PATIENT INFORMATION

• Patients look up to pharmacists for

information about health and medicines

• Knowledgeable pharmacists can play a vital

role in providing this information

• Incomplete and inadequate information leads

to inappropriate use of medicines, leading to

serious health and economic consequences for

both individuals and the community at large

OBJECTIVES

By the end of this study, the pharmacists will be

able to understand :

• Various areas in which the pharmacist can

provide information

• What information the pharmacist can provide to

the patient

• Various methods and tecniques to provide this

information

• The pharmacist’s role in patient compliance

• The pharmacist’s role in effective counselling

INFORMATION/COUNSELLING TO BE PROVIDED TO THE

PATIENTA. On Prescribed Treatment

List of things to be told to a patient :

What each medicine is for

How to take medicine (what time, how

many/much, before or after food)

How to use certain devices

The instructions to be given for each

medicine

The specific precautions to be taken with

certain medicines

What side effects to expect

What condition should the medicines be

stored under

For Example :

Medication to be take on an empty stomach :

Levofloxacin : To be taken on an empty

stomach one hour before, or two hours after

meals, with a full glass of water.

Presence of food may slightly decrease or delay

absorption.

Medication to be taken at a particular time of

the day for better effect

Indapamida : preferably to be taken in the

morning to minimize the effect of increased

frequency of urination during sleep

Atorvastatin : to be taken at night after

dinner because it is most effective when

synthesis of cholesterol is maximum at during

the night

Medication to be taken on a full stomach :

Alfacalcidol : to be taken after food for better

absorption

Fluconazole : to be taken after food because

it is absorbed better on a full stomach

Doxycycline : to be taken after food. Food

does not affect absorption. If taken on an

empty stomach, howevwe, it can cause GI

upset

Instructions to be given with certain medicines

Example : Use of Antibiotics

The medicines has been prescribed for you

for a particular infection;

Complete the entire course of therapy and

do not miss a dose;

Do not stop treatmen if you feel the

symptoms are gone in two or three days,

causing the infection to recur;

Do not give this medicine to others to take;

Do not use this medicine in future, even for

a similer illness, unless specifically

recommended or prescibed by the

physician;

In case of any adverse effect, report to the

physician immediately.

Case Study 1

Could you tell me how I

should take my

cholesterol

tablets and the other two

tablets?

The pharmacist finds out the

following from the patient’s

prescription -

Atorvastatin 10mg 1OD..continue

Metoprolol 50mg 1b.d…. continue

Pantoprazole 40mg 1ODC10days

1. You have been prescribed Atorvastatin for

lowering your cholesterol levels. The physician has

written O.D. i.e. Once daily. This should be taken

preferably in the night after dinner, everyday.

2. Metoprolol has been prescribed for high B.P. It

has to be taken after breakfast in the morning and

once after dinner (as per the prescription).

Continue taking these two medicines till your

physician advises you to stop.

3. Pantoprazole has been prescribed for increased

acid

secretion in your stomach. It has to be taken one

hour before breakfast with two glasses of water.

The physician has recommended that you take

these only for ten days.

Thank you

For your treatment to work well,

make sure you don’t miss your daily

dose of Atorvastatin and continue to

take Metoprolol till you see your

physician next.

Stopping the medicines without the

physician’s advice will not be good

for your health, so please stick to the

schedule.

If you forget to take a dose, take it as

soon as you remember, but please do

not double the dose to compensate

for the missed dose...

Just to make sure that you have

understood, can you repeat how you

are going to take your tablets?

Yes ----------

----------

That’s perfect! Hope you begin to feel

better soon. If you have any other

query, please don’t hesitate to call on

us anytime.

Thank you so

much.

GUIDELINES

Pharmacists should be educated to provide

information about prescribed medicines;

Pharmacists should be knowledgeable about

the time of administration of medicines and

about the rationale behind each instruction;

A pharmacists should be accessible to clients

at all times to provide information and advice

appropriate to their needs.

Practically speaking :

o Due to rush loads and paucity of time, it

may not be possible to give such detailed

information to every patient;

o An attempt must, however, be made to

instruct as many patients as possible

about how to take the prescribed

medication.

PLEASE REMEMBER :

• It is the RIGHT of every patient to know

and be given various

instructions/information about the

prescribed medication.

Case Study 2

• Patients approach pharmacists not only

for instructions on how and when to take

their medicines, but also for queries

regarding the therapy prescribed by the

physician;

• Make sure that they are aware of that to

expect of the treatment, or to provide

additional important information.

