Patient counseling--a focus on maintenance therapy

Understanding Fibroadenoma of the Breast: A Comprehensive Review of Pre-operative and Post-operative Clinicopathological Correlations

Fibroadenomas of the breast are common benign lesions that predominantly affect young women. This review provides a comprehensive overview of fibroadenoma management, encompassing their definition, clinical presentation, diagnostic tools, surgical management, clinicopathological correlations, treatment outcomes, complications, and emerging research. Fibroadenomas typically present as palpable breast lumps, often with no associated nipple discharge, and their diagnosis relies on a combination of clinical examination, breast imaging, and pathological confirmation. Surgical interventions, including excisional biopsy and lumpectomy, offer symptom relief and favorable long-term outcomes. Minimally invasive techniques and ongoing research into genomics and molecular aspects hold promise for the future of fibroadenoma management. Multidisciplinary collaboration among healthcare providers is paramount, ensuring accurate diagnosis, personalized treatment decisions, and holistic patient care. As research advances, the management of fibroadenomas is poised to evolve, providing improved diagnostic accuracy, minimally invasive treatments, and enhanced patient outcomes.

Quantitative association of educational status and effect of patient counseling among cancer patients: A cross-sectional analysis in a tertiary care hospital in South India

CONTEXT

Patient Counseling is desirable in chronic disease condition which is influenced by innumerable predictors. Educational status is one of the primary predictor which is usually ignored while considering the effect of patient counseling in cancer patients. Therefore, this study was aimed to determine the measure of association between education level and patient counseling among cancer patients.

DESIGN AND METHOD

In the cross-sectional analysis, 90 cancer patients in inpatient setting at Oncology department of tertiary care hospital in South India were examined for a 24-week period through pharmacist-patient interview. The data were recorded in well-customized and validated data collection form.

STATISTICAL ANALYSIS USED

Bivariate analysis and linear regression analysis were performed using IBM SPSS Statistics 16.0, USA to assess the empirical relationship between the two determinants: education level and patient counseling.

RESULTS

The study participants were aged between 11 to 80 years with 7:11 male to female ratio. Among 90 interviewed patients, 83.3% were counseled. Linear regression analysis demonstrated significant association between education status and patient counseling (p < 0.05).

CONCLUSIONS

The study findings suggest that poor education status can be a barrier to patient's ability to seek and act on the counseling provided by the health care professionals. Thus, it recommends improvisation of counseling practice on patients from different educational divisions.

Implementation of a medication education training program for student pharmacists employed within an academic medical center

Purpose

To describe the implementation of a student pharmacist medication education training program (the REWARDS Method), to determine if training was effective in preparing employed student pharmacists to provide medication education, and to assess medication education completion rates.

Summary

Hospital readmissions are often attributable to poor transitions of care (TOC), and medication education prior to discharge may improve TOC. To expand upon existing medication education efforts, the Johns Hopkins Hospital Adult Inpatient Pharmacy (AIP) designed and implemented the REWARDS Method, a training program to prepare employed second- and third-year student pharmacists to provide medication education. The REWARDS Method includes 6 distinct steps, which incorporate student self-directed and pharmacist-facilitated learning. Students were trained to provide patient education targeting 4 classes of high-risk medications (anticoagulants, inhalers, insulin, and naloxone) on multiple inpatient units served by the AIP. A total of 43 hours of pharmacist time was needed to complete training for the 10 employed student pharmacists. A survey was used to assess preparedness for completing medication education. Survey responses indicated that participants were sufficiently to exceedingly prepared to perform medication education. The division’s completion rate for patients requiring education was 79% in 2017, compared to 86% in 2018 (p = 0.006).

Conclusion

The REWARDS Method is an effective training program that successfully incorporated employed student pharmacists into medication education efforts. Our study demonstrated high rates of students successfully completing training and an increase in the rate of patient education completion.

