Wednesday, January 6, 2016 The Nugget Newspaper, Sisters, Oregon
15
New approach to medication counseling highly effective
By David Stauth
Oregon State University
CORVALLIS – It takes
about one minute longer, but
pharmacists who employ
an unconventional, interac-
tive patient counseling tech-
nique can more than double
the chance that people will
properly take, understand and
manage their use of prescrip-
tion drugs.
A new study just published
in the Journal of the American
Pharmacists Association pro-
vides compelling evidence
that this technique could sig-
nificantly improve the under-
standing of drug use and
storage, possible side effects,
what to expect from a medica-
tion and what to do if some-
thing isn’t working.
“This approach to prescrip-
tion drug counseling has now
been shown to be a dramatic
improvement over conven-
tional methods,” said Robert
Boyce, director of pharmacy
services in the Student Health
Center Pharmacy at Oregon
State University, and corre-
sponding author on the study.
“This is the first real analy-
sis to prove that it works,
and that the approach could
be extremely important for
health care in America.”
Historically, pharma-
cists who provided patients
with information about their
prescription medications —
when that was done at all —
most often used what was
called a “lecture format,”
essentially a one-way form of
communication that was often
referred to as reading off the
label. The efficacy of this sys-
tem varied widely, and gave
little assurance that patients
had heard and understood a
range of details about the drug
they were preparing to take.
By contrast, Boyce co-
developed an alternative
approach during a 21-year
career with the Public Health
Service pharmacy program
of the Indian Health Service,
a federal health program
for American Indians and
Alaskan natives. It empha-
sizes a questioning of patients
about the drug they have been
prescribed, and answers ques-
tions about whatever they
don’t understand. It’s a dis-
cussion, not a presentation.
The concept, Boyce said,
was released in 1991 to every
school and college of phar-
macy, and is now gaining
much wider acceptance across
the nation. This study, which
included a survey of 500 par-
ticipants at four community
pharmacies in Oregon, is the
first of its type to confirm the
value of the new approach. A
lead author was Naomi Lam,
a pharmacy resident at the
OSU Student Health Center
Pharmacy at the time of the
research.
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 new study found that
71 percent of patients using
the new counseling approach
could answer all three ques-
tions correctly, compared to
33 percent of patients who
were instructed with the con-
ventional 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 under-
stood 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 phar-
macists to use the new coun-
seling 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 man-
dated pharmacist counseling
for Medicare patients receiv-
ing new prescriptions, phar-
macist counseling was quite
variable, and often not done
at all.
Since that time, all but
three states in the country
have enacted laws that require
patient counseling on medica-
tion, or an offer to counsel, be
made available. As a result,
the activity of counseling is
far more common. The alter-
native system being proposed,
however, has the ability to
take such counseling and
make it far more effective,
Boyce said.
“This approach to counsel-
ing 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 expe-
rience side effects, they know
better how to handle it and
when to contact their doctor
or pharmacist.”
The conversational, inter-
active approach also becomes
highly favored by patients
once it is implemented,
Boyce said. People better
remember what they heard
and discussed, feel as if they
are being listened to, and they
appreciate the attention, he
said. Gaps in understanding
are addressed during the con-
versation and before moving
on to the next question.
Some common sense con-
cerns can also be immediately
identified with this format,
which may be less obvious
in conventional counseling.
A patient may have hearing
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problems; language barriers;
or cognitive circumstances
that must be considered. An
immediate understanding of
that can significantly improve
the level of communication.
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.
— Robert Boyce
Previous research has
shown that when people do
not understand the proper use
of their medications, adher-
ence 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 by
both doctors and pharmacists.
The study suggested that
additional research with more
groups be done to verify the
value of the new system.
It also outlined stages of
improvement as pharmacists
adapt to the new approach,
become more comfortable
with it and increase both their
speed and communication
effectiveness.
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