I have been suffering from diarrhea for the last 4

days. The doctor has advised me to take ORS.

How will it help? I don’t think my diarrhea will

stop with it

ORS means Oral Rehydration Salt, commonly

called as electrolyte. Its role is to replace the salts

and fluid lost due to diarrhea

Shouldn’t I take tablets to stop my

diarrhea? Why hasn’t he prescribed me

any?

The doctor has diagnosed your diarrhea to be

viral. Viral diarrhea passes off on its own. All that is needed

is to keep yourself hydrated. Drink lot of water and avoid

spicy, heavy meals

GUIDELINES

The pharmacist should be reasonable and

approachable enough to facilitate a client-

pharmacist dialogue in a convenient and

responsive manner;

The pharmacist should ensure that clients are

provided with sufficient information to

facilitate the safe and effective use of

medicines;

GUIDELINES

The pharmacist should ensure that he does

not leave the patient with doubts about the

appropriateness of the treatment prescribed

by the physician or about the physician’s view

of the patient’s condition;

A common man believes in a pill for every ill

and so expects the physician to prescribe a pill

for every condition. In the above case study,

the pharmacist explains why a pill is not

requared.

Information regarding prescribed

medicines can prove very important in the

success of the treatment prescribed for the

patient. Pharmacists must inform patients

that following the dosing instructions is the

key to ensure that the treatment work as the

physician intended it to.

B. Awareness About the Role of Therapy

The pharmacist has to take up the

responsibility to :

Inform the patient about the therapy

prescribed;

Make him/her aware of the seriousness of

medicines;

Make him/her aware of the need to adhere

to the therapy.

Case Study 3

• The duration of therapy is a very important

factor as far recovery is concerned.

• The case study given below enumerates an

acute condition in which a patient has to

told that compliance to the treatment is

mandatory.

• That treatment should not be discontinued

unless advised by the physician, or unless

side effects are experienced.

I just want to make you aware

that you have been prescribed

an antibiotic. Please complete

the course of 15 capsules i.e. 3

capsules X 5 days.

What if I feel better in 3

days?

Even if you feel better after 3 days,

complete the course for 5 days to make

sure all the bacteria are eradicated. If

your condition does not improve or

recurs, do not take more of this

antibiotic. In such cases, the best thing

to do is to consult the physician.

OH! I’ll make sure I

remember this

GUIDELINES

• The pharmacist must have acces to a variety

of resource materials, texts and references so

that he can give the required information to

patient;

• The pharmacist should make the patient

aware of the role of therapy and encourage

the patient to adhere to the therapy;

• The pharmacist should provide back-up

information in the form of hand-written

instructions or printed leaflets.

Always bear in mind

• The patient may not know what his illness is,

or what exactly is wrong with him/her;

• The patient may very apprehensive or

scared unnecessarily over a condition that

can be treated or controlled with therapy;

• The atmosphere, layout, attitude in the

pharmacy should be such that patients feel

comfortable asking questions about their

medication/condition.

Case Study 4

• Pharmacist while dispensing a

prescription for antihypertensive

Your BP seems to have gone high.

You have been prescribed medicines

to lower your BP

I know! The physician said to take

the tablets continuously for

15 days and then see him again

Yes, that’s right! Don’t miss your dose till you see the

physician. Even if you happen to meet him after more

than 15 days please see that you do not stop therapy

(unless, of course if you get some intolerable, severe

adverse effects or you feel bad). You may have to

continue taking the medication to keep your blood

pressure under control.

Thank you. I didn’t know

that

GUIDELINES

• Patient compliance is the key to succes of

treatment and pharmacists have a vital

role to play in this;

• Pharmacist can facilitate compliance by

making the patient aware of the

seriousness of the prescribed medicines

and the need for compliance.

Patient Counseling Area (PCA)

• Apotek harus menawarkan layanan

profesional kepada pasien

• Alihkan perhatian pasien ke PCA dengan

membuat tanda-tanda yang cocok

Need a Separate Counselling Area

• Pasien terkadang malu mengklarifikasi ttg

masalahnya didepan umum (banyak

pelanggan lain disamping meja)

• Menasehati pasien di PCA lebih mudah

daripada di meja

• Demonstrasi alat instrumen lebih baik

dilakukan di PCA

• Duduk di PCA bersama Pharmacist

membuat pasien yakin didengar tanpa

gangguan

Patient Counselling Area

Sebuah area tertentu tempat kegiatan yang

berkaitan dgn pelayanan pasien/jasa

profesional dilakukan

Jasa Profesional (Apoteker ) :