An assessment of counseling quality provided by community pharmacies to type 2 diabetic adult patients for oral therapy: a simulated patient study from Pakistan

This study was conducted to assess quality of counseling provided to type 2 diabetic patients. For this cross-sectional study, a simulated patient method was applied in 562 selected community pharmacies of Punjab, Pakistan. A scenario for the metformin oral therapy was developed that illustrates direct counseling for adult diabetic patients. Counseling and communication skills were also assessed. Descriptive statistics and chi-square tests were used for analysis. Only 29.4% of simulated patients received medication counseling directly; 47.6% received it on request. About 32.8% of clients were referred to a physician without counseling. The most frequently provided information was dietary instruction (94.8%) and dose of therapy (84.5%). Only one quarter (25.3%) of simulated patients were asked about disease duration and similar rate (25.0%) was found for discussions of special warnings. The side effects, drug storage, drug-drug interactions and duration of therapy were ignored. Minimal information was provided about other medication during therapy (0.2%) and effect of medicine withdrawal (2.7%). About 59.5% simulated patients were instructed for compliance to medication. Counseling to type 2 diabetic patients in Pakistani community pharmacies is not very satisfactory. Pharmacies' staff have little focus on counseling. Professional training of staff could improve counseling and communication skills.

Sustaining Effect of Intensive Nutritional Intervention Combined with Health Education on Dietary Behavior and Plasma Glucose in Type 2 Diabetes Mellitus Patients

Diabetes mellitus is very common in elderly Chinese individuals. Although nutritional intervention can provide a balanced diet, the sustaining effect on at-home dietary behavior and long-term plasma glucose control is not clear. Consequently, we conducted a long-term survey following one month of experiential nutritional intervention combined with health education. Based on the Dietary Guidelines for a Chinese Resident, we found that the food items met the recommended values, the percentages of energy provided from fat, protein, and carbohydrate were more reasonable after one year. The newly formed dietary patterns were “Healthy”, “Monotonous”, “Vegetarian”, “Japanese”, “Low energy”, and “Traditional” diets. The 2h-PG of female participants as well as those favoring the “Japanese diet” decreased above 12 mmol/L. Participants who selected “Japanese” and “Healthy” diets showed an obvious reduction in FPG while the FPG of participants from Group A declined slightly. “Japanese” and “Healthy” diets also obtained the highest DDP scores, and thus can be considered suitable for T2DM treatment in China. The results of the newly formed dietary patterns, “Japanese” and “Healthy” diets, confirmed the profound efficacy of nutritional intervention combined with health education for improving dietary behavior and glycemic control although health education played a more important role. The present study is encouraging with regard to further exploration of comprehensive diabetes care.

Practicing Health Promotion Through Pharmacy Counseling Activities

Dramatic changes in the U.S. health care system have emphasized the need to promote good health. To achieve this, different types of health care professionals have now started working together. These teams often include participants, such as doctors, pharmacists, and nurses. However, there are many health professionals, such as pharmacists, working in noninstitutionalized settings, such as pharmacies, who are not being fully utilized. One of the ways pharmacists can promote good health is by counseling patients. This article provides some insights regarding the various health promotion activities that are or can be performed by pharmacists. Health promotion educators can play a significant role in educating pharmacists to become effective health promoters. Some hypothetical scenarios and examples, as well as models, are also provided to demonstrate active health promotion through pharmacist counseling activities.

Discussions between medical providers and children/caregivers about the benefits of asthma-control medications

OBJECTIVES

To describe the content of discussions between general pediatric providers and children and their caregivers about the benefits of asthma-control medication; describe the extent to which these discussions occur; and examine factors that are associated with medication benefit discussions.

DESIGN

Cross-sectional secondary analysis of audiotaped medical visits.

SETTING

Five primary care pediatric clinics in North Carolina.

PARTICIPANTS

35 pediatric providers and 248 children with persistent asthma and their caregivers.

MAIN OUTCOME MEASURES

Presence of discussion about benefits associated with asthma-control medications.

RESULTS

Providers discussed benefits associated with asthma-control medications during 56% of medical visits. Benefits were more likely to be discussed when the child was younger and when medication adherence was discussed during the visit. When providers discussed benefits of asthma-control medications, they were most likely to ask questions and make statements regarding symptom control/prevention.

CONCLUSION

General pediatric medical providers often do not discuss the benefits of asthma-control medications. Pharmacists could fill this information gap by counseling both children and their caregivers about benefits that a child with asthma can expect as a result of treatment.

