Counselling and advice on medicines and appliances in community pharmacy practice

Section 1: Introduction

1.1 Purpose of the Guidelines

Counselling and the provision of advice on medicines and appliances are traditional functions of the community pharmacist. The knowledge and skills for these functions are now established in undergraduate Pharmacy courses and developed through a combination of experience and continuing post qualification education. The purpose of these Guidelines is not to teach pharmacists what they already know, but to provide a framework within which pharmacy practice can further develop. Thus the Guidelines focus on the process of counselling and aim to provide a systematic and structured approach. In practice, methods of meeting the desired objectives for counselling will vary with the preferred styles of different practitioners and the variable needs of individual patients.

1.2 Who are the Guidelines aimed at?

These Guidelines are aimed at all community pharmacists and it is hoped that they will prove helpful to experienced pharmacists and newly qualified pharmacists alike. A one page 'Checklist for Counselling' is provided in Section 2.2 and reference to further practical guidance on counselling is given in the Bibliography ( Annex A6).

1.3 Definitions

For the purpose of these Guidelines, the term "counselling" will be used to describe the interactive process involving a consultation about medicines or appliances between a pharmacist and a patient, and the term "advice" will be used to describe the oral or written provision of professional opinion. Further definitions of terms used in these Guidelines are given in the Glossary ( Annex A1).

Rational and effective therapy relies on competent diagnosis and prescribing. However of equal importance, is the need for the patient to have the necessary knowledge and understanding of their disease and their therapy, the ability to take or use their medicines and/or appliances correctly, and the motivation to follow the prescribed course of therapy. To achieve this requires skill, expertise and investment of time on the part of the professionals involved and the full attention and involvement of the patient.

For prescribed medicines the general practitioner has the primary responsibility tor counselling and advising patients at the time of writing the prescription. Barriers to effective communication at this point are well documented and include a shortage of time and the inability of patients to recall oral advice, particularly if it relates to a complex regimen and/or is given in a relatively stressful situation. The role of the community pharmacist therefore in complementing and reinforcing the counselling and advice given by physicians is essential. Independently, community pharmacists perform an important counselling and advisory function in relation to over-the-counter medicines. Uniquely, the pharmacist has the opportunity to ensure compatibility between prescribed medicines and those purchased over-the-counter, a role likely to increase as more potent medicines are released from the ' POM' to the 'P' category.

There should be close liaison between health care professionals involved in counselling and advising patients on medicines and appliances; in particular, care must be taken to assess the wishes of the prescriber. Meeting to discuss the nature and extent of counselling and advisory services offered to particular patient groups by each of the health care professions involved at a local level helps to structure and integrate the advice which patients receive from different sources. Whilst this will usually involve the community pharmacist and the general practitioner, effective liaison with other primary care team members who regularly visit patients is of obvious value. Where appropriate for particular patients and indications, referral and/or consultation between the health care professionals involved is necessary.

1.6 Developing practice

In line with other health care professions, pharmacists have an ethical and professional obligation to develop their practice to improve patient care. The fact that the counselling function is traditional and routine for all community pharmacists does not remove the need to ensure that standards of practice are high and that patients are receiving a good pharmaceutical service. Thus the Annexes within the Guidelines deal with Ethical and Legal Considerations ( A2), Education and Training ( A3), Clinical Audit ( A4) and Research and Development ( A5).

It is not the purpose of these Guidelines to labour aspects of counselling with which pharmacists are already familiar. No attempt is made to provide the technical or scientific knowledge or to teach the communication skills which underpin the counselling process. However, extensive use is made of examples to illustrate the process.

The needs of patients for counselling and advice may extend beyond the areas of medicines and appliances. The role of the pharmacist in recognising such needs is outwith the scope of this document. It is an increasing role, however, as exemplified by topics such as infant feeding, aspects of adult nutrition, family planning, biochemical tests and screening, health education, travel advice and response to symptoms.