NTA Level 6 • Semester 1 • PST06102

Counselling and Guidance – Complete Full Notes

Complete educational source text in one page

Completeness safeguard: this page keeps the complete educational module/source wording in one place so learning material is not lost when browsing topic by topic. Presenter/tutor metadata is intentionally excluded.

COUNSELLING AND GUIDANCE SKILLS

Introduction to Counselling and Guidance

Complete learning session

1 / 20

Counselling and Guidance Skills

Learning outcomes

• Define Introduction to Counselling and Guidance.

• Explain its main principles and classifications.

• Apply the concept safely in pharmaceutical practice.

• Recognise common errors and appropriate corrective action.

2 / 20

Counselling and Guidance Skills

Why this topic matters

• Counselling is a purposeful helping relationship that supports informed choices.

• Confidentiality, respect and non-judgment build trust.

• Correct understanding supports safe, effective and accountable practice.

3 / 20

Counselling and Guidance Skills

Core definition

• Introduction to Counselling and Guidance is studied as a structured concept within Counselling and Guidance Skills.

• Counselling is a purposeful helping relationship that supports informed choices.

• Use precise terms before attempting application or calculation.

4 / 20

Counselling and Guidance Skills

Foundational principles

• Confidentiality, respect and non-judgment build trust.

• Active listening uses attention, reflection, clarification and summarising.

• Each principle should be linked to a practical decision.

5 / 20

Counselling and Guidance Skills

Key components

• Counselling is a purposeful helping relationship that supports informed choices.

• Active listening uses attention, reflection, clarification and summarising.

• Open questions encourage clients to explore concerns and options.

6 / 20

Counselling and Guidance Skills

Classification and organisation

• Group the subject by function, structure, source, risk or stage as appropriate.

• Use one classification system consistently.

• State the feature that separates one category from another.

7 / 20

Counselling and Guidance Skills

How the process works

• Confidentiality, respect and non-judgment build trust.

• Active listening uses attention, reflection, clarification and summarising.

• Follow the sequence from input or cause to outcome.

8 / 20

Counselling and Guidance Skills

Professional terminology

• Distinguish related terms that are often confused.

• Use names, units and abbreviations consistently.

• Define technical words before using them in explanations.

9 / 20

Counselling and Guidance Skills

Practical application

• Open questions encourage clients to explore concerns and options.

• Prepare the required materials, information or records before starting.

• Complete each step in order and document important observations.

10 / 20

Counselling and Guidance Skills

Quality requirements

• Referral is necessary when needs exceed the counsellor’s competence.

• Check identity, accuracy, completeness and fitness for purpose.

• Record deviations and take corrective action promptly.

11 / 20

Counselling and Guidance Skills

Safety and risk control

• Identify hazards before beginning the task.

• Use appropriate protective, ethical and legal safeguards.

• Stop and refer when the situation exceeds competence or available resources.

12 / 20

Counselling and Guidance Skills

Common errors

• Using an incorrect definition, unit, category or sequence.

• Skipping verification, documentation or a final reasonableness check.

• Applying a general rule without considering the patient, material or research context.

13 / 20

Counselling and Guidance Skills

Preventing avoidable mistakes

• Use a written procedure or checklist.

• Independently verify high-risk calculations and decisions.

• Communicate unclear or abnormal findings before proceeding.

14 / 20

Counselling and Guidance Skills

Worked application

• Start with a clearly stated problem related to Introduction to Counselling and Guidance.

• Select the correct principle from the earlier slides.

• Show the decision or calculation step by step.

• Confirm that the final answer is reasonable and professionally usable.

15 / 20

Counselling and Guidance Skills

Practice scenario

• A routine situation requires the learner to apply Introduction to Counselling and Guidance.

• Identify the information that must be collected first.

• Explain the safest action and the record that should be completed.

16 / 20

Counselling and Guidance Skills

Decision points

• What finding confirms that the chosen approach is suitable?

• What warning sign requires correction, referral or further investigation?

• What evidence must be documented to support the decision?

17 / 20

Counselling and Guidance Skills

Connection to patient care

• Accurate practice reduces preventable harm.

• Clear communication helps patients and colleagues use information correctly.

• Monitoring outcomes shows whether the intended benefit was achieved.

18 / 20

Counselling and Guidance Skills

Session summary

• Counselling is a purposeful helping relationship that supports informed choices.

• Confidentiality, respect and non-judgment build trust.

• Active listening uses attention, reflection, clarification and summarising.

• Open questions encourage clients to explore concerns and options.

• Referral is necessary when needs exceed the counsellor’s competence.

19 / 20

Counselling and Guidance Skills

Self-check questions

• Define Introduction to Counselling and Guidance in your own words.

• List three important principles or components.

• Describe one practical application and one common error.

• Explain one quality or safety control.

20 / 20

PST 06102

:

Counselling and Guidance

Session

2: Principles of Counselling and Guidance

Learning tasks

At the end of this session, students are expected to be able to

:

• Define principles of counseling and guidance

• Explain principles of quality counseling

• Identify principles of quality guidance

• Explain the differences between guidance and counseling

Definition of Principles of counselling and guidance

Principles

are fundamental norms, rules, or values that represent what is desirable and positive for a person, group, organization, or community, which help in determining the rightfulness or wrongfulness of its actions.

Principles

are more basic than policy and objectives, and are meant to govern both.

Activity:

Buzzing

What are the principles

of Quality Counselling

The

principles of quality

counseling

The following are the principles of quality counseling

Establish and maintain rapport with the client

Assess the client's needs and personalize discussions accordingly

Work with the client interactively to establish a plan

Provide information that can be understood and retained by the client

Confirm client understanding

a. Establish

and maintain rapport with the client

This is

vital to the encounter and achieving positive outcomes,

it can

begin by creating a welcoming environment and should continue through every stage of the client encounter, including follow-up.

Counseling

models that emphasized the quality of the interaction between client and provider have been associated with

increased

rational use of medicines,

increased

use of more effective methods,

increased

use of repeat or follow-up services,

increased

knowledge, and enhanced psychosocial determinants of medicines

b. Assess

the client's needs and personalize discussions accordingly

Each visit should be tailored to the client's individual circumstances and needs, standardized questions and assessment tools can help providers determine what services are most appropriate for a given visit

Assess the client's needs and personalize discussions accordingly to his or her problem, for example if it is problem of poor adherence to prescribed medicines, outcomes of counseling can increase poor adherence or eliminate poor adherence.

c. Work

with the client interactively to establish a plan

Working with a client interactively to establish a plan, including a plan for follow-up, is important.

Establishing

a plan should include setting goals, discussing possible difficulties with achieving goals, and developing action plans to deal with potential difficulties.

Use

of computerized decision aids before the appointment can facilitate this process

by interactive

framework for clients to analyze their available options systematically

. Provide

information that can be understood and retained by the client

Clients need information that is medically accurate, balanced, and nonjudgmental to make informed decisions and follow through on developed plans.

When speaking with clients or providing educational materials through any medium e.g., written, audio/visual, or computer/web-based, the provider must present information in a manner that can be readily understood and retained by the client.

Confirm

client understanding

It is important to ensure that clients have processed the information provided and discussed. One technique for confirming understanding is to have the client restate the most important messages in her or his own words.

This teach-back method can increase the likelihood of the client and provider reaching a shared understanding, and has improved compliance with treatment plans and health outcomes

Using the teach-back method early in the decision-making process will help ensure that a client has the opportunity to understand her or his options and is making informed choices.

Principles of Quality Guidance

The following are the principles of quality guidance

Take time to solve problems and make decisions.

Let the counselee develop his own insights.

Guidance is a lifelong process.

Guidance service should be extended to all, not simply to the maladjusted.

Guidance workers should rigorously observe a code of ethics

Guidance places emphasis on the dignity, worth and individuality of the clients as a means of promoting the democratic way of life.

Guidance is concerned with the choices and decisions to be made by the client.

Guidance is primarily concerned with prevention rather than cure.

Guidance is a continuous process throughout the treatment process.

Difference Between Guidance and Counseling

Guidance process aims at making clients be aware of the rightness or wrongness of their choices and

decision

, on which their future depends.

is a service that assists clients in selecting the most appropriate treatment for them, to discover and develop their psychological abilities and ambitions.

Guidance

results in self-development and helps a person to plan his present and future

wisely

Counseling is not just giving advice or making a judgment, but also helping the client to see clearly the root of problems and identify the potential solutions to the issues.

The

counselor also changes the viewpoint of the client, to help him take the right decision or choose a course of action.

will also help the client to remain intuitive and positive in the future

Similarities of Guidance and

Counseling

Both

are helping services

Both aim at solving problems

Both are principled

activities

Key Points

Principles

are fundamental norms, rules, or values that represent what is desirable and positive for a person, group, organization, or community, and help in determining the rightfulness or wrongfulness of its actions

Principles

are more basic than policy and objectives, and are meant to govern both.

Review questions

What are the differences between counseling and guidance?

What are the Principles of Quality Guidance

References

Beardsley, R. S., Johnson, C. A., & Wise, G. (1977). Privacy as a Factor in Patient Counseling.

Journal of the American Pharmaceutical Association (1961),

(6), 366-368. doi:10.1016/s0003-0465(16)34218-5.

Bernstein L, Bernstein RS.

Interviewing: (

2000)

A Guide for Health Professionals. N

ew York: Appleton-Century-Crofts,

Agrawal, R (2006)

Educational, Vocational Guidance and Counselling

, New Delhi,

Sipra

Publication

MOHSW (2005).

National Guidelines for Voluntary Counselling and Testing.

Dar

Salaam, Tanzania: National AIDS Control

Programme

USP (2003).

USP Medication Counseling Behavior Guidelines.

USP Convention,

Inc

, Rockville MD,

PST 06102

:

Counselling and Guidance

Session 3:

General Types of Counselling

Learning tasks

At the end of this session, students are expected to be able to

:

Explain

individual counseling

Explain group counseling

Explain couple counseling

Activity:

Buzzing

What

individual counseling?

Individual counselling

is a one-to-one helping relationship in which the counsellor helps the client to accept, own, solve or cope with the problem.

Features of individual counselling includes client comes on his/her own or he/she is referred from another counsellor/source

Individual counselling

Client coming for counselling may be an adult, youth or child who is:

Able to talk rationally

Mentally distraught – unable to think/talk rationally

With

varied life experience

Duration of individual counselling

It may

involve one or more than one sessions.

The setting

can be a

counselling

centre

, VCT

centre

/hospital.

The nature and duration of individual counselling cannot be determined until the nature of the problem is clarified.

In most cases the initial session begins in a similar way of staying with a client for 45 minutes to 60 minutes per session.

Counselling relationship may be terminated when a counsellor and client reach to a successful conclusion of the counselling relationship or client referral is made.

Group Counseling

It is a one-to-group helping relationship in which the counsellor works with the group in seeking a solution to their common problem. Example: new candidates of ARV therapy

Group Counselling is designed to help clients in a group to achieve increased mutuality, integration, and acceptance of reality, socialization, realistic goals, adaptability and responsibility for self esteem.

The general aim is to help members appraise themselves so that they may gain understanding, and broad perceptive of themselves in relation to others.

Features of Group

Counseling

A

group of clients must have the following features;

Clients in the group must have a common problem.

There must be dynamic integration among members.

Members must be reasonably mature and mentally sound to be able to talk about and tackle their common problem.

Members must have capacity for self-direction.

Members should be as compatible as possible

Couple Counselling

Couple

refers to two people, usually of opposite sex, who may be:

Married

Cohabiting (not married but a man and woman are staying together)

Friends

Couple counselling occurs when two individuals who have had or who intend to have sexual relations wish to discuss issues concerning HIV together and look for ways to cope with the situation.

Couple Counselling

Usually two people come in for couple

counseling

if:

They intend to get married

One or both member/s is/are sick

They intend to have children

They are having conflicts in the home around being honest about sexual practices and safer sex

The couple has a sick child; or the child dies of AIDS or any other diseases

They have been referred to the clinic by a doctor

Key

points

Individual

counseling is a one-to-one helping relationship in which the counsellor helps the client to accept, own, solve or cope with the

problem

Features

of individual counselling includes client comes on his/her own or he/she is referred from another counsellor/source.

Review questions

What

are the features of group counselling?

What

is couple counselling?

References

MoHSW (2005)

National guidelines for the clinical management of HIV and AIDS

, Dar

Salaam

Hubley

, J. (1993).

Communicating Health. An action and guide to health and health

Promotion.

1st Edition. British

Angotti

N, et al. (2009)

Increasing the acceptability of HIV counseling and testing with

three C’s: convenience, confidentiality and credibility. Thailand

MM,

Ostermann

J, Crump JA, (2010).

Characteristics of HIV voluntary counseling and testing clients before and during care and treatment scale-up

.Moshi, Tanzania.

Jones A. J (1951),

Principles of Guidance and Pupil Personal work

. New York. McGraw Hill

PST 06102

:

Counselling and Guidance

Session 4:

Counselling Techniques

Learning tasks

At the end of this session, students are expected to be able to

:

Define counseling technique

Explain counseling techniques

Identify qualities and values of effective counsellors

Activity:

Buzzing

What

is counseling technique??