Pilot testing of a pharmacist led care program for asthma patients in Saudi Arabia

This study aimed at evaluating the usefulness of a structured patient counseling program on clinical outcomes of asthma patients in Saudi Arabia. This cross sectional study enrolled 10 asthma patients and all were evaluated for their baseline knowledge on asthma, quality of life, compliance, patient satisfaction and drug related problems among randomly selected 5 (of the total 10) patients. The median (IQR) age of the patients was 46 (33.5–56.2) years. The baseline knowledge scores was 9 (8–11), the maximum possible scores to be 21. Cronbach alpha of the KQ was 0.65. The overall total median (IQR) compliance (Morisky) score was 4 (3–5), the maximum possible score was 5. The patient satisfaction median (IQR) score was 35.5 (32–46.25), the maximum possible score was 70. Of the total patients 3 (30%) had a history of allergy. There were total 18 allergens observed in these patients. There has been no drug–drug or drug–food interactions observed between among the prescribed drugs of the patients. Altogether 2 patients reported a total of 2 ADRs. The knowledge of the asthma patients was found to be poor. Missing the dose was the most commonly encountered drug taking behavior. The compliance was found to be good and the patient satisfaction was average.

Health literacy: a primer for pharmacists

PURPOSE

The literature surrounding health literacy and its importance in everyday practice are reviewed.

SUMMARY

Health literacy includes a patient's reading, writing, and numeracy skills, as well as his or her cultural experiences, understanding of health concepts and pathophysiology, and basic communication skills. Over one third of the American population lack the skills necessary to understand health information, make health care decisions, or follow medication instructions. Independent risk factors for low health literacy include poor socioeconomic status, ethnicity, older age, and limited education. Mounting evidence suggests that low health literacy leads to poor health outcomes, increased mortality, increases in health care costs, and poorly self-managed chronic diseases. Communication with a pharmacist to gain clarification of medication instructions is often the last opportunity to ensure that patients understand how to use their medications appropriately. Low health literacy is not always easily recognized, as patients use well-practiced coping mechanisms or avoidant behaviors. Clear communication strategies help patients become more involved in their care plans and increase positive interactions. Tools to assess health literacy have been developed and can be used by pharmacists to guide education and counseling. Advanced methods of written and oral communication should be used to improve patient comprehension and understanding.

CONCLUSION

Tools such as simple word-recognition tests or comprehensive tests of functional health literacy can be used in daily practice to assess patients' health literacy. Being familiar with communication techniques such as the Indian Health Service, teach back, and Ask Me 3 can help facilitate individualized medication-related education and maximize patient comprehension.

A standardized patient counseling rubric for a pharmaceutical care and communications course

OBJECTIVE

To restructure a required pharmaceutical care and communications course to place greater emphasis on communication skills and include a high-stakes assessment.

DESIGN

A standardized counseling rubric was developed for use throughout the pharmacy curriculum and the counseling laboratory practicals were changed to high-stakes assessments.

ASSESSMENT

An annual mid-semester and end-of-semester high-stakes patient-counseling objective structured clinical examination (OSCE) conducted prior to and after revision of the course and counseling rubric documented improvements in students' scores. Performance on the post-course annual assessment patient counseling OSCE improved compared to that on the pre-course (p<0.001).

CONCLUSION

The 2010 course revision improved students' medication counseling abilities and readiness to practice. Major course revisions should be undertaken only after input from all stakeholders and with data to support the need for change.

Implementation and evaluation of a workshop on patient counseling about antidiabetic medications for final-year pharmacy students

OBJECTIVE

To implement an interactive workshop for final-year pharmacy students on patient counseling about antidiabetic medications and to assess its impact on knowledge and self-reported confidence of students in counseling.

SUBJECTS AND METHODS

The workshop was organized for all final-year pharmacy students (n = 27) during the academic year 2011-2012. It included various teaching and learning activities: interactive lectures, group work and role-playing. Pre-/postworkshop questionnaires were used to assess the impact of the workshop on students' knowledge about medications and attitudes to patient counseling, respectively. The workshop and the teaching activities were evaluated using an evaluation sheet. Data were analyzed using SPSS version 17. Paired Student's t test was used to compare the results of pre-/postintervention instruments. Statistical significance was accepted at a p value of <0.05.

