Counseling in Community Pharmacy

Zach Bratek
November 28, 2011
Filed under Campus Life

While the pharmacy education system has adopted a 6 year doctoral program focused on patient centered care, a majority of pharmacists have little opportunity to utilize their clinical knowledge working for retail giants for whom product sales is the principal concern.

Is our current pharmacy model to blame for this trend? We see drug related injuries and deaths which potentially can result from the patient’s lack of knowledge about their medication. Pharmacists are only required by law to counsel for new patients, new medications for a patient, or a change in strength, dose, directions or route of administration. If more time was spent with each patient, we might improve medication utilization and improve patient outcomes.

One major issue that needs to be addressed is a lack of pharmacist-patient interaction. Patients are often treated like customers and rushed through the process of receiving their medication. As future pharmacists, we need to realize that while counseling all patients is not required, it should be utilized much more frequently than it currently is.

A recent study concluded that only 63% of new patients were given adequate counseling, and this number decreased with increased busyness. While the pharmacist is only legally required to counsel a patient in certain circumstances, it should become second nature to monitor medication utilization and communicate with the patient. This doesn’t only require talking to the patient while they’re at the counter, but also reviewing their medication history, checking for potential medication related problems and informing the patient of such.  We should not rely on legal backstops such as tiny stickers on bottles to inform patients of potential concerns. By not taking the extra time to counsel, we are doing both an injustice to our patients and failing to meet our professional responsibilities.

While it is the responsibility of the pharmacist to counsel patients, there are some factors which may limit their ability to do so. A lack of patient based information may cause a pharmacist to feel less comfortable counseling. In order to properly prevent medication related problems, a pharmacist should have access to lab values and other medical information which could aid in the counseling process. By making this information computer based and readily available, we could increase the amount of counseling pharmacists perform.

The pharmacy system has become much less personal with the incorporation of time saving systems. For example, the on-screen checkout allows patients to easily bypass any communication with a pharmacist when receiving their medication.  Regardless of a patient’s level of intelligence, they might not fully understand the medications they are taking and the potential consequences which could arise. While technology such as this is a great way to reduce waiting time for the patient, it also might make a pharmacist feel less obligated to counsel.

Studies have shown that patients are typically most curious about the adverse effects of the medications they take. By allowing them to interact with a screen instead of a pharmacist, we are possibly leaving them uninformed about the possible risks of their medications. Adequate counseling by the pharmacist would leave the patient better informed and more prepared.

With the current problems of the pharmacy practice, several solutions need to be implemented in order to rectify this situation. While pharmacists are educated on counseling during their schooling, we are not trained on how to deal with the sometimes overbearing amount of prescriptions that need to be filled on a daily basis.

By teaching students how to properly manage their staff’s use of time, pharmacists would be able to spend more time educating patients. Additionally, the incorporation of universalized patient medical records would allow pharmacists to have up to date information about patient’s health concerns. This system would put pharmacists on an even playing field with physicians as to the reasons why a patient is on a current medication regimen.

Even with our knowledge of medications and disease states, the pharmacist’s role has predominantly become that of prescription validation.  Statistics have shown that some pharmacists are not counseling as frequently as they need to be.  Pharmacists who pump out medications are rewarded, while those who take the time to interact and educate their patients are often times not. We need to change this way of thinking if future pharmacists are to act more like medical professional and spend more time caring for their patients.

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