Patient Education and Counselling

Communication
Communication is two-way process of information sharing between patient and health care provider Patient counselling
provides an opportunity to elicit the necessary information from a patient, and to enable safe and effective use of
medicines. Patients have the right to expect that the pharmacist will counsel them privately about their medicines …
Counselling is also the final checking process to ensure the correct medicine is supplied to the correct patient. (Pharmacy
Board of Australia)

It is the process in which messages are generated and sent by one person and received by other person

Purposes
 To improve the health of the patient by solving drug related problems
 Reduce medication errors
 To improve prescribing practices
 To enhance patient monitoring
 What to Communicate
 Purpose of medication
 How medication works
 Dose and duration of the therapy
 Goals of the therapy
 ADR monitoring
 Drug specific issues

How to Communicate/Counselling
Develop suitable therapeutic relationship

Start with patient name, give self introduction, describe the purpose of your presence

Verbal Communication
Use suitable words, ask direct questions, ask indirect questions, effective communication involves good mixture of both
direct and indirect questions.

Non-verbal Communication
Establish eye contact with patient, facial expression, tone of voice, body language and gesture

Listen
Passive listening

When pharmacist listen to the patient

Active listening

When two way communication is present

 Communication Barriers
 Language barrier
 Environmental barrier
 Choice of words
Complementary and alternative medicines (CAMs)
 Complementary and alternative medicines (CAMs) are treatments that fall outside of mainstream healthcare.
 These medicines and treatments range from acupuncture and homeopathy, to aromatherapy, meditation and colonic
irrigation.
 There's no universally agreed definition of cams.
 Although "complementary and alternative" is often used as a single category, it can be useful to make a distinction
between the 2 terms.
 The us national centre for complementary and integrative health when a non-mainstream practice is used instead of
conventional

(NCCIH) uses this distinction:

 When a non-mainstream practice is used together with conventional

 Medicine, it's considered "complementary".
 Medicine, it's considered alternative".
 There can be overlap between these categories.

For example, aromatherapy may sometimes be used as a complementary treatment, and in other circumstances is used as
an alternative treatment. A number of complementary and alternative treatments are typically used with the intention of
treating or curing a health condition.

For example, aromatherapy may sometimes be used as a complementary treatment, and in other circumstances is used as
an alternative treatment.

Examples

 Homeopathy
 Acupuncture
 Herbal
 Aromatherapy

Deciding to use complementary or alternative treatments to understand whether a treatment is safe and effective, we need
to check the evidence.

Some complementary and alternative medicines or treatments are based on principles and an evidence base that are not
recognised by the majority of independent scientists.

Others have been proven to work CAMs and regulation

The practice of conventional medicine is regulated by laws that ensure that practitioners are properly qualified and adhere
to certain standards or codes of practice. This is called statutory professional regulation.

Acupuncture

Acupuncture is treatment derived from ancient chinease medicine. Fine needles are inserted at certain sites in the body for
Therapeutic purpose. It involves stimulating sensory nerves under the skin and in the muscles.

This results in the body producing natural substances, such as pain relieving endorphins. It is likely that these naturally
released substances are responsible for the beneficial effects experiences with acupuncture.

A course of acupuncture usually creates longer lasting pain relief than when a single treatment is used.

Traditional acupuncture is based on the belief that an energy, or life force, flows through the body.in channels called
meridians. This life force is known as qi.

Practitioners who use acupuncture in the traditional way believe that when qi does not flow freely through the body, this
can cause illness.
They also believe acupuncture can restore the flow of qi and so restore health.

Uses

Acupuncture practitioners, known as acupuncturists, use acupuncture to treat wide range of health conditions. However,
the use of acupuncture is not always based on rigorous scientific evidence.

National institute for health and care excellence provides guidelines for the following treatments

Chronic tension type headaches

Migraines

Acupuncture is also often used to treat musculoskeletal condition Like

Chronic pain, such as neck pain, Joint pain, Dental pain, Postoperative pain

How acupuncture is performed

An initial acupuncture session usually lasts 20 minutes to 1 hour and involves assessment of your general health, medical
history and a physical examination, followed by insertion of the acupuncture needles.

The needles are inserted into specific places on the body, which are known as acupuncture points.

During the session, you will be asked to sit or lie down. You may also be asked to remove some clothes so the
practitioner can access certain parts of the body.

The needles used are usually a few centimetre long.

They should be single use, pre-sterilised needles that are disposed Of immediately after use.

Acupuncture practitioners choose specific points to place the needles based on your condition.

Several points may be used during a typical session, depending on

The number of symptoms you have.

The needles may be inserted just under the skin, or deeper so they reach muscle.

Once the needles are in place, they may be left in position for a length of time lasting from a few minutes up to around 30
minutes.

