Judith A. Rees

Introduction

Pharmacists have always provided information and advice on the use of medicines. The Nuffield Report (1968) recognized that there were ‘some categories of individuals who certainly will need advice, help and encouragement in the handling of their medicines’ and that ‘anyone who has to rely on a continuous drug regime, should be a candidate for additional support and help from pharmacies’. These statements highlight the traditional role of the pharmacist in the provision of advice to patients/customers.

The NHS Plan 2000 in the UK outlined the need for pharmacists to become more involved in helping patients to get the best from their medicines. The aim was to ‘Give patients the confidence that they are getting good advice when they consult a pharmacist’. The introduction of MURs and the new medicine service (NMS), further develops the pharmacists role in advice and information giving. Other examples of advice giving by pharmacists include when handing out prescription medicines, selling OTC medicines, on hospital discharge and during medication reviews.

Medicines research has led to the production of new, effective drugs formulated in many specialised dosage forms, such as modified-release formulations, aerosols, patches, nail lacquers, etc. which utilize conventional and other absorption routes (e.g. percutaneous, nasal and vaginal) (see Ch. 29). Often these medicines are packaged in specialized containers, for example aerosols for rectal use, self-administration parenteral products, metered-dose nasal sprays. These developments mean that pharmacists are in an excellent position to provide advice to patients/consumers on how to correctly use/administer these medicines in as safe a manner as possible.

What is information and advice giving in pharmacy?

Patients and customers have a right to be involved in the decisions about their treatment and their use and choice of medicines (see Ch. 18). Thus, pharmacists require effective communication skills to be able to identify the individual needs of a patient/customer and to determine the type and amount of advice and level of explanation appropriate to provide at that particular time.

The BNF uses the term ‘counselling’ rather than advice in individual monographs to detail the type of advice to be given to a patient. Such advice is above that required on the label of a dispensed product and usually involves unusual/complicated methods or times of administration or the potential interaction with foods. For example, bulk-forming laxatives have the counselling statement, ‘Preparations that swell in contact with liquid should always be carefully swallowed with water and should not be taken immediately before going to bed’.

The need for information and advice giving

It has been estimated that up to 50% of older people do not take their medicines as intended. Similarly, 50% of patients (not necessarily older people) with hypertension fail to take their medicines correctly. Thus, it has been suggested that advice by pharmacists could lead to better compliance and hence less therapeutic failure and possible death.

The aims of information and advice

Pharmacists in their patient-advising roles may adapt and make use of the problem-solving model of counselling developed by Egan (1990).

Thus the aims, in addition to the provision of advice, could be to:

Opportunities for giving information and advice

The pharmacist is often the last healthcare professional whom a patient sees before starting drug therapy. It is at this stage that the pharmacist should identify the information and advice needs of the patient. Pharmacists should take a prominent and proactive role. The opportunities for giving information and advice to patients are many, but the main opportunity is at the end of the dispensing process, the sale of a medicine, during a MUR or NMS opportunity (see Ch. 14).

No patient should receive a dispensed medicine without the pharmacist making an assessment of the needs of the patient. The availability of PMRs and the information contained within them will underpin the extent and type of information and advice provided to an individual patient.

The sale of medicines from a community pharmacy can be the result of: (a) a direct request for a named medicine by a customer and (b) a request for advice on the treatment of a symptom or minor ailment by a patient. The amount and content of the information and advice given to a patient will vary with the type of initial request, the medicine sold and the patient.

Thus, the opportunities for community pharmacists to become involved in patient advice are wide ranging. Other possible areas include:

Similarly, there are many opportunities for hospital pharmacists. Inpatients may require advice on their medicines during admission and should be made fully aware of any alterations in their medication on discharge. Outpatients will, also, require advice on newly prescribed medicines.

Pharmacists may be involved in providing medication to patients in long-term residential homes. In such situations it may be necessary to give information and advice to both the patient and/or their carers.

How to provide information and advice

Information and advice giving, wherever it occurs, should take place in a thoughtful, structured way. The pharmacist must possess not only a sound knowledge of the drugs and appliances being dispensed or sold, but also excellent communication skills. Pharmacists should be able to provide information and advice in a non-paternalistic way that allows the patient to ask questions in order to understand the information, so that they can make decisions about their own treatment and care. Pharmacists must have the ability to explain information clearly and unambiguously and in language the recipient can understand. They must know the right questions and how to ask them and, most importantly, they must know how to listen. For information and advice giving to be successful, it must be a two-way process. Rapport is built-up between the pharmacist and the patient and a much more meaningful dialogue can take place.

The Cambridge–Calgary model (see Chs 17 and 18) details how to provide explanations to patients. It is important to provide the correct amount and type of information:

To help the patient recall and understand the advice/information that you provide, the pharmacist should: