Transcript Patient Counseling and Physician Interaction Skills

Communicating with Patients
and Providers
HIV Care and ART: A Course for
Pharmacists
Unit Learning Objectives
 Describe the team approach to HIV care and
treatment
 Explain basic principles and behaviors of ART
counseling
 List the 5 points that should be covered when
counseling a patient
 Describe essential steps in communicating with
an HIV-positive patient
 Demonstrate effective communication with
patients and providers
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Team Approach in ART
 Involves pharmacist or druggist, physician and
nurse working together towards comprehensive
patient care
 Involves information sharing between providers
and patients
 Ensures patient confidentiality
 May involve others (family members) as patient
chooses
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Objective of ART Counseling
 Pharmacists and druggists need to be able to
share information in order to work effectively
with patients, physicians and nurses
 On a professional level with physicians and nurses
 With an individual patient on a level that he/she can
understand
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Communicating with Physicians
and Nurses
 Begin by identifying yourself
 Identify the patient you are to discuss
 Present the issue or concern that you have
identified
 Do not be judgmental
 Use professional rapport to gain respect
 Be prepared to discuss the issue on a
professional level
 Propose a solution
 Await feedback
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Communicating with Physicians
and Nurses (2)
 You may not always have all of the answers to
the questions that follow
 Be comfortable saying that you do not know the
answer at the moment, that you will look into it
and get back to the provider as soon as you can
 The provider will respect that you provide only
information about which you are confident
 Over time, you will build a working relationship
with the physicians and nurses that you work
with
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Essential Counseling Points
when Communicating with Patients
 Assess readiness to start ART
 Identify barriers to success with ART, for example,
knowledge about ART, fears of side effects, financial
concerns, sustainability, non-adherence
 Work with the team to correct barriers before starting
therapy. Every patient has unique barriers to success
 Provide specific ART information
 Dosing, schedule, meal requirements, early and late
side effects, side-effect management, drug
interactions, storage requirements, efficacy
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Five-Point Counseling Summary
 Review 5 points for all new prescriptions:


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
Name of drug
Directions for use
Common or severe side effects
Significant drug interactions
Storage
 Ask patient to tell you how they will use the
medication
 Correct misunderstandings before they leave
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Counseling Points when
Communicating with Patients
 Review need for strict adherence
 > 95% adherence necessary for treatment success
(< 3 missed doses per month)
 Prevents resistance and treatment failure, which may
limit future treatment options
 Give patients specific examples of how to
remember to take their doses: for example,
when they brush their teeth or when they wake
up their children
 Assist patients in preparing for changes in their
routine: for example, vacation or visiting family
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Counseling Points when
Communicating with Patients (2)
 Review the need for ongoing clinical and
laboratory monitoring
 Success/failure of ART regimen
 Toxicities
• Detect ART side effects that the patient may not feel
• Evaluate symptoms
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Counseling Points when
Communicating with Patients (3)
 Assess adherence each time patients refill their
ART
 Ask “When did you last miss a dose?” rather
than, “Have you missed any doses?”
 Congratulate the adherent patient
 Identify the reason for missed doses and provide
possible solutions to avoid missing doses in the
future
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Counseling Points when
Communicating with Patients (4)
 If written information is provided, identify whether
the patient has any learning barriers such as low
literacy
 Use pictures to communicate information
 Indicate colors of the pills to familiarize patients with
their regimen
 Ensure written information is provided in patient’s
native language
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Counseling Points when
Communicating with Patients (5)
 Show patients their regimen before they start
ART
 Familiarize them with the medication and allow them
to express any concerns, for example, tablet or
capsule size
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Role Plays
Role Play Scenario
 A patient brings a prescription to the pharmacist
for stavudine + zidovudine + nevirapine
 Contact the patient’s physician to alert them to
the drug interaction between stavudine and
zidovudine and recommend an alternative
regimen
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Role Play Scenario (2)
 A patient comes to your pharmacy and through
your conversation with him you discover that he
meets the criteria for starting PCP prophylaxis
(he just completed treatment for PCP 2 weeks
ago). He is not currently taking Bactrim for PCP
prophylaxis
 Ask the patient if he has had Bactrim in the past
and try to find out if he has any drug allergies.
Then, contact the patient’s nurse/physician to
suggest that the patient be started on Bactrim
DS daily for PCP prophylaxis, if appropriate
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Role Play Scenario (3)
 A patient that you have gotten to know over the
past few months lets you know that he has been
losing weight lately. He has lost 5 kg and now
weighs 55 kg. You look at his medication record
and notice that he is taking stavudine +
lamivudine + nevirapine
 Contact the patient’s physician or nurse and ask
that the dose of stavudine be reduced from
40mg to 30mg BID
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Role Play Scenario (4)
 A patient comes to your pharmacy with new
prescriptions for:
 Stavudine
 Lamivudine
 Nevirapine
 He or she has never taken these medications
before
 Counsel the patient about these medications
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Role Play Scenario (5)
 A patient comes to the pharmacy and tells you
that he has been feeling itchy. He pulls up his
shirt and shows you a rash on his skin
 You look at his medication profile and see that
he started the following regimen 3 weeks ago:
stavudine + lamivudine + nevirapine
 You need to gather more information from the
patient to determine if the patient is having a
mild rash or a serious rash. Talk with him and try
to determine the severity of the rash
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Role Play Scenario (6)
 You have established that the patient discussed
in Role Play Scenario 5 has a mild rash
 Contact the patient’s nurse or physician and
pass on the information about the Nevirapine
drug reaction
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Role Play Scenario (7)
 A patient comes to your pharmacy with prescriptions
for:
Nelfinavir, Stavudine, Lamivudine
Rifampin, Isoniazid & Pyridoxine, Pyrazinamide, Ethambutol
 You remember the drug interaction between
Nelfinavir and Rifampin and recognize that these
two drugs should not be combined together
 Contact the patient’s physician/nurse with this
information. Recommend an alternative regimen (or
beginning ART after TB 2-month initiation)
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Role Play Scenario (8)
 A woman comes to your pharmacy to refill her
prescriptions for stavudine + lamivudine +
nevirapine. She also has a new prescription for
oral contraceptives
 You notice the drug interaction between the oral
contraceptives and Nevirapine
 Counsel her that she needs to use an alternate
form of birth control to prevent becoming
pregnant
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Role Play Scenario (9)
 A 24 year-old young man comes to your
pharmacy to refill his prescriptions for stavudine
+ lamivudine + nevirapine. Since you have been
keeping a history of his previous refills, you
notice that he has been 10 to 15 days late
picking up his refills for the past 2 months
 Use your patient counseling skills to find out if
the patient has been missing doses, and if so,
why. Offer him solutions to correct the problem
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Key Points

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A team approach to HIV care and treatment is
an effective way to care for HIV-positive
patients
Good communication with providers and
patients is essential for successful HIV care
and treatment
Pharmacists need to counsel patients on ART
readiness, ART information, and the
importance of adherence and ongoing
monitoring
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