You may feel a tingling or a dull ache when the needles are inserted but you should not experience any significant pain.

When it is done by qualified practitioner, acupuncture is generally very safe.

Some mild, short term side effects are present like; pain at place of needles Bleeding, Drowsiness, Feeling sick,
Worsening the pre-existing symptoms

Aromatherapy
Aromatherapy is the systematic external use of essential oils in treatments to improve physical and emotional well-being.
Essential oils, extracted from plants, possess distinctive therapeutic properties, which can be utilised to improve health
and prevent disease.

These natural plant oils are applied in a variety of ways:

 Massage (most used method)

 Baths (add a few drops to warm water)
 inhalations (not for asthmatics)

Aromatherapy is an especially effective treatment for stress related problems and a variety of chronic conditions. It can be
used on any age but the training is required to ensure the aromatherapist blends oils safely as they are chemical
substances which can be harmful if misused.

Examples

Massage with almond oil + lavender oil (20 minute treatment session on feet, legs, hands, arms and forehead, two
consecutive days): effective for anxiety

Massage with plain orange oil + any oil as base (20 minutes on feet): effective for anxiety

Massage with lavender oil (15-30 minutes session on hands, arm, Feet): anxiety and mood

Chamomile oil alone or together with some base (one treatment per week for three consecutive sessions): effective for
anxiety, tension

Bath aromatherapy

You can add aromatherapy, in the form of essential oils, vegetable oils, and salts to the bath, if you use a suitable
dispersing agent. A dispersing agent, such as coconut emulsifier, or bath gel, helps to ensure that the essential oils,
vegetable oils, and bath salts are properly diluted in the bath water.

In general, you can use approximately 2 -12 drops of an essential Oil to one teaspoon of the dispersing agent, depending
upon the Essential oil and/or the dispersing agent. Note that vegetable oils Will make the bath tub slippery.

Bath aromatherapy may be helpful in

Stress and anxiety

Chronic pain

Muscle and joint pain

Detoxification

Stimulation circulation

Skin health

Fatigue and exhaustion

Inhalation aroma therapy

Aromatherapy steam inhalation is particularly useful for colds, flu, sinus infections, and congestion in the nose and chest.
It may also help with respiratory problems such as asthma and bronchitis.

Add upto 6 drops of essential oil to boiling Water

fill up a bowl with required amount of water Place bowl on table

cover head with towel lean over the bowl and breath

Examples

 Eucalyptus
 tea
 lemon
 Thyme

Aromatherapy spray

Aromatherapy sprays are made up of essential oils, water, and a Dispersant

Use aromatherapy sprays as body and facial sprays, to energize or clear a space, as a room spray, in massage practice, or
simply to

 Cleanse the air.

 They can be used for both emotional and physical problems.0
 Aromatherapy diffusion
 There are many different types of aromatherapy diffusers Used for Stress and anxiety Insomnia
 Purify the air Increase motivation
 Reduce fatigue
 Increase mental alertness
 Relaxation

Limitations

Chemical sensitivities

Allergies

Pets

Medical complications

Herbal medicine
Herbal medicines are those with active ingredients made from plant parts, such as leaves, roots or flowers. But being
"natural" doesn't necessarily mean they're safe for you to take. Just like conventional medicines, herbal medicines will
have an effect on the body, and can be potentially harmful if not used correctly.

They should therefore be used with the same care and respect as conventional medicines, if you're consulting your doctor
or pharmacist about health

Matters, or are about to undergo surgery, always tell them about any herbal medicines you're taking.

Philosophy

Classification of humans with reference of temperament on the basis of histology & body fluids. The exact etiology and
pathology on the basis of temperament. Health is restoring through natural drugs and physiotherapy which leads To less
or negligible possibility of adverse effect.

There are four states (hotness, coldness, dryness and moistness circling around us alternatively in the form of seasons
(summer, autumn, winter And spring).

These qualities (kafiyat) are also present in our body, when the equilibrium is maintained between the external and
internal states a person is said to be in healthy state

If the equilibrium between these states of suitable internal environment according to the external environment is disturbed
or if body fails to maintain it, the person will be diseased.

So heart, brain, vessels, liver, skin, autonomic nervous system and endocrine system (hormones), metabolism are all
assistants to tabiat and tabiat is responsible to maintain the individual's temperament. The temperament of heat,
moistness, coldness and dryness interact with each other in nature in such a way that one active temperament and one
passive temperament combine to give rise to a compound qualitative effect, e.g. Heat can be combined with dryness or
moistness resulting in hot & dry qualities or hot & moist temperament.

Temperaments are always experienced in duality, either:

Hot and moist or cold and moist or dry and hot etc.

