but surprisingly it does not take much longer and seems to work well, but might not work for everyone.

I think it works well; I don't go into the little questions under each main one (like how did your dr tell you to store this med) - but the main probing ones are good. Especially for antibiotics, i.e good to differentiate UTI's from pneumonias, especially in terms of non-pharm therapies. If it's a new person and you're not sure about their knowledge, it's a good way to establish a first conversation. It if it's someone long term and you know them better, you can go accordingly.