• Pengukuran klinis (TD, GD, TBB, BMI)

• Demonstrasi pemberian sediaan obat (TH,

TT, TM, S Insulin)

• Tempat mendiskusikan masalah

kesehatan/medis dan tempat

mendistribusikan handout

Activity

• Tempatkan meja dan 2-3 kursi di daerah

terpencil

• Tawarkan privasi dan pastikan

kenyamanan pasien berkonsultasi

• Berikan label PCA

• Siapkan selebaran, pamflet (menarik)

• Tawarkan pengukuran klinis

• Secara bertahap mulai dgn layanan seperti

diatas, sesuai kenyamanan dan tingkat

keyakinanmu

Written information

Instruksi tertulis sangat berguna bagi

pasien (stiker, pamflet, selebaran)

A. Stickers (instruksi tertulis)

Tempatkan pd bagian luar kemasan

obat

Tempat pada bagian yg tdk

menghilangkan detail label

Do not stop taking this

medicine without the

doctor’s advice

Avoid exposure to

sunlight after taking this

medicine

Avoid alcoholic drinks

While taking this

medicineThis medicine may cause

drowsiness. Avoid

driving or operating

machinery after taking

this medicine

B. Medicine information cards

Berisi informasi tentang obat (dosis, efek

samping, dll)

Melengkapi instruksi lisan (Dokter atau

Apoteker), meningkatkan kepatuhan

pasien

C. Patient Information Leaflets (Pils)

Sumber informasi lain bagi pasien

Melengkapi informasi dari Pharmacist yg

mungkin hilang

Mencakup informasi terkait obat-obatan,

penyakit, perawatan dan masalah

kesehatan lainnya

D. Charts

Tampilkan di wilayah Konseling, ruang

tunggu

Menerangkan ttg aspek penyakit umum

Berisi tindakan pencegahan yg harus

diambil sehubungan dgn obat-obat

tertentu

Uncontrolled dibetes effects the :

Kidneys Heart

Eyes Feet

Good diabetes control will reduce the risk or delay the onset of

diabetic complications...........

SO, CONTROL YOUR DIABETES!!!

E. Booklets

• Buku tentang topik kesehatan

• Dapat disimpan di apotek untuk dibaca atau

untuk dijual

NON-PHARMACOLOGICAL MEASURES

Tindakan non-farmakologis secara sederhana,

selain obat-obatan, dapat membantu pengobatan

bekerja dengan baik, atau yang memiliki efek

menguntungkan pada kesehatan pasien :

Membatasi asupan kalori dapat membantu

dalam mengurangi kemungkinan diabetes /

obesitas

Meminimalkan asupan garam dapat

membuktikan penurunan resiko tekanan darah

tinggi

Case Study 5

• Dalam kasus-kasus tertentu, obat-obatan

mungkin tidak diperlukan sama sekali, atau

obat-obatan mungkin tidak bekerja dengan

baik tanpa tindakan diet yang ditentukan

• Jika pasien yang membutuhkan nasihat

meminta pendapat pharmacist, ia mungkin

harus meyakinkan mereka bahwa obat

tidak diperlukan untuk kondisi / tahap

tertentu penyakit

I have been suffering from joint pain and joint

swelling especially my big toe. The doctor recently

told me that I have high uric acid levels in my blood

and has given medicine. Can you help me lessen my

suffering?

Don’t worry! Take your tablets as per your doctor’s advice. Besides that

remember, avoid all alcoholic drinks as they increase uric acid production.

Purine rich foods like crabs, red and organ meat, shellfish, cauliflower,

spinach has to be avoided.

Thank you! I have been consuming

alcohol every night lately...no

wonder my pain got only worse

with the tablets!

Another thing that is very important is you have

to learn to relax. Stress often triggers an attack of

pain in those with high uric acid levels. Also,

remember not to fast because that is another

trigger factor. Drink 1.5-2 L of water through the

day and check on your weight-the lesser the

better!

Some Change In Your Lifestyle And

Dietary Habits can help you feel better. Don’t

forget to check your uric acid levels after

certain intervals (monthly or after months)

Thank you! I hope these measures

really work and reduce my suffering

to a certain level.

Tindakan-tindakan non - farmakologis dapat

disarankan oleh pharmacist bersama dengan OTC

atau resep obat-obatan, untuk membuat mereka

bekerja lebih baik atau sebagai alternatif untuk obat

bebas.