Counseling

technique

They

are

tools a counsellor/healthcare provider uses in order to

get

information

from a patient/client in order to build a relationship, assess the

presenting problem

, understand the problem and be able to lead a patient/client reach a solution

It is an art that requires

practice

counsellor

should adequately possessed basic counseling skills so that he/she can recognize and handle most barriers and end up with successful counselling

sessions

Activity:

Buzzing

What

are the techniques for effective Counseling???

Counseling Techniques

Greetings,

The greeting must reflect warmth not only in the spoken words but also in the tone of voice as well as the facial features of the client.

Empathizing

, empathy means feeling with a person, understanding why the person is in pain while sympathy means feeling sorry for a person and putting oneself in the others shoe

Accepting,

Means valuing another person unconditionally as a human being, when a counsellor shows disrespect or contempt for the client’s values and way of life the client would assume that the counsellor does not respect him/her and this will affect the rapport building between them.

Affirming

, this means congratulating or complimenting clients on the positive actions that they have been able to take whether it is the decision to come for counseling.

Using silence;

silence is sometimes necessary if a client becomes upset and needs a few minutes to calm down or collect his thoughts.

Active listening;

ctive

listening by the counsellor encourages the client to share information by providing verbal and nonverbal expressions of interest.

Attending behaviours,

is expressing awareness and interest in what the client is communicating both verbally and nonverbally.

Paraphrasing, m

eans repeating the key points of what a client has said. This skill serves many purposes

Reflection of feelings,

the counsellor tries to perceive the emotional state of the client and respond in a way that demonstrates an understanding of the client’s emotional stat

Summarizing

Means Summing up the main points of a person’s story and eliminating the less relevant details.

The counselor takes the main points of the conversation and presents them to the client in a succinct manner that touches all that was covered during the session.

Questioning and probing, t

his skill is the primary tool that a counselor uses to obtain information or seek clarifications from clients.

Speaking simply, t

his means making use of language that is easy enough for a person to understand.

Focusing,

is a skill which enables the counsellor help, the client prioritize and choose the most pressing problem that they would like to resolve.

Correcting misperceptions, t

his means providing accurate information to a client and correcting any misinformation that the client has expressed during the session.

Supporting, t

he counselor offers encouragement and help clients in order to give them confidence for taking action, the counselor has to be sure that he/she does not sound patronizing to the client

Self – disclosing

, Clients prepared emotionally for the outcome of disclosing, they are helped to identify who the disclosure might be affect (e.g. spouse, children) and to be aware of potential negative consequences.

Qualities and Values of Effective Counsellors

Counselor:

where

clients/patients

explore and understand their worlds and so discover better ways of thinking and living.

A counselor must attempt to facilitate a client to solve their own problems, yet demonstrate a genuine concern and compassion for the client's dilemmas, the rapport of the client and counselor is an important factor in counseling.

Possible Qualities

Competence

Maintains confidentiality

Trustworthiness

Demonstrate self-awareness and understanding

Good psychological health

Can build good

rapport

Show warmth and sensitivity

Show empathy

Remain objective and open minded

Active listener

Be able to reflect and clarify their needs

Patience

Be non-judgmental

Effective

Counselling

private, confidential, and respectful

Views the patient as the expert on his or her own life

Respects that patients come to counselling with great strengths and knowledge upon which to build

Doesn’t tell the patient what to do, and never forces the patient to do something

Understands that the patient lives in a social setting that influences choices

Views social relationships as a resource for improving health

Is developed through training and practice

Values

guide the beliefs and opinions that you stand for.

Because values guide what you stand for and what you do not want, you cannot assign

them any monetary value.

Your values determine who you are, what you decide and how you behave.

Proper application of your values results in respect, love, good health and good habits.

Values are developed during growth. Therefore, the family and environment contribute

alot

to the development of an individual values.

It is important to respect values of others because we all have different values

Values of an Effective

Counselor

Social

values

: These are some standards of behaviors determined by society (e.g. good manners)

Moral values

: Objective and unchangeable, and are a born knowledge of what is right

and wrong (e.g. telling lies)

Religious values

: Based on a particular faith or creed in a society

Key

points

Counselor should adequately possessed basic counseling skills

for successful

counseling sessions

Counselor

needs to help clients focus on the issues that are most important to them at the time of the session and it is important to respect the client’s feelings, and address the issues that they feel are most important

Review questions

What are the different counseling techniques?

What is the effective counseling?

What are the values of effective counselors?

References

MoHSW (2005)

National guidelines for the clinical management of HIV and AIDS

, Dar

Salaam

Hubley

, J. (1993).

Communicating Health. An action and guide to health and health

Promotion.

1st Edition. British

Angotti

N, et al. (2009)

Increasing the acceptability of HIV counseling and testing with

three C’s: convenience, confidentiality and credibility. Thailand

MM,

Ostermann

J, Crump JA, (2010).

Characteristics of HIV voluntary counseling and testing clients before and during care and treatment scale-up

.Moshi, Tanzania.

Jones A. J (1951),

Principles of Guidance and Pupil Personal work

. New York. McGraw Hill

PST

06102

:

Counselling and Guidance

Session 5:

Guidance Techniques

Learning tasks

At the end of this session, students are expected to be able to

:

Define guidance techniques

Explain guidance techniques

Describe characteristics of a good guidance services

Identify quality of effective guidance

counselors

Definition of Guidance Techniques

It is the assistance or help rendered by a more experienced person to a less experiences person to solve certain major problems i.e. educational, vocational, personal etc.

They help

the individual to become increasingly competent in self-direction and self-help; it is a continuous process of service to

individuals

They are

designed to help one individual or group of individuals in making necessary adjustment to environment whether that be health problems or outside it

Activity:

Buzzing

What are the techniques for effective guidance

Guidance Techniques

The following are the techniques for effective guidance

Positive verbal environment, positive reinforcement, using consequences, warning, effective praise, suggesting, persuading, redirecting, listening, ignoring and encouraging

Techniques

for effective

guidance

Positive reinforcement

Positive verbal environment

Using consequences

Warning

Effective praise

Persuading

Redirecting

Listening

Encouraging

Ignoring

a. Positive

reinforcement

:

Involves the addition of a reinforcing stimulus following a behavior that makes it more likely that the behavior will occur again in the future. When a favorable outcome, event, or reward occurs after an action, that particular response or behavior will be strengthened

b. Positive

verbal environment:

Means

establishing Positive Verbal Environments that is strategies for promoting social development through positive guidance.

As social creatures, we all interact with each other in an environment that we create together through our communication, positive, nurturing interactions over time lead to a more positive self-esteem to client

Negative verbal environments are ones in which clients feel unworthy, unlovable, insignificant, or incompetent because of what counselor say or do

c. Using

consequences

letting

client experience the natural or logical consequences of their actions is one way to teach responsibility, natural consequences are the inevitable result of a client’s own

actions

d. Warning

The act of warning, the state of being warned he had warning of his illness, something that warns or serves to warn especially a notice or bulletin that alerts the public to an imminent hazard (such as a tornado, thunderstorm, or flood) warning

d. Effective

praise

Effective Praise can increase your client’s positive behaviors while decreasing negative behaviors. Effective Praise also builds confidence and creates greater family harmony.

It is a four-step teaching process that is planned and

pur

–

poseful

. It is specific, genuine, and contingent on positive

behavior

e. Persuading

To make someone do or believe something by giving them a good reason to do it or by talking to that person and making them believe it

f. Redirecting

To direct (someone or something) to a different place or by a different route. E.g., If you redirect your energy, resources, or ability, you begin doing something different or trying to achieve something

different

g. Listening

It i

s giving one's attention to sound,

; speech, music or natural sounds. Listening involves complex affective, cognitive, and behavioral processes

h. Encouraging

The act of making something more appealing or more likely to happen. something that makes someone more determined, hopeful, or confident. Something that makes someone more likely to do

something.

. Ignoring

Do not encourage inappropriate behavior, if not dangerous, avoid giving them attention and do not look directly at them

Ignoring is inappropriate if the behavior is harmful or damaging property, tell the client what behavior you are ignoring and what behavior you desire

Characteristics of a Good Guidance Service

Identifiable aids to assist individuals.

Involved

in achieving goals of treatment.

Provide for competent pharmaceutical personnel or other health workers.

Supported by functional preparations for pharmaceutical personnel in guidance services.

Based on the knowledge of the needs of the clients and upon competencies of other health workers.

Services made available to clients.

Needs the cooperation of family members and community.

More preventive than curative.

Founded on the concept of the totality of the individual.

Should be evaluated constantly

Quality of effective guidance counselors

Detail oriented,

Discreet and trustworthy,

Problem solver,

Compassionate.

Great manager of time,

Great communication skills in order to talk to patients and relatives.

Tolerant

and understanding of clients situations

Motivational and enthusiastic for clients success

Belief in the ability of all clients to succeed

Key

points

Techniques for effective guidance are; Positive verbal environment, positive reinforcement, using consequences, warning, effective praise, suggesting, persuading, redirecting, listening, ignoring and

encouraging

Characteristics of a good guidance service: identifiable aids to assist individuals, involved in achieving goals of treatment,

Review questions

What are the techniques for effective guidance?

What are the characteristics of a good guidance service?

References

MoHSW (2005)

National guidelines for the clinical management of HIV and AIDS

, Dar

Salaam

Hubley

, J. (1993).

Communicating Health. An action and guide to health and health

Promotion.

1st Edition. British

Angotti

N, et al. (2009)

Increasing the acceptability of HIV counseling and testing with

three C’s: convenience, confidentiality and credibility. Thailand

MM,

Ostermann

J, Crump JA, (2010).

Characteristics of HIV voluntary counseling and testing clients before and during care and treatment scale-up

.Moshi, Tanzania.

Jones A. J (1951),

Principles of Guidance and Pupil Personal work

. New York. McGraw Hill

PST 06102

:

Counselling and Guidance

Session 6

: Situations Require Counselling

Learning tasks

By the end of this session students are expected to be able to:

Define

situation require counseling

Explain

situations require counseling

Explain

crisis counseling

Explain

genetic counseling

Definition of Situations Requiring

Counselling can be useful in a number of different life situations, it help with all sorts

of different

issues, it can help with positive events such as choosing a direction in life or

reaching your

full potential.

When

a person feeling a

bit

stuck‘ and would value the viewpoint of a counsellor, it can be

things

from his/her past that s/he would like to tackle or there may be things in the present

that s/he

want to try and change.

Situations that require counseling are, psychotherapeutic counselling, health counselling,

personal

counseling , crisis counselling, genetic counselling, and marriage counselling

What are the situations required counseling?

Situations Required Counselling

Psychotherapy Counselling:

defined as a form of therapy in which a trained professional uses method based on

psychological

theories to help a person with psychological problems.

refer to almost any kind of human interaction such as talking or demonstrating that is

based

on a psychological theory of the problem but it does not include medical

treatment such

as medication.

is the use of psychological methods, particularly when based on regular

personal interaction

, to help a person change and overcome problems in desired ways.

Psychotherapy

aims to improve an individual's well-being and mental health, to resolve

or mitigate

troublesome behaviors, beliefs, compulsions, thoughts, or emotions, and to

improve relationships

and social skills.

Certain

psychotherapies are considered evidence-based for treating some diagnosed

mental disorders

Situations Required Counselling

Health counseling

Health

"health is a state of complete physical, mental and social well-being and not

merely

the

absence of disease or infirmity

Health

counseling: define as the process where by an individual or group mental, spiritual

or physical

health is being counsel by a professional counselor and provide support to

sustain them

Patient

Counselling is defined as "an individualized process involving guidance

and collaborative

problem solving to help the patient to better manage the health problem"

Situations Required Counselling

P

urpose

of patient education and counselling:

help patients manage their chronic disease by using available health, social and economic

resources

Assist

Patients to develop their own understanding of the problem and what can be done

about

it.

provide appropriate training to patient so that they can obtains a higher quality of life,

the

disease remains under control, the treatment is consistent and hospital costs are

smaller for

both the individual and the state.

Situations Required Counselling

The benefits of patient education counseling (PEC) for hospitals are:

Shortening

the length of stay

Decreasing

medical, personal and social costs

Increasing

patient satisfaction

Improving

quality and effectiveness of health care

B

enefits

of counseling for people with chronic diseases are

:

Improving

the quality of life

Fostering

independence for the patient

Improving

the control over disease

Emphasizing

the importance of prevention and early recognition of the disease

Personal

Counselling

A

confidential meeting between yourself and a professional counsellor.

Often the purpose is to solve one or more problems or to give you information

Goals

and values

of Counselling

What goals and values does Counselling hold?

It encourage healthy

independence, being yourself, self-confidence, honesty about

who you

are and how you feel,

encourage clients to face the world and to take appropriate

risks in

order to grow and change

Expressing

emotion (feelings) is preferable to repressing them;

Choosing

your own way in life instead of living by the standards of others;

Self-discovery through self-disclosure.

Marriage Counseling

Marriage

, is also called matrimony or wedlock, is a socially or ritually recognized union

between

spouses that establishes rights and obligations between those spouses, as well

as between

them and any resulting biological or adopted children and affinity (in-laws

and other

family through marriage)

Individuals

may marry for several reasons, including legal, social, libidinal,

emotional, financial

, spiritual, and religious purposes.

