What should be noted when implementing counseling skills in practical communication at drug-retailing establishments in Vietnam?

What should be noted when implementing counseling skills in practical communication at drug-retailing establishments in Vietnam?

Pursuant to Subsection 2.2.4.c Section 2.4 Chapter II Practical manual at drug-retailing establishments (Issued together with Decision 696/QD-QLD in 2021) prescribes some notes when performing counseling skills in practical communication at drug-retailing establishments as follows:

Avoid using technical jargon

Patients or customers often have little or no professional knowledge of medicine, so professional words are difficult to understand. Pharmacists - drug retailers should avoid using professional words, and should use simple words that are easy to understand.

For example, a pharmacist - a drug retailer who wants to find out the side effects that patients experience when using a drug should not ask, " Did you encounter any ADR while taking this drug?" The word ADR is a technical term and the patient may not understand what it means. In this situation, the pharmacist-retailer should ask the patient, "Did you notice any unusual symptoms while taking this medicine?" .

Pharmacists - drug retailers need to pay attention to the patient's symptoms, check the information if the patient is confused by asking questions. When asking a question to find out about the patient's understanding, you should ask "Is there anything that you are not clear about?" this is better than saying “Do you understand what I am saying?”. With the first way of saying it will make customers more comfortable because the unclear information here is the fault of the drug retailer.

Make sure the patient is not too worried when being consulted

The psychology of customers when coming to the pharmacy is often lack of calm, fear, shyness or anger… This may be the customer's nature, it may also be due to the influence of illness or other personal problems. One study showed that anxiety levels and the ability to remember information are related.

If pharmacists - drug retailers see that customers are very worried, they should pay attention and remind customers to pay attention to the information exchanged. For example, in a situation where a female customer goes to the pharmacy to buy fever-reducing medicine for her child and the drug retailer sees that the customer is very worried, she should say: "I know you are very worried so you can go home and give the baby some medicine. But it is very important that me teach you how to use this medicine correctly. Please listen carefully."

If the pharmacist-retailer sees that the patient is not worried and likely will not comply with the treatment, it is necessary to remind the patient to pay attention. “It is very important to take these pills for the full five days. If you don't drink enough time, you can get pneumonia again. Then the treatment will be more difficult and you may have to take a longer time off work.”

Amount of verbal advice appropriate to an exchange

When the amount of information is small, the ability to remember all the information is better. When the amount of information is less, the ability to remember information decreases.

When the amount of information is more than 3, customers tend to not remember all the information exchanged. Therefore, pharmacists - drug retailers must know how to analyze the situation to select information that is considered important, usually 3 to communicate verbally with patients. If the pharmacist - drug retailer has more than 3 information to exchange, then other measures must be used to help the patient get the necessary information.

Important information is provided at appropriate times during the consultation period

There is a relationship between the time of exchange and the information being remembered. An evaluation study on the relationship between the location, the time of providing information and the ability to remember (Figure 2.4) showed that at the beginning and the end of the counseling period, the ability to remember information is the best. Therefore, it is important for the pharmacist - the drug retailer to choose to exchange at the beginning or the end of the consultation period with the patient. With new drugs used by the patient for the first time or a new prescription with a patient, the information that is considered important to exchange with the patient is information about the disease and the drug (effects, usage, storage,...). When advising on drug use in situations where patients have used drugs or prescriptions many times, becoming familiar, pharmacists - drug retailers also need to evaluate their experience, patients' perceptions of drug use. The information drug retailers need to exchange with patients are: feelings about the effectiveness of the treatment regimen, of the drug; the control of disease symptoms when using drugs; the actual effects encountered when using the drug; the reason why the patient stopped or changed the medication or treatment regimen (adherence to treatment).

The information provided should be clear to avoid misunderstandings

Information if given is not specific and clear, it may cause the patient to misunderstand leading to errors in treatment.

Pharmacists - drug retailers cannot control how patients understand the information received. Therefore, the pharmacist-retailer must always remind himself of what can happen and ensure that the retailer's communication is as clear as possible.

In addition, during the consultation process, the pharmacist - the drug retailer must respect the patient's point of view. Patients have their own opinions about medications and their health status. This is not necessarily based on 'scientific evidence' but should be respected and understood. Patients may give verbal or nonverbal cues to express opinions or feelings about health issues. Understanding patients' views and emotions helps pharmacists - drug retailers to build good relationships with patients, making it easier for them to follow advice on drug use and lifestyle changes. For example, when a patient walks into a pharmacy and tells a drug retailer that they have just been diagnosed with cancer. Instead of immediately asking about the purpose of going to the pharmacy, the pharmacist-retailer can talk about their feelings or the impact on their family.

Evaluation to ensure that the patient remembers the counseling information

Pharmacists - drug retailers need to assess whether the patient understands the information provided by asking or asking the patient to describe how he or she will use the medication or by asking the patient to try the equipment. supportive treatment such as inhaler/spray. When checking that the patient remembers the information exchanged, the pharmacist - the drug retailer should apply the technique of "teach back" or "show me" to the patient. Confirm that the patient has fully understood the information instructed through the skill of reflecting, repeating, and summarizing information. For example, "I want to make sure that everything I explain is correct. If you need instructions on how to use this medicine for your husband" or "Can you tell me how to use this spray?"