Keuntungan dari tindakan-tindakan non farmakologis

:

Umumnya hemat biaya.

Bermanfaat bagi pasien yang tidak ingin menyukai

obat-obatan.

Mencegah obat yang tidak perlu.

Kebanyakan pasien lebih sesuai untuk pengobatan

rumah daripada obat-obatan.

GUIDELINES

• Pharmacist harus menyarankan tindakan-

tindakan non-farmakologis yang terbukti

atau dapat diandalkan.

“ Kadang-kadang, obat terbaik adalah

TIDAK OBAT sama sekali !! “

• Pharmacist harus memperbarui diri dengan

tindakan-tindakan non-farmakologis

sederhana dan merekomendasikan langkah-

langkah tersebut untuk berbagai penyakit /

kondisi.

GUIDELINES

• Tips non-farmakologis harus sama sekali

tidak mengganggu pengobatan dokter.

• Pharmacist harus menasihati untuk

melakukan dan Larangan untuk

membantu pemulihan.

Perintah dan Larangan untuk pasien hipertensi :

Do’s Don’ts

Regular visit to your physician Ignore medication

Use less salt Smoking

Control weight Be inactive

Regularly exercise Drink alcohol

Eat fruits and vegetables rich in

potassium. E.g. carrot, cabbage, peas,

green turnip, tomato, orange, grapes,

pineapples etc.

Eat fatty foods

Tindakan-tindakan non-farmakologis

dapat membantu membuka jalan untuk

pemulihan lebih cepat. Pharmacist dapat

memainkan peran utama dalam membantu

pasien mengontrol kesehatan mereka

dengan menasihati mereka tentang

langkah-langkah diet atau perubahan gaya

hidup

THE PHARMACIST AND OTC MEDICINES

• Obat OTC/obat non resep, dibeli/dijual

tanpa resep dokter

• OTC dapat dibeli oleh klien sendiri

• OTC dapat direkomendasikan oleh

Apoteker

• Sering dianggap obat “tidak begitu serius”

• Sebenarnya OTC adalah obat yg serius

• hati-hati saat menggunakan OTC

Kebutuhan pasien untuk meminta OTC,

disebabkan oleh :

Pengaruh iklan atau media

Rekomendasi teman/kerabat

Penggunaan sebelumnya untuk kondisi

sama

Ketidakmampuan ke dokter (faktor biaya,

waktu, tdk ada dokter)

Adanya pendapat bahwa kondisi klien

sederhana shg dgn OTC sudah cukup

What the Pharmacist can do :

• Tanyakan apakah pasien tahu penggunaan

obat yg benar

• Tanyakan gejala pasien shg klien

menginginkan OTC tertentu

• Tanyakan apakah klien mengkonsumsi

obat lain

• Tanyakan apakah pasien menderita

penyakit lainnya

• Membantu klien memilih OTC yg cocok

• Rekomendasikan metode pengobatan lain

Inform the patient :

• How to take

• How much to take (Maximum permissible

daily dose)

• When to take

• For how long to take

• Any adverse drug reactions observed

• Any side effects likely to occur

• Any precations to be taken

• To see a physician if the condition does not

improve in a few days or if worsens

Case Study 6

Can you give me Disprin

(Aspirin) for my body ache?

Sure. But I would like to ask a few questions to make sure

that Aspirin is the right choice for you. Are you asthmatic,

or do you have any breathing problems? Do you have any

gastrointestinal (GI) problems, GI bleeding, or an active

ulcer? Have you had an ulcer before? Are you taking any

other medication? Aspirin is not suitable for asthmatics. It

can trigger an asthmatic attack in susceptible persons. It

can also precipitate or aggravate an underlying ulcer.

GUIDELINES

• Pharmacist harus dilengkapi dgn

pengetahuan dan keterampilan shg

kompeten untuk memberikan nasehat

ketika klien meminta obat OTC

• Pharmacist dapat membantu pasien

memilih obat OTC yg benar, tapi keputusan

ada pada pasien

• Klien memiliki hak untuk menolak

pengobatan atau saran, atau untuk mencari

pendapat alternatif

BAHAN DISKUSI

• SELF CARE

• SWAMEDIKASI PADA DEMAM

• SWAMEDIKASI PILEK DAN ALERGI

• SWAMEDIKASI PADA ASMA

• SWAMEDIKASI PADA SEMBELIT

• SWAMEDIKASI PADA DIARE

• SWAMEDIKASI PADA DIABETES