Marriage counseling/ couples therapy:

a type of psychotherapy, it helps couples of all types recognize and resolve conflicts

and

improve their relationships.

Through

marriage counseling, you can make thoughtful decisions about rebuilding your

relationship

or going your separate ways

Marriage counseling typically includes both partners, but sometimes one partner chooses to work with a therapist alone. . The specific treatment plan depends on the situation.

Marriage Counseling

Couples

seek marriage counseling to improve a troubled relationship.

I

ssues which can be addressed by marriage counseling includes:

Communication

problems, Sexual difficulties

Conflicts

about child rearing or blended families

Substance

abuse, Financial problems

Anger

, Infidelity and health problems

Marriage

counseling might also be helpful in cases of domestic abuse, if violence

has escalated

to the point that you're afraid, however, counseling alone isn't adequate, contact

the

police or a local shelter or crisis center for emergency support.

Crisis

Counselling

Crisis is any event that is going to lead to an unstable and dangerous situation

affecting an

individual, group, community, or whole society.

Crises

are deemed to be negative changes in the security, economic, political,

social, or

environmental affairs, especially when they occur abruptly with little or no warning.

Eight

Categories of crises

Natural

disaster:

, earthquakes, volcanic, floods, tsunamis and storms

Technological

crises:

, software failures, industrial accidents, and oil spills (

human manipulation)

Confrontation

:

, individuals and/or groups fight businesses, government, and

various interest

groups to win acceptance of their demands and expectations.

Eight Categories of crises

Malevolence:

, tampering, kidnapping, malicious rumors and terrorism

Organizational

Misdeeds:

, crisis of skewed management values, crises of

deception, and

crises of management misconduct.

Workplace

Violence:

, Verbal or written threats, Physical attacks.

Rumors

:

, false information about an organization or its products creates crises

hurting the

organization‘s reputation.

Terrorist

attacks/man-made disasters:

, the result of human intent, error, or as a

result of

failed systems. They can be divided into categories such as terrorism,

technological hazards

, transportation hazards and environmental accidents.

The

primary purpose of crisis counseling is to help an individual to restore some sense

of control

and mastery after a crisis event or disaster.

Individuals

can become overwhelmed emotionally and may have difficulty with

problem solving

and other coping skills

What are the goals for crisis counseling?

Goals for crisis

counselling

The primary purpose of crisis counseling is to help an individual to restore some sense

of control

and mastery after a crisis event or disaster.

Individuals

can become overwhelmed emotionally and may have difficulty with

problem solving

and other coping skills

consequently

they need

help

To provide emotional support and concrete feedback/assistance for the individual.

Helps

problem-solve and assists individuals in obtaining available resources.

There

are number of common elements consistent with the various theories of crisis counseling:

Assessing

the Situation

Education

Offering

Support

Developing

Coping Skills

E

lements of theories

of crisis counseling:

1. Assessing

the Situation: Assessing the client‘s current situation.

This

involves listening to the client, asking questions and determining what the

individual needs

to cope effectively with the

crisis.

Counsellor

needs to define the problem while at the same time acting as a source of

empathy, acceptance

and

support. It

is also essential to ensure client safety, both physically and psychologically.

2. Education

:

People

who are experiencing a crisis need information about their current condition and

the steps

they can take to minimize the

damage.

Mental

health workers often help the client understand that their reactions are normal

but temporary.

While

the situation may seem both dire and endless to the person experiencing the crisis,

the goal

is to help the client see that he or she will eventually return to normal functioning.

3. Offering

Support:

One

of the most important elements of crisis counseling involves providing

support, stabilization

and resources.

Active

listening is critical, as well as offering unconditional acceptance and reassurance.

Non-judgmental

support during a crisis can help reduce stress improve coping.

4. Developing

Coping Skills,

involves helping the client explore different solutions to the problem, practicing

stress reduction

techniques and encouraging positive thinking.

is not just about teaching these skills to the client; it is also about helping the client to make

a commitment

to continue utilizing these skills in the future.

Genetic

counselling

Genetic counseling is the process by which the patients or relatives at risk of an

inherited disorder

are advised of the consequences and nature of the disorder, the probability

of developing

or transmitting it, and the options open to them in management and family planning.

This

complex process can be separated into diagnostic (the actual estimation of risk)

and supportive

aspects.

The National Society of Genetic Counselors (NSGC) officially defines genetic counseling

the

understanding and adaptation to the medical, psychological and familial implications

of genetic

contributions to disease

. This process integrates:

Interpretation

of family and medical histories

to assess the chance of disease

occurrence or

recurrence.

Education

about inheritance, testing, management, prevention, resources

Counseling

to promote informed choices and adaptation to the risk or condition.

Genetic

counselors

work

as members of a health care team and act as

patient advocates

as well as genetic resources to physicians

provide

information and support to families who have

members with

birth defects or genetic disorders, and to families who may be at risk for a

variety of

inherited conditions.

identify

families at risk, investigate the problems present in the family,

interpret information

about the disorder, analyze inheritance patterns and risks of recurrence,

and review

available genetic testing options with the family

Genetic counselors are present at high risk or specialty prenatal clinics that offer

prenatal diagnosis

, pediatric care centers, and adult genetic centers, It can occur before

conception (i.e

. when one or two of the parents are carriers of a certain trait)

A

person may also undergo genetic counseling after the birth of a child with a

genetic condition

, in these instances, the genetic counselor explains the condition to the

patient along

with recurrence risks in future children.

all cases of a positive family history for a condition, the genetic counselor can

evaluate risks

, recurrence and explain the condition itself.

The

goals of genetic counseling are to:

Increase

understanding of genetic diseases

Discuss

disease management options,

Explain

the risks and benefits of testing.

Counseling

sessions focus on giving vital unbiased information and non-directive assistance

inthe

pat

ient's

decision-making process.

What

are reasons of attending genetic

counseling?

Reasons

of attending genetic counseling

Counseling sessions focus on giving vital unbiased information and non-directive assistance

in the

patient's decision-making process.

Families or individuals may choose to attend counseling or undergo prenatal testing for

a number

of reasons.

Family

history of a genetic condition or chromosome abnormality

Increased

maternal age (35 years and older)

Increased

paternal age (40 years and older)

Abnormal

maternal serum screening results or ultrasound findings

Strong

family history of cancer

Predictive

testing for adult-onset conditions

Counselors

are present to put all the possibilities in perspective and encourage clients to

take time

to think about their decision, when a risk is found, counselors frequently

reassure parents

that they were not responsible for the result, an informed choice without pressure

is made

when all relevant information has been given and understood.

Key points

Counselling can be useful in a number of different life situations, it help with all sorts

of different

issues, it can help with positive events such as choosing a direction in life or

reaching your

full potential.

