PATIENT COUNSELING - A FOCUS ON MAINTENANCE THERAPY

Pharmacist counseling of patients receiving long-term medications for chronic diseases is discussed. Patient counseling should be viewed as one component of the overall drug-use process. Pharmacists counseling patients prescribed long-term medications need to understand the lifes tyle effects of chronic illness, particularly the different types of ' 'work'' the chronically ill patient must undertake. Pharmacists need t o go beyond traditional sender-message-receiver communication models i n counseling patients and to adopt a problem-solving approach through which each patient's needs and level of understanding are taken into a ccount. Patients should be actively invoIved in their therapy decision s. Patients will be at varying stages in terms of making any behaviora l changes needed to maximize therapeutic outcomes, and counseling must be adapted to fit the stage of change. The Indian Health Service (IHS ) model of counseling uses open-ended questions to determine patients' knowledge of their disease and medications; this enables the pharmaci st to fill in any gaps and review specific points. The health communic ation model provides strategies for enhancing patient compliance and r ecall and complements the IHS model. Ln practice, the techniques used will depend on whether the patient is a new-prescription patient or an established patient. The models can be adapted to counseling caregive rs and can be complemented by compliance aids. The demand for pharmaci st counseling of patients with chronic illnesses is likely to increase , and, to effectively counsel patients about long-term medication use, pharmacists need to appreciate the personal impact of chronic illness beyond the direct effects of the biomedical disease itself, and must understand modem communication models.