Patient counselling and medicine information – does one size fit all?

Wednesday 15 August 2018 | 19h00-20h00

Session facilitator: Dr Mariet J Eksteen

Speakers: Mr Gary Black & Dr Mariëtta Basson

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• Audio only, microphone muted

• Handouts

• Questions

Objectives of this webinar

1. Define pharmacists’ professional and ethical obligations to fulfil their legal duty of pharmaceutical care to provide accurate and understandable patient information;

2. Understand all legislation that impacts on the pharmacist’s responsibility to provide patient counselling and medicine information;

3. Be aware of the different needs of patients based on their personality types; and

4. Adopt positive changes in current patient counselling and medicine information practices.

Participate in a Poll

How serious do you take

patient counselling

and/or medicine

information daily?

Speaker 1:

• Mr Gary Black

• Pharmacist

• Executive Director: Cape Western Province Branch, PSSA

• gary@pssacwp.co.za

• 021 683 7313

Ethical obligations

The relationship between a pharmacist and his patient is one of trust.

Patients trust pharmacists to use their special skills and knowledge of medicines to:

• evaluate medicines for safety, efficacy or appropriateness of use

• advise them correctly

• provide accurate and appropriate information for them to be able to use the medicine safely in order to achieve the desired outcomes.

When reciting the Pharmacist’s Oath, pharmacists undertake:

“To uphold the profession of pharmacy as the custodian of medicine, and regard medicine as the instrument entrusted to me to protect and improve the quality of life,”

Ethical Obligations (cont.)

1st Principle of the Code of Conducti

”A pharmacist’s prime concern in the performance of his/her professional duties must be for the wellbeing of both the patient and other members of the public,”

Pharmacist is expected to provide all the information necessary:

• in a suitable format and appropriate language,

• to ensure that the patient fully understands the purpose of the medicine, how to use it correctly, storage conditions, any significant side-effects and what to do when experiencing any adverse reactions, and

• information provided should be accompanied with effective counselling to ensure that the information provided is both accurate and understood.

Patients’ Rights

Participation in decision-making… everyone has the right to participate in decision making on matters affecting one’s health.

Access to health care… counselling without discrimination, coercion or violence on matters such as reproductive health, cancer or HIV/AIDS;

Informed consent… everyone has the right to be given full and accurate information

Patient Responsibility: To provide health workers with relevant and accurate information for diagnostic, treatment, rehabilitation or counselling purposes.

What does the law say?

The National Health ActPatient’s Rights are given legal effect in the of the National Health Act.

Section 6. User to have full knowledge: ...the health care provider must inform the patient in a language that the patient understands and in a manner which takes into account the patient’s level of literacy.

Section 7. Consent of user: ...a health service may not be provided to a patient without the patient’s informed consent and a health care provider must take all reasonable steps to obtain the necessary informed consent.

Section 8. Participation in decisions: …a patient has the right to participate in any decision affecting his or her personal health and treatment.

What does the law say? (cont.)

The Consumer Protection Act

No medicine is risk free. It is by character, an inherently unavoidably unsafe product. To avoid CPA liability, all medicine must:

• be effective and safe for its intended purpose

• be of good quality throughout its shelf-life

• have adequate instructions and warnings (label, PI and PIL) provided to the consumer

(Adv.Rene Doms.”Forensic Corner”)

What does the law say? (cont.)

The Medicines and Related Substances Act

Section 18 Labels and Advertising: ...provides for setting of standards and content of information provided to the patient in terms of labelling and advertising.

Registration of a medicine includes provision of both a package insert and a patient information leaflet.

General Regulations specify minimum requirements including:

• Regulation 10. Labelling of Medicines Intended for Human Use.

• Regulation 12. Patient Information Leaflet.

• Regulation 42. Advertising of medicines.

Good Pharmacy Practice Rules include compliance with the requirements of the Medicines and Related Substances Act.

Pharmaceutical Care......the difference the pharmacist makes!

The pharmacist is accountable for the provision of pharmaceutical care by taking responsibility for the patient’s medicine-related needs including:(i) evaluation of a patient’s medicine-related needs by

determining the indication, safety and effectiveness of the therapy;

(ii) dispensing of any medicine;(iii) furnishing of information and advice to any person with

regard to the use of medicine; (iv) determining patient compliance with the therapy and follow-

up; (v) the provision of pharmacist-initiated therapy;

The information and counselling provided by the pharmacist is a vital key to successful outcomes and prevention of foreseeable harm.

In summary... a legal duty of care

The fact that, the pharmacist -

• has a duty imposed by regulation to provide correct information,

• is recognised as “adviser on the safe, rational and appropriate use of medicine”,

• possesses particular skills, information and knowledge on which the patient relies for a successful outcome of treatment.

and that:

• a patient may suffer physical injury or damage as a result of incorrect information.

indicates that a legal duty of care exists and that the pharmacist must take all reasonable steps to fulfil this mandate using his specialised skills and knowledge of medicines

What does this all mean in practice?

Information - divided into:

• risk assessment information: - enables patients to assess the risks involved in medicine therapy and for healthcare workers to thereby obtain informed consent

• risk management or risk minimisation information: -provides patients with information is to decrease the risks of side effects and increase the benefits of a course of medicine therapy

Providing counselling and medicine information

Dispensing procedure:

Phase 1: Interpretation and evaluation of the prescription

(risk assessment)

Phase 2: Preparation and labelling of the prescribed medicine

(risk minimisation)

Phase 3: Provision of information and instructions to the patient to ensure the safe and effective use of medicine(risk management)

Consequences of failing to counsel

and provide information.Failure to provide either risk assessment information or risk minimisation information constitutes:

• an omission in terms of the legal duty of providing pharmaceutical care

• a breach of the first of the “Ethical Rules” (“Failure to furnish advice or information for the safe and effective use of medicines supplied by him.”)

and means that the pharmacist could incur delictual liability.