Psychotherapy

Counselling, is a form of therapy in which a trained professional uses

method based

on psychological theories to help a person with psychological problems, it refer

to almost

any kind of human interaction such as talking or demonstrating that is based on

a psychological theory of the problem but it does not include medical treatment methods such as medication

Evaluation

What are the situations require counseling?

What

are goals of providing crisis counselling?

Reference

USP (2003). USP

Medication

Counselling

Behavior

Guidelines. USP Convention,

Inc

Rockville MD

, USA

Agrawal, R (2006) Educational, Vocational Guidance and Counselling, New Delhi,

Sipra

Publication

Beardsley RS, et al. (2007)Privacy as a factor in patient

counseling.Journal

theAmerican

Pharmacists

Association.

Jones A. J (1951), Principles of Guidance and Pupil Personal work. New York. McGraw Hill

PST 06102

:

Counselling and Guidance

Session

7:

Situations Require

Guidance

Learning tasks

By the end of this session students are expected to be able to:

Define

situations require guidance

Explain

situations require guidance

List

principles of direct and indirect guidance

Definition of the Situations Required Guidance

Guidance

as a process, developmental in nature, by which an individual is assisted

to understand

, accepts and use his/her abilities, aptitudes and interests and attitudinal patterns

in relation

to his/her aspirations.

is a process of helping or assisting an individual to solve their problems, it help them

to identify

where to go, what to do and how to do for post accomplishment of their goals.

Guidance

as an educational construct involves those experiences that assist each learner

to understand

him/herself, accept him/herself, and live effectively in his/her society, this is

in addition

to the learner‘s experiences in the world of work

Definition of the Situations Required Guidance

Guidance can also be looked at as a

programme

or services to individuals based upon the

need of

each individual, an understanding of his/her immediate environment, the influence

of environmental

factors on the individual

Guidance

is designed to help each individual adjust to his/her environment, develop the

ability to

set realistic goals for him/herself, and improve his/her knowledge.

a process, guidance is not a simple matter, but involves a series of actions or

progressive steps

which move towards a goal, as a service, we can isolate four major services, those

of educational

, vocational, personal and social guidance

Situations that require counselling are educational guidance, vocational guidance,

career guidance

, avocational guidance and personal and Social Guidance

What are the situations required

guidance

Situations

Require Guidance

1. Educational

Guidance

Educational

guidance is, essential in the counselling service, guiding and educating

patients to

take right treatment and adhere to the medications, guiding young people to pursue

the right

type of education, while ensuring that the right balance is kept in order to meet

the human

resource needs of a nation

Helping

an individual to reflect on personal educational issues and experiences and to

make appropriate

educational choices and appropriate treatment choice.

2. Vocational

Guidance

Vocational

guidance is a process for helping individuals to choose an occupation,

prepare for

it, enter it and develop in it. Vocational happiness requires that a person‘s

interests, aptitudes

and personality, be suitable for his/her work.

plays its part by providing individuals with an understanding of the world of work

and essential

human needs, and familiarizing individuals with such terms as

the

dignity

of ‘labor

‘ and

‘work

value‘.

It based

on psychological tests and interviews to

find out

what career or occupation may

best suit

a person, it

is the

process of assisting a student to choose, prepare for and enter

an occupation

for which

he or

she shows aptitude.

3. Personal

and Social Guidance

Personal

and social guidance is the process of helping an individual to know how to

behave with

consideration towards other people.

Primarily

, personal and social guidance helps the individual to understand himself,

know how

to get on with others, learn manners and etiquette, pursue leisure time

activities, practice

social skills, develop family and family relationships, and understand social

roles and

responsibilities

4. Career

guidance

Career

guidance includes a wide variety of professional activities which help people

deal with

career-related challenges.

Career

counselors work with adolescents seeking to explore career options,

experienced professionals

contemplating a career change, parents who want to return to the world

of work

after taking time to raise their child, or people seeking employment.

Career

guidance is also offered in various settings, including in groups and individually,

in person

or by means of digital communication, several approaches have been undertaken

to systemize

the variety of professional activities related to career guidance and

counseling such

as:

The Career Educator "supports people in developing their own career management competences"

The Career Information & Assessment Expert "supports people in assessing their personal characteristics and needs, then connecting them with the

labour

market and education systems"

The Career Counsellor "supports individuals in understanding their situations, so as to work through issues towards solutions“

The

Programme

& Service Manager "ensures the quality and delivery of career guidance and counselling

organisations'

services"

5. Avocational

guidance

avocation is an activity that someone engages in as a hobby outside their

main occupation

. There are many examples of people whose professions were the ways

that they

made their livings, but for whom their activities outside their workplaces were

their true

passions in life.

assist individual with leisure attitudinal or behavior problem with choosing

and effectively

participating in an avocation, as a newly emerging independent profession,

a vocational

guidance has the task of developing theory, techniques and tools for

doing the

job with greater precision.

What are the Principles of direct and indirect guidance?

Principles of Direct

Guidance

The followings are the principles of direct guidance

Use

simple language

Speak

in a relaxed voice

positive

Offer

choices with care

Encourage

independence and cooperation

firm

consistent

Provide

time for change

Consider

feelings

Intervene

when necessary

Key Point

Guidance as an educational construct involves those experiences that assist each learner

to understand

him/herself, accept him/herself, and live effectively in his/her society, this is

in addition

to the learner‘s experiences in the world of work and the people found there,

Guidance

can also be looked at as a

programme

or services to individuals based Up on the

need of

each individual, an understanding of his/her immediate environment, the influence

of environmental

factors on the individual

Situations

require guidance are; educational guidance, vocational guidance, career guidance,

a vocational

guidance and personal and Social Guidance

Key Point

What are the situations require guidance?

What

is avocational guidance?

References

Bernstein

L, Bernstein RS. Interviewing: (2000)A Guide for Health Professionals. New

York: Appleton-Century-Crofts

Agrawal, R (2006) Educational, Vocational Guidance and Counselling, New Delhi,

Sipra

Publication

USP (2003). USP Medication

Counseling

Behavior

Guidelines. USP Convention,

Inc

Rockville MD

MOHSW (2005). National Guidelines for Voluntary Counselling and Testing. Dar

Salaam, Tanzania

: National AIDS Control Programme.

PST 06102

:

Counselling and Guidance

Session 8

: Counselling and Guidance Process

Learning

Tasks

the end of this session students are expected to be able to:

Define

counselling and guidance process

Explain

stages of counselling process

Identify

factors that hinder effective counselling

What

counseling and guidance process?