RESULTS

The mean ± standard deviation of the pre- and postworkshop knowledge questionnaire scores were 47.9 ± 17.6% and 70.7 ± 18.6%, respectively (p < 0.05), indicating that the workshop significantly improved students' knowledge about antidiabetic medications. It also had significant effects on students' self-reported confidence in communicating effectively with patients and counseling them on antidiabetic medications. All participants strongly agreed that the workshop was very useful. The case discussion in small groups was ranked as the most preferred learning method by the students.

CONCLUSION

This workshop was successful in improving knowledge and self-reported confidence of pharmacy students in counseling patients about antidiabetic medications. Adapting the use of engaging teaching methods allowed the students to become active, independent and self-directed learners and thus enhanced their confidence in providing pharmaceutical care to patients.

Effect of a diabetes counseling programme on knowledge, attitude and practice among diabetic patients in Erode district of South India

The prevalence of diabetes in India has grown over the past decade. Diabetic patients develop complications due to poor awareness regarding the disease and inadequate glycemic control. Patient education is the most effective way to lessen the complications of diabetes and its management. A total of 207 (85 males and 122 females) type 2 diabetes mellitus patients were enrolled and randomized into test and control groups. Patients in the test group received counseling at each visit and information leaflets from the pharmacist; the control group patients received counseling and information leaflets only at the end of the study. A validated knowledge, attitude, and practice (KAP) questionnaire was administered to both test and control group patients at baseline and at final follow-up to assess awareness regarding disease management. Glucose and lipid levels were also evaluated at baseline and final follow-up in both the groups. At the end of the study, the KAP score of test group patients improved significantly (P<0.0001), whereas no significant changes were observed in control group patients. The postprandial blood glucose (PPBG) levels decreased significantly in the test group. Total cholesterol (TC), triglycerides (TGL), and low density lipoprotein levels (LDL) also showed a decrease in the test group. Thus, our study reveals that pharmacist counseling might be an important element in diabetes management programs.

Attitudes and behaviors of practicing community pharmacists towards patient counselling

The present study was conducted to assess the attitudes and behaviors of practicing community pharmacists towards patient counselling and use of patient information leaflets in the state of Karnataka. Convenient sampling method was adopted to collect the responses with the help of self-completion questionnaires. A total of 258 practicing community pharmacists in the age group of 22–60 y of both gender with practicing experience of 2-30 y participated in the study. Majority of respondents (80%) agreed that, patient counselling is their professional obligation. About 17% of the respondents mentioned that, they try to give basic information regarding drug usage to the patient. The reasons stated by the pharmacists to provide patient counselling were, professional satisfaction (43%), patients go with satisfaction (32%), observed increase in sales (8%), and also improved patient compliance (7.5%). The major barriers for offering patient counselling were mentioned as pharmacists' inadequate knowledge and confidence (78%), doctor dispensing (72%), no professional fee (56%), poor response from patients (82%), inadequate continuous professional development programs (75%). Many respondents agreed that, patient information leaflets certainly help in counselling but available information leaflets are company generated and prescriber focused. Many respondents found the present continuing professional development module was useful and are interested in weekend workshops to update their professional knowledge (83%). Restrictions on doctor dispensing, legalization of patient counselling, regular continuing professional development programs are the factors observed to motivate the pharmacists to offer patient counselling.

Evaluation of the community pharmacist's behavior towards a prescription of antidiabetic and antiasthma drugs

OBJECTIVE

The objective of this study is to assess the performance of community pharmacist towards antidiabetic and antiasthma prescriptions, and also to assess the lack of information provided by community pharmacists regarding patient counseling and missing data, using a simulated patient technique.

METHODS

A prescription including antidiabetic and antiasthma drugs was used by simulated patient to assess community pharmacist's performance in 194 pharmacies. A performance assessment sheet was used to measure the patient counseling process. A quantitative descriptive and comparative analysis was done for the collected data. Pearson chi-square test (crosstabs) was used with a level of significance 95%).

