After reading this chapter, the pharmacy student, community practice resident, or pharmacist should be able to:
Discuss the role of patient counseling techniques such as the three prime questions and behavioral change models.
Recognize pharmacist-centered, patient-centered, and environmental barriers to change and how to overcome them.
Explain how motivational interviewing is useful and effective as a style of counseling.
Discuss the role of the five core communication principles as they apply to motivational interviewing.
Assess a patient's readiness and self-efficacy to change their behaviors.
Whether in a community or clinical setting, pharmacists usually do not have abundant time to fully discuss medication and behavior change issues with patients. In the case of many community settings, the environment and other factors may serve as barriers; however, evidence-based communication strategies are crucial to resolving barriers, to increasing patient adherence to medications, and to improving clinical outcomes. Even in environments conducive to optimal counseling and effective medication therapy management (MTM), the most effective medications can be rendered ineffective if patients struggle to make behavior changes in medication adherence and other disease management behaviors. Motivational interviewing (MI) has been shown to be an effective counseling method for ambivalent or resistant patients, as it is designed to resolve ambivalence and to help patients decide internally and on their own to make changes.
Patient counseling standards originally were set in the Omnibus Budget Reconciliation Act of 1990 (OBRA 1990), which is a law mandating that pharmacists offer counseling to patients regarding their prescriptions.1 If the patient accepts this offer, pharmacists should discuss the following:
- Name of medication
- Intended use and expected action
- Route, dosage form, dosage, and administration schedule
- Proper storage
- Common adverse effects that may be encountered
- Techniques for self-monitoring of drug therapy
- Prescription refill information
- Action to take if a dose is missed
- Potential drug–drug or drug–food interactions or other therapeutic contraindications
Although the law was intended for Medicaid patients, individual states adopted rules to make counseling applicable to other patients, as well.1 Thus, counseling is one of the tools that may be used to provide MTM services. One of the limitations of counseling, however, is that information generally is provided in a one-way, provider-centered manner (i.e., pharmacist to patient or pharmacist to caregiver). Instead, the pharmacist should ask questions to elicit needed information from the patient to fill the medication(s) in question and also to ensure that all of the patient's medications are providing optimal benefit. This can become a time-consuming process.
To streamline the process for discussing medications, the “three prime questions” of the Indian Health Service Model can help determine the patient's baseline understanding of a medication.2 This method promotes a conversation with the patient during which the pharmacist elicits information that the patient already knows, with the intention to fill in any gaps of understanding. Thus, discussing medications does not consist of simply the pharmacist ...