Coordinating both oral and written language in counseling

When planning treatment for patients, pharmacists - drug retailers should use both oral and written language (instructions for use, drug labels, through leaflets, preparation of drug use tables, etc.) . When communicating with patients in written language, pharmacists - drug retailers need to create a focal point to help patients remember where to find information. Keep product information (brochures, instructions for use) in a place where both the retailer and the patient can see it, or use the written information as a guide for consultation (prepare, mark important points). At the same time, pharmacists - drug retailers need to monitor patient feedback during the exchange process, avoiding making the information the retailer writes down the sole focus point. Some notes when using written language in communication at pharmacies:

Use an ink color that contrasts with the paper color such as black or blue on a white background.

- Write clearly, easy to read.

- Label title must be specific.

- Record the time on the label.

- Full information, avoid ambiguity, unclear.

- Write information according to the form or according to regulations on mandatory contents for retail drugs without external packaging attached.

- Sign and specify title (if necessary).

- Additional labels or additional information are required in some special cases.

Coordinating the use of a number of guiding methods and techniques when conducting consultations (if possible)

When conducting consultations, if possible, pharmacists - drug retailers should use some measures and techniques to help patients easily remember how to use drugs, especially in situations where the prescription is being evaluated for the patient. There are many different reasons why a prescription is considered complicated for patients, such as: (1) The frequency of taking the drug more than twice a day or the drugs being used diversely at other times. each other during the day. Some studies have shown that when the frequency of drug use is greater than twice a day, patients tend to have a lower adherence to treatment. (2) Problems related to the dosage form of the drug such as difficult to use dosage forms or complicated instructions for use or prescriptions with many different dosage forms also make it difficult for patients to use medicine. (3) In addition, additional instructions to ensure that the patient can use the correct medication can also cause confusion for the patient. Therefore, to ensure the effective treatment of drugs, pharmacists - drug retailers need to take notes, remind and find suitable solutions for patients.

For drugs whose dosage forms or ways of use are considered complicated and difficult for patients, pharmacists - drug retailers can use methods and techniques such as modeling or using tissue devices to teach the patient how to use it. In addition, the application of the "teach back" technique in this situation is often chosen by pharmacists - drug retailers. Encouraging patients to practice right in front of the drug retailer how to use the drug will help the pharmacist - the drug retailer to assess whether the patient is using the drug correctly and make adjustments if necessary. Or using a combination of instructions for use during the consultation process will also help patients use the drug more easily, this is especially useful in case the instruction sheet has pictures describing the operations.

Pharmacists - drug retailers may also recommend a simpler dosing regimen to the patient or physician, such as using a slow-release tablet to help reduce the frequency of medication or use a combination product. It helps to reduce the number of drugs that must be used in the prescription. If possible, the patient should be advised to use the same dosage form, device to deliver the drug into the body.

In addition, pharmacists - drug retailers need to help patients make a drug use plan in accordance with their daily routine. This will help facilitate and increase treatment adherence in patients. In case the prescription is too complicated, the pharmacist - the drug retailer can help the patient to make an appropriate drug use table or advise the patient on the use of dosing devices.

In case there is a need for additional notes for the patient, the pharmacist-retailer needs to find a solution to help simplify the instructions so that the patient can follow. Pharmacists - drug retailers must give specific instructions on how to use the drug for the patient so that the patient can break or crush the pill before using it more easily. For drugs that require dissolving the powdered drug in water to form a suspension or emulsion before use by a pharmacist - drug retailers should also have reminders. For drugs that when used for patients must be calculated by weight or age, the pharmacist - drug retailer also needs to calculate the dose in terms of simple dose units for the patient. For example, the instructions to use paracetamol instead of saying the dose is 10-15mg/kg pharmacists - drug retailers should convert to a dose unit of one pack or one tablet each time. For drugs that are used in different doses or on alternate days, the drug retailer should convert specifically to a drug use schedule so that patients can adhere to it and use it easily. For example, Monday 2-4-6 take one pill, Tuesday 3-5-7-Sunday take two pills. Some drugs to have a good effect on patients need to be taken at a certain time or to increase absorption need to be used away from meals or when eating, pharmacists - drug retailers also need to instruct patients to disease know and obey. The drug retailer also needs to advise the patient when the drug interacts with food and drink so that the patient knows and avoids it.

Some patient cases need to be noted when consulting

In case the patient has a serious or malignant disease, it is necessary to consult to help the patient understand the disease, the route of examination and treatment, and the patient to have a better psychological and more comfortable treatment. Pharmacists - drug retailers also need detailed advice in case the patient has many comorbidities because in these cases the patient has to use many drugs, easy to occur drug interactions.

In case the patient has to use drugs with a narrow therapeutic range or when the patient has to take many drugs with different ways of using the drug, the pharmacist - the drug retailer must give full advice to ensure that the patient can use the drug proficiently and correctly use all forms of medication.

In case drug users are special subjects such as the elderly, or patients unable to self-administer the drug (children, seriously ill ...) or patients with a history of non-compliance with treatment, not responding well to treatment, have a history of side effects, or foreigners, ethnic minorities have difficulties, language differences, pharmacists - drug retailers also need to pay more attention to the advise process.

Best Regards!