RESULTS

The analysis of the 194 pharmacies visited revealed that most of the pharmacists were male (61%), Arabs (35%) and Indians (55%) with some other nationalities. The dispensing time in the pharmacy ranged between 2 to 10 minutes. Spending time with patients was not affected by gender (p-value 0.087), slightly affected by nationality (p-value 0.04), and highly affected by age (p-value 0.002) leaning towards older pharmacists who spent more time with patients than younger pharmacists. Most pharmacists (90%) started preparing the prescription once they received the prescription with no actual prescription screening. fifty five percent of the pharmacists asked about the duration of the treatment after preparing the prescription. ninety six percent did not counsel patients about diet, exercise and lifestyle changes. Less than 40% asked if the prescription was intended to be used for the same patient.

CONCLUSION

This study recommends that health authorities consider follow up plans in order to ensure the best pharmaceutical care is provided by community pharmacies.

The use of consultation skills assessment tools in pharmacist-patient consultations

Objective

The consultations assessed in this study occurred as part of a larger randomised controlled trial (the HeartMed trial) which was evaluating the impact of home visits by pharmacists to patients with heart failure. Pharmacists are increasingly being expected to take on roles involving extended interviews with patients, but while the doctor-patient consultation has been well researched, such analysis has rarely been undertaken in pharmacy practice. The aim of this study was to analyse the consultation skills used by pharmacists using two validated consultation skills assessment tools (the Henbest and Stewart rating scale and the SEGUE score), and to assess the applicability of these tools to the pharmacist-patient consultation.

Setting

The study involved pharmacist consultations with patients who were aged over 18 years, living in independent accommodation and were prescribed two or more medicines taken on at least a daily basis. These patients were recruited to the HeartMed trial during an acute admission to hospital with heart failure, and were visited by a pharmacist during the first six weeks following hospital discharge.

Method

The pharmacist-patient consultations were tape-recorded, transcribed and evaluated using two different consultation skills tools — the Henbest and Stewart rating scale which assesses ‘patient centredness’ and the SEGUE score which assesses the content of the consultation.

Key findings

Both consultation skills tools were easily applied to the pharmacist-patient consultations. The pharmacists scored well on both the tools despite relatively little formal training.

Conclusions

Existing consultation skills tools can be used to assess pharmacist-patient consultations.

Perfil da assistência farmacêutica na atenção primária do Sistema Único de Saúde

Este artigo apresenta uma revisão e análise da assistência farmacêutica como parte integrante do sistema de atenção primária à saúde, no qual a qualidade do uso de medicamentos está diretamente relacionada à qualidade do serviço de saúde e aos elementos para a avaliação desta. As Unidades Básicas de Saúde constituem a principal porta de entrada do sistema de assistência à saúde estatal em nosso país. Entretanto, o vínculo do serviço farmacêutico está relacionado com o modelo curativo, centrado na consulta médica e pronto atendimento, com a farmácia apenas atendendo a essas demandas. A atividade de orientação aos usuários na farmácia das Unidades Básicas de Saúde torna-se praticamente impossível, pois na farmácia deságuam quase todas as mazelas do sistema de saúde, por estar no elo final do processo de atendimento. A solução do problema, no âmbito geral, não será simples, se mantida a forma como o serviço está estruturado, pois grande parte das pressões de demanda não depende do serviço de saúde em si, mas de políticas sociais inclusivas, as quais têm impacto direto nas condições de saúde da população. No âmbito específico, é fundamental que os gestores racionalizem a utilização dos medicamentos desde a prescrição até a utilização por parte do usuário.

An inquiry into medication meanings, illness, medication use, and the transformative potential of chronic illness among African Americans with hypertension

BACKGROUND

Hypertension is a chronic illness with serious economic and clinical consequences. The asymptomatic nature of this condition contributes to the challenge of persistent medication use.

OBJECTIVES

The objectives of this qualitative study were to explore perceptions of medication meanings, illness, identity, and biographical disruption among people with hypertension, and to examine how salient themes and categories relate to medication use.