Temperament depends upon fluids and biochemistry fluids are of three types Intracellular Tissue fluids, Blood

Temperament of body fluids

Blood (hot and moist)

Balgham (cold and moist)

Yellow bile (hot and dry) black bile (cold and

Homeopathy

homeopathy is a "treatment" based on the use of highly diluted substances, which practitioners claim can cause the body
to heal itself.
A central principle of the treatment" is that like cures like" - that a substance that causes certain symptoms can also help
to remove those symptoms.

A second central principle is based around a process of dilution And shaking called succussion. Practitioners believe that
the more a substance is diluted in this way, the greater its power to treat symptoms.

Many homeopathic remedies consist of substances that have been diluted many times in water until there's none, or
almost none, of the original substance left. Homeopathy is used to "treat" an extremely wide range of conditions,
including physical conditions such as asthma and psychological conditions such as depression.

When is it used?

Homeopathy is used for an extremely wide range of health conditions. Many Practitioners believe it can help with any
condition. Among the most common conditions that people seek homeopathic

Treatment for are:

 Asthma
 Ear infections
 Hay fever
 Mental health conditions, such as depression, stress and anxiety
 Allergies, such as food allergies
 Dermatitis (an allergic skin condition)
 Arthritis
 High blood pressure
Health policy and system research

Definition

Health Policy and System Research (HPSR) can be defined as; that seeks to understand and improve how societies
organize themselves in achieving collective health goals, and how different actors interact in the policy and
implementation processes to contribute to policy outcomes. By nature, it is interdisciplinary, a blend of economics,
sociology, anthropology, political science, public health and epidemiology that together draw a comprehensive picture of
how health systems respond and adapt to health policies, and how health policies can shape - and be shaped by - health
systems and the broader determinants of health.

Is multidisciplinary research field, distinguished by the issues and questions addressed through the research rather than by
particular disciplinary base or set of methods. Includes research that focus on health services as well as on the promotion
of health in general Includes concerns for global and international issues as well as national and sub-national issues, as
global forces and agencies have important influences over health systems in low and middle income countries
Encampasses research on or of policy which means that it is concerned with low policies are developed and implemented

Four central elements in HPSR are

Health system

Health policy

Health system development or strengthening

Health policy analysis

Goals

The defining goal of health systems is generally seen as health improvement, achieving not only through the provision of
curative and preventive health services but also through the protection and promotion of public and emergency action.

Wider goals include, equity, or fairness, in the distribution of health and the costs of financing the health systems as well
as protection for households from catastrophic costs associated with disease, responsiveness to the expectations of the
population and promotion or respect of persons

Last two goals require, ethical integrity, citizen's right, participation and involvement of health system users in policy
development, planning and accountability along with building and maintaining the social relations

Elements and characteristics

It includes three parts Encompassing the population as well as the supply or delivery of service, the members of
population play following roles Patients with health needs Consumers with expectation of how they will be treated
Taxpayers who provide the main source of financing for the system Citizens who may have access to health care

Elements and characteristics; Functions/services performed as

 Service delivery
 Health workforce
 Information
 Medical products, vaccines and technologies
 Financing
 Leadership/governance
 Incorporation of services by

General curative and preventive services aimed at specific problems, Including specific disease control programs and
personal and population based services A range of modes or channels of service delivery including various levels of
facility, other outlets for health goods (pharmacies or shops) and other strategies (e.g. community based health workers
and activities)

A complex mixture of service providers (public, private, for profit and not profit, formal and informal, professional or
non-professional, allopathic or tradition)

Multi-levels of operation

Balancing policies, strategies, resources allocation and health worker reward system Coordination across functions and
services delivery activities and interventions. The development of policy and regulations Engaging with health system
actors, including citizens. Interaction with other national agencies that influence health as well as international agencies
and process Systems should respond to local needs and circumstances, should coordinate among local actors and should
manage health services, activities and health workers, supervision and training of service providers and adaptation of
health policy.

Health Policy can be understood as

Courses of action that affect the sets of institutions, organization, services and funding arrangements of the health system.
It Includes policy made in the public sector as well as policies In the private sectors.

Commonly health policies are understood as the formal, written documents, rules and guidelines that present policy
makers decisions about what actions are deemed legitimate and necessary to strengthen the health system and improve
health.

Health systems are shaped by both structural components and social elements. In order to identify actions to develop or
strengthen health systems researchers need to consider Changes in the structure of the system What can be done to
influence the behaviour and practices of both health system agents how to implement both sets of changes in ways that
are most likely to secure intended effects. These system level interventions sometimes focus on more than one of the
building blocks, such as pay for performance systems that together address human resources and financing issues
alternatively, through the governance of Information building blocks, such intervention can encompass process and
strategies that bring about changes across the system as a whole that is, across system building blocks, levels and/or
dimensions Structural as well as elemental components of health systems may together be addressed by, for example, new
accountability mechanism or process and monitoring and evaluation strategies, There is also potential for new leadership
and management approaches to focus on the deliberate development of the institutional and relational nature of the health
system
Some disease or program specific interventions also have system wide effects, such as scaling up antiretroviral therapy or
integration vouchers for malaria prevention bed nets

However, most disease program or service specific strategies are unlikely by themselves to bring about improvements
across the health system.