Definition of Counselling and Guidance Process

The counseling process often takes time, it is probably not realistic to expect that

clients‘ problems

will be solved after one or two sessions, because counseling is a process, it is wise

to give

it a few weeks before you decide it is not working for

a client

There

are time when a client may have a very specific questions or concern that can be

resolved quickly

in one or two sessions, something may have been troubling client for months or even

for years

, in that case, it may take a longer time to build a trusting relationship with counsellor

and to

resolve problem, client and counsellor can talk over what client‘s goals for counseling are

and how

long it will take client to achieve these goals

Definition of Counselling and Guidance Process

Guidance

is the process of assisting the individual to choose, to prepare, to enter upon

and progress

in course of action pertaining to the educational, vocational, health, recreational

and community

services, it is a process of helping individuals through their own efforts to

discover and

develop their potentialities both for personal happiness and social usefulness.

Guidance

as a concept guidance is concerned with the optimal development of the

individual and

guidance as a process guidance helps the individual in self- understanding

ones strengths and

limitations and in self-direction (ability to solve problems, make choices and decision

on ones

own.

What

are the stages of

counseling process?

Stages of the Counselling Process

In order to counsel a patient effectively, the counsellor needs to have a variety of skills and

work with

the patient through different steps. Most of these steps and skills fall under the umbrella of

four main

stages in the counseling process. These four stages are detailed below.

Relationship

Building

Rather

than telling patients about a subject, counsellors first ask patients what they know

or what

they have heard, and correct their misperceptions through discussion.

Establishes

rapport

Establishing

rapport should be the very first step in starting a relationship. If the

patient does

not trust the counsellor, s/he may be reluctant to discuss lifestyle issues

behaviours

. Establishing rapport serves to open communication between the

counsellor and

the patient.

Relationship

Building

Greets

the patient and makes him or her feel welcome

Establishes

the reason the patient has come

Confirms

what the counsellor can and cannot do

Assures

the patient of confidentiality

Sets

the rules for the session (e.g. time)

Uses

language at a level that the patient can understand

2. Exploration

The patient shares his or her own feelings and views about the problem at hand. The

counsellor listens

, encouraging the patient to express his or her main concerns. The counsellor gives time

for the

patient to tell their stories, so the counsellor can understand the issues and see things the way

the patient

sees things.

The

counsellor listens carefully

The

counsellor asks questions so the patient will provide more information

The

patient leads the discussion, and not the

counselor

3. Understanding

The

counsellor helps the patient to understand some of the concerns that patient

has discussed

. The counsellor helps to draw conclusions, and to interpret the information.

The

counsellor listens to the patient and interprets some of the information the patient

has given

The

counsellor might help the patient to understand some of the patient‘s attitudes

or actions

that could be creating challenges

The

counsellor also sees how ready or able the patient is to change those attitudes

and actions

3. Action

Plan

Counsello

uses information the patient has provided, and information about what the

patient is

able and willing to do about the issue of concern to talk about concrete steps the

patient will

take

The

pair collaborates in creating a plan for action

The

pair discusses available resources to support the plan and can plan for the next session

The Outcomes of Counselling

The results or resolutions of a counselling process aim to enable the patient to:

Make

some of the changes that he/she wants in life

Develop

positive relationships and explore his or her potential

Cope

with painful situations, like death, terminal illness and disability

Outcomes

of Effective Counseling

;

When

counseling is effective, patients:

Develop

a greater awareness of their problems

Create

new responses to old issues

Develop

a relationship with the person providing the counselling

Are

more likely to return to the clinic for additional care and treatment

Factors that Hinder Effective Counselling

Language barrier

Lack

of counseling skills

Personality/attitude

of counselor

Cultural

relationship and social economic differences

Lack

of trust and confidence between counselor and counselee

Unrealistic

expectations of patients/clients

Key points

The counseling process often takes time, it is probably not realistic to expect that

clients‘ problems

will be solved after one or two sessions, because counseling is a process, it is wise

to give

it a few weeks before you decide it is not working for client.

Effective

Counselling , is private, confidential, and respectful, views the patient as the expert

on his

or her own life, respects that patients come to counselling with great, strengths

and knowledge

upon, which to build, doesn‘t tell the patient what to do, and never forces the

patient to

do something

• The Outcomes of Counselling, the results or resolutions of a counselling process aim to

enable the

patient to, make some of the changes that he/she wants in life, develop positive

relationships and

explore his or her potential, cope with painful situations, like death, terminal illness

and disability

Evaluation

What are the stages of counseling process?

What

are the guidance processes?

Reference

Angotti

N, et al. (2009) Increasing the acceptability of HIV counseling and testing with three

C‟s: convenience

, confidentiality and credibility. Thailand

MM,

Ostermann

J, Crump JA, (2010).Characteristics of HIV voluntary counseling and

testing clients

before and during care and treatment scale-up .Moshi, Tanzania.

Beardsley RS, et al.( 2007) Privacy as a factor in patient counseling. Journal of the

American Pharmacists

Association.

PST 06102

:

Counselling and Guidance

Session 9

:

Counseling and Guidance in promoting Rational Use of Medicine

Learning tasks

By the end of this session students are expected to be able to:

Explain

concept of counseling and guidance in promoting rational use of medicines

Describe

Role of counseling and guidance in promoting rational use of medicines

Describe

Counseling and guidance matters to improve rational use of medicines

How counselling and guidance promot

e rational use of medicines

Introduction to Counselling and Guidance in Promoting Rational

Use of

Medicines

Counselling and Guidance in Promoting Rational Use of Medicines is mandated since

medicines are

weapons used by man to fight against diseases therefore patient should be counselled

and guided

on the proper use of medicines.

Pharmaceutical

personnel can set up a different counselling space for guiding patients, he

can keep

up points of interest of patient history, hypersensitivities and other vital information for

the treatment

, and in addition, he/she encourages the patients to take the measurements

in appropriate

time in order to keep any antagonistic results.

The amount and type of counselling and guidance required to be provided to patients

by pharmaceutical

personnel varies depending on the patient‘s individual needs, and the

individual situation

in question.

Pharmaceutical

personnel are reminded that they have a duty of care to their patients, and

must at

all times act in the best interests of their patients, exercising due diligence and his/her

own professional judgment

to ensure rational use of medicines.

What are the role of

counselling and guidance

in promoting

rational use of medicines?

Role of Counselling and Guidance in Promoting Rational Use

of Medicines

Help patients

to get

correct information

and advice regarding their medicine therapy to improve rational use of medicines.

Counselling

and guidance process if properly implemented and consistently maintained

result in

the safe supply of prescribed medicinal products and ensure that they are used rationally

and appropriately

Adequate Counselling and guidance provided to patient by pharmaceutical personnel must

be satisfied

that, patient has sufficient information to take their medicinal product safely and

as prescribed

, and that they know how to store the medicinal product to ensure rational use

of medicines

When

pharmaceutical personnel ensure that the patients provided with appropriate

counselling and

guidance are the right patient, or approved representative it will avoid any

unintentional breaches

of patient confidentiality hence increase rational use of medicines.