METHODS

In-person interviews were conducted with 20 participants. Eligibility criteria included being 18 years or older, diagnosed with hypertension, and currently taking antihypertensive drug treatment. Interviews were tape-recorded and transcribed. Data were analyzed with grounded theory methodology using coding techniques and constant comparison.

RESULTS

All participants were African American and most were between 45 and 64 years. Key themes including perceptions of the medication being effective, lifesaving, part of life, and a reminder of the regimen were found to have a positive impact on medication use. Themes including fear of side effects, fear of dependency, forgetting to take medication, the medication being a hassle, and the experience of medication-related sexual side effects were found to be negatively related to medication use. Participants were cognizant of consequences of uncontrolled hypertension, and illness control was important to them. Biographical disruption was minimal. Taking medications and changing diet were the most significant changes in the lives of participants after being diagnosed with hypertension. Achievement of lifestyle modifications had a positive impact on identity.

CONCLUSIONS

Findings contribute to our understanding of medication use behavior and have implications for patient education and counseling.

Development and validity of a method for the evaluation of printed education material

Objectives

To develop and study the validity of an instrument for evaluation of Printed Education Materials (PEM); to evaluate the use of acceptability indices; to identify possible influences of professional aspects.

Methods

An instrument for PEM evaluation was developed which included tree steps: domain identification, item generation and instrument design. A reading to easy PEM was developed for education of patient with systemic hypertension and its treatment with hydrochlorothiazide. Construct validity was measured based on previously established errors purposively introduced into the PEM, which served as extreme groups. An acceptability index was applied taking into account the rate of professionals who should approve each item. Participants were 10 physicians (9 men) and 5 nurses (all women).

Results

Many professionals identified intentional errors of crude character. Few participants identified errors that needed more careful evaluation, and no one detected the intentional error that required literature analysis. Physicians considered as acceptable 95.8% of the items of the PEM, and nurses 29.2%. The differences between the scoring were statistically significant in 27% of the items. In the overall evaluation, 66.6% were considered as acceptable. The analysis of each item revealed a behavioral pattern for each professional group.

Conclusions

The use of instruments for evaluation of printed education materials is required and may improve the quality of the PEM available for the patients. Not always are the acceptability indices totally correct or represent high quality of information. The professional experience, the practice pattern, and perhaps the gendre of the reviewers may influence their evaluation. An analysis of the PEM by professionals in communication, in drug information, and patients should be carried out to improve the quality of the proposed material.

Health care providers' influence on HIV-infected women's beliefs and intentions related to AZT therapy

This study examined how women's relationship with their primary health care provider (PHP) and their perceptions about how effective their PHPs believe zidovudine (AZT) to be in decreasing perinatal transmission related to women's AZT beliefs and intentions. It used a cross-sectional design to collect data from 59 HIV-infected African American women. Almost half the women (45%) had given birth since HIV diagnosis. Most of the babies born to HIV-infected mothers (87%) were seronegative. Data analysis with Pearson's r indicated that the quality of the women's relationship with their PHP was positively correlated to how important the PHP would be in decision making related to AZT therapy. Significant positive correlation was observed between women's perceptions about how effective their PHPs believed AZT to be in decreasing perinatal HIV transmission and the women's own beliefs about AZT, their intent to take AZT if pregnant, and intent to give AZT to a newborn.

Adherence to combination therapy in persons living with HIV: balancing the hardships and the blessings

Evidence from clinical trials demonstrates the benefits of combination therapy in persons living with HIV (PLWHIV); however, there is little information about the patient's experience when taking a complex regimen. Thus, the primary purpose of this preliminary study was to describe the everyday experience of PLWHIV who were prescribed combination therapy in order to identify a potential intervention to enhance adherence to this regimen. The secondary purpose was to examine the association between adherence to combination therapy and quality of life. The researchers purposively sampled six PLWHIV (two women and four men) to reflect the diverse demographic characteristics of the population of PLWHIV. The themes that evolved were decision making, difficulties, problem solving, and quality of life. Clinical indicators provide only one measure of the effectiveness of combination therapy. When the informants described the outcome of this therapy as "having their life back," they spoke of having quality in their lives that they viewed as more than their physical health.