Strategies

Such strategies suffer one or more of the following weakness Limit the policy options considered in system improvement
by focusing more on actions at all levels (local, national and international levels)

Crowd-out routine activities (when a number of training activities occurs at the

expense of service)

Achieve short-term goals (as when donor funded financial incentives

Health policy analysis

Health policy analysis is a central strand of HPSR.

 It is sometimes understood as the technical work that underpins the development of new policies or the central element of
their evaluation.
 It includes, for examples, epidemiological analysis that identifies risk factors for particular diseases and the important
targets for health interventions; cost effectiveness analysis that identifies which of several possible interventions to
address a particular health problem provides the best value for money.
 However, a more political and organizational approach to policy analysis sees policy itself as a process, the process of
decision making, rather than focusing only on policy as the outp process or as a management input
 Technical analysts often conceive of policy analysis as including several stages, such as getting a problem or issue
prioritized for policy action, defining what the problem is and what objectives would represent an improvement to it,
identifying the causes of the problem and how they are inter linked, identifying the possible interventions that would
address the factors causing the problem, considering options for intervention, implementing selected options, evaluation
and feedback.However, analysts adopting a political and organizational approach to policy analysis do not assume that
these stages are sequential or that they always occur in every decision making process. Indeed, these policy analysts often
describe the policy process as a mess, a set of incremental decision
 Policy actors include those who Have specific responsibility for developing formal policies in the public or private
sectors, including those outside the health sector working on health influencing policies, national and international
agencies
 Influence how policies are translated into practice (such as manager, health workers, patients and citizens). Seeks to
influence the formal policy process (such as civil society groups or interest groups at national and international levels).
EXPERIMENTAL DESIGN

Experimental studies are prospective trials in which intervention, an attempt to regulate the variables in a study, occur on
the part of the investigators.

Types

There are two types of experimental studies, controlled studies and uncontrolled studies.

Controlled studies in contrast to uncontrolled studies, use a comparison group in addition to the group receiving the drug
being investigated. This allows the investigator to help account for the possible influence that other outside factors could
have on a study's outcomes independent of the drug being evaluated.

Several design aspects warrant consideration when analysing the quality of a published experimental study. The first
involves the type of control employed. The active control uses a drug with proven efficacy for the treatment of a
condition as a comparison to the drug being evaluated. A placebo control incorporates a group of subjects receiving a
placebo as the comparison group.

An active control can only provide information about the relative efficacy of drug, whether one was more efficacious, less
efficacious or the same as another. However, it is possible that neither the active control nor the drug being evaluated
were truly efficacious for the patient groups being studies.

In contrast, a placebo control allows one to determine the true efficacy of a drug for the treatment of a certain conditions.
Placebo controls are preferable to no treatment controls because they minimize possible bias introduced by the patient as
a result of knowing what they are receiving.

Either placebo or no treatment controls can pose an ethical dilemma, however, for studies involving serious illness in
which patients should receive active therapy.

Concurrent control design

Patients are divided into at least two groups, control versus experimental. They only receive the intervention of the one
group they are assigned to. Results obtained from the experimental group are then compared with those from
experimental group. With this design, it is important that the experimental and control group patients are as similar as
possible to help ensure comparability of the results.

Crossover design

The patients are initially assigned to either the control or experimental groups, After completion, they are then placed in
the other group so that each patient eventually receives each intervention. The crossover design generally includes a
washout period between each intervention to allow the treatment and its effect to be eliminated from the body prior to
beginning the next study phase. Since the patients are the same in the control and experimental groups, it is easier to
eliminate differences in patient characteristics as being responsible for any differences identified between groups.

Time series design

Each patient also receives each study intervention except, in contrast to crossover design, they receive each intervention
at the same time.
Randomization

Is the process of randomly assigning the enrolled patient to study group, using a technique such as numbers. This is very
important procedure for ensuring a study's quality. It helps to eliminate subjective factors and biasness when assigning
subjects to treatment groups. It also eliminates the likelihood that difference in subject characteristics are actually
responsible for the outcomes observer rather than the treatment itself.

Studies will usually compare the study groups after randomization with regards to characteristics that might Influence
outcomes (age, sex, race, number of years with certain condition) to ensure that they are indeed comparable. If baseline
differences exist, these can often be accounted for later using statistical methods.

Blinding

Is process in which the identity of the control and experimental groups in a study is not known to the subject and
investigator. Unblinded Both subjects and investigators are aware of the group assigned