When

medicinal product is substituted, the Pharmaceutical personnel must take the

necessary steps

to ensure that patient is aware of the substitution and is fully counselled and guided on

the change

, as is the case with the initiation of any new medication to improve rational use

of medicines

The

Pharmaceutical personnel should ensure that patient get sufficient counselling and

guidance on

the active ingredient in the medicinal product and is aware of how to use their

medicinal product

safely to improve rational use of medicines

Counselling and Guidance Matters to improve rational use of medicines

A

of effective patient counselling and guidance is to enable and encourage the

safe and

proper use of medications by patients in order to achieve the required

therapeutic outcomes

achieve such positive results, a pharmaceutical personnel may undertake to counsel

and guide

patient or his/ her representative on the following matters, as deemed appropriate:

The

nature and use of the medicinal product, the directions for use; how to take/administer

it and

duration of treatment

The

therapeutic benefit which may be expected from the use of the medicinal product

and potential

side effects that are likely to be experienced and how to deal with them

Any special precautions to be taken while using the medication; special regard for food

or drink

like which foods to avoid, which drinks to avoid, take with(out) food, take

with(out) drink

and which other medicinal products to avoid

The

importance of the need for compliance with the directions for use, where a

medicinal product

has been interchanged in line with prescriber‘s , instruction/consent, or

in accordance

with the HPRA interchangeable list, to avoid confusion for patients and

to ensure

that the risk of duplication of therapy is avoided

Storage

of the medicinal product, what to do if they think the medicinal product is

not working

, what to do in the event of a missed dose, what to do in the event of an

overdose, the

correct use of therapeutic devices (including demonstration, if applicable)

If the patient is using the medication long term, whether they are experiencing any difficulties with it, counselling and guidance on change to medication or any new medications being introduced

Any other matters which may be included or referred to in the Summary of Product Characteristics (

SmPC

) for the medicinal product concerned, what to do with any previously dispensed medicinal product(s), no longer required (i.e. disposal of medicinal product)

The

pharmaceutical personnel should aim to confirm patient understanding at regular

intervals in

the counselling process, assessing whether or not the information was understood as intended.

The

pharmaceutical personnel should ensure that the patient understands how to use

the information

furnished to them in order to improve the probability of positive

therapeutic outcomes

Key points

The main aim of effective patient counselling and guidance is to enable and encourage the

safe and

proper use of medications by patients in order to achieve the required therapeutic outcomes.

The

Pharmaceutical personnel must be satisfied that the patient has sufficient information

to take

their medicinal product safely and as prescribed, and that they know how to store

the medicinal

product

Patient counselling and guidance is a key component of pharmacy-based care. It is vital that Pharmaceutical personnel are in a position to give appropriate, reliable and trustworthy information to patients regarding their usage of prescribed medicinal products.

Evaluation

What is role of counselling and guidance in promoting rational use of medicines?

What

are the things to remember when providing counselling and guidance on the use

of medicines

Reference

MOHSW (2005). National Guidelines for Voluntary Counselling and Testing. Dar

Salaam, Tanzania

: National AIDS Control Programme

Hogerzeil

HV.(1995). Promoting rational drug use: an international

perspective. 8

. Br J

Clin

Pharmac

; 39: 1-6. British

USP (2003). USP Medication

Counseling

Behavior

Guidelines. USP Convention,

Inc

Rockville MD

, USA

Bhatnagar

A, and Gupta N, (1999) Guidance and Counselling, A theoretical approach

(

Ed) New

Delhi,

Vikash

Publishing house.

PST 06102

:

Counselling and Guidance

Session

: Care and treatment Clinic (CTC)

Learning tasks

By the end of this session students are expected to be able to:

Explain

Concept of care and treatment Clinic (CTC)

Identify

core elements of HIV preventions, treatment and support at CTC

Explain

organization of care and treatment services

Introduction to Care and Treatment Clinic (CTC)

a National Plan which was launched in 2004 for

Tanzania mainland

, with the aim of providing quality care, Education, Counseling and guidance

and treatment

for all people living with HIV/AIDS (

PLHIV).

CTC

have been set up, in both public and private hospitals, and in referral hospitals down

to health

centers and dispensaries, throughout Tanzania.

Standard

Operating Procedures (SOP) for Care and Treatment Clinics (CTC) in hospitals

have been

developed based upon various National Guidelines, the SOP outline the procedures in

a standardized

manner on how to operate the set down objectives of the programme.

CTC is

an integral part of the delivery of care and treatment made to ensure that

effective monitoring

and evaluation of the stated programme takes place in one roof, Data collected

from CTC

, as well as data from other sources of the programme like Inpatient, are made useful

to inform

about progress in delivering the services to Patient Living with HIV (PLHIV), and on

the impact

these services have on the lives of patients that access them.

Core

goals for management of HIV in CTC are

;

maximal

suppression of viral replication

and

promotion

of immune reconstitution through combination antiretroviral therapy and

promoting long-term

adherence, avoiding drug interactions, minimizing toxic effects, simplifying

treatment regimens

, decreasing drug costs, managing comorbid conditions, and preventing transmission

of HIV

by achieving undetectable viral

load

WHO

promotes a comprehensive approach to the management of people living with HIV that addresses the individual‘s full range of

health related

needs, many of which may change during his or her lifetime.

What are the core elements of HIV prevention, treatment and support at CTC?

Core Elements of HIV Prevention, Treatment and Support at CTC

The core elements of HIV prevention, treatment and support that need to be available within

CTC services

at any level include

This

includes

the following

:

Education

about behavioral risks and condom use for infected people

Orientation

on care and treatment services available in hospital and district

Education

and regular counselling on life-long disease management, and in particular

on treatment

adherence

Education

and counselling on actions that may delay progression of disease and reduce comorbidities; for example, addressing nutrition, food safety, clean water and use of

insecticide treated

bed-nets

Early identification and management of co-morbidities such as TB

Prophylaxis

for OIs and cancers including

Cotrimoxazole

, TB preventive therapy and

cervical screening

Assessing

eligibility for ART i.e. clinical staging, social eligibility and CD4 counts

Effective

referrals to essential hospital services such as antenatal clinics for MTCT,

family planning

advice before and while on ART, STI or other specialized clinics

Recording

and reporting according to the established electronic and paper based system

Registration

and appointment systems for effective treatment continuation and

preventing missed

appointments

Referral

to community services such as HBC, social welfare and legal support

Prophylaxis for OIs and cancers including

Co-

trimoxazole

, TB preventive therapy and

cervical screening

Assessing

eligibility for ART