In conclusion....

Pharmacists have a legal and ethical duty to provide accurate and appropriate information about the medicine supplied to patients.

An important component of pharmaceutical care is the skill of counselling at a level and in a language which is understood and accepted by the patient.

Empowering the patients with this necessary knowledge about their medicines can motivate them to adhere to the treatment and result in successful outcomes.

Participate in a Poll

Have you ever experienced

the situation that the same

counselling previously well-

received by one patient may

be perceived differently by

another patient?

Speaker 2:

• Dr Mariëtta Basson

• Industrial Psychologist

• Senior Lecturer, Department of Pharmacy Practice, School of Pharmacy, North-West University

• Marietta.Basson@nwu.ac.za

• 018 299 2227

Communicating with patientsDoes one size fit all?

E-I Dichotomy

Focus of energy and

attention

E Extraversion E I I Introversion

On the outer world of

people and activity

On the inner world of

ideas and experiences

S-N Dichotomy

Way of taking in

information

S Sensing S N N Intuition

Using the five senses,

focussing on the here and

now

Seeing the big picture

and patterns and future

possibilities

T-F Dichotomy

How you make

decisions

T Thinking T F F Feeling

Analyse cause and effect

objectively

Consider effect or

importance of decision on

people involved

J P Dichotomy

Dealing with the outer

world

J Judging J P P Perceiving

Planned and organised

and prefer things settled

Flexible and spontaneous

and prefer to keep

options open

The four preference pairs of the MBTI® ²

Extraversion or Introversion (E or I)Where you focus your attention and

get your energy ¹ ² ³

The natural focus of the Extravert is the external

world

The natural focus of the Introvert is the internal world

Extraversion or Introversion (E or I)

Sensing or Intuition (S or N)How you gather information¹ ² ³

Sensing-taking in and presenting information in a sequential step by step way

Intuition-taking in and presenting information in a snapshot or big picture way

Sensing or Intuition (S or N)

Thinking or Feeling (T or F)On what do you base your

decisions? ¹ ² ³

Thinking-making decisions by stepping back from the situation,

taking an objective view

Feeling-making decisions stepping into the situation,

taking an empathic view

Thinking or Feeling (T or F)

Judging or Perceiving (J or P)How you deal with the outer

world ¹ ² ³

A planned approach to meeting the deadline in a

scheduled way

A spontaneous approach to meeting the deadline just in

time

Judging or Perceiving (J or P)

Facts with practicality ¹Sensing and Thinking (ST)• Be brief, give concise facts

• Be straightforward and honest

• Know the facts about my condition and expect to be

questioned on them

• Give me information on the specific treatment options

so I can weigh them

• Present the information in a logical way, do not go off on a tangent

• Give me factual written information about my condition/treatment

• Have available percentages or relevant data for comparison and

information

• Expect to be ‘tested’

Personal service¹Sensing and Feeling (SF)• Listen carefully to me, give me your time and

complete attention

• Be warm and friendly

• Give me factual information honestly, but with

a personal touch-for example, remember what

I’ve already told you

• Provide practical information and examples

about my condition

• Tell me about other people who have had the

same treatment

• Explain any options clearly and allow me to decide

Supporting the vision¹Intuition and Feeling (NF)• Treat me with respect, as a whole person,

not a case number

• Listen to and value my concerns

• Provide overall solutions, an overview without

details

• Take time to discuss my concerns, be honest but kind

• Know that my case is unique to me

• Be sincere

• Get to know me as a person

• I may want to discuss alternatives or complementary treatments; take this seriously

Logical options with competence¹Intuition and Thinking (NT)

• Respect my intelligence and my need to

understand

• Demonstrate your competence

• Answer my questions in a a honest open way

– do not hide anything

• Give me overall options so I can see a pattern

• Be informed about new alternative treatments

• Listen to my views, ask before giving advice

• Do not expect/assume a personal relationship

-that will be built when competence is shown

• Show that you continually update your knowledge

Reference list

1. Health care communication using personality type. Judy Allen and Susan A Brock

2. Introduction to type. 6th edition Isabel Briggs Myers

3. Introduction to type and communication. Donna Dunning

Handout documents

1. Patient counselling reference documentG Black, 2018

2. Pharmacists, Communication preferences and CareBasson, MJ & Eksteen MJConference publication, 2012

3. Discovering the value of personality types in communication training for pharmacy studentsMJ Eksteen & MJ BassonAfr J Health Professions Educ 2015;7(1):43-46

Recording of this webinar

• This webinar is recorded

• Link will be available on the PSSA website under News & Events, together with handouts

Post-webinar survey

• Please participate in the post-webinar survey, in order for us to monitor the impact of this webinar.

Questions

Thank you for attending

• Mr Gary BlackExecutive Director: Cape Western Province Branchgary@pssacwp.co.za021 683 7313

• Dr Mariëtta BassonSenior Lecturer: North-West Universitymarietta.basson@nwu.ac.za018 299 2227

• Dr Mariet J EksteenProfessional Development and SupportPharmaceutical Society of South Africa (PSSA)profoffice@pharmail.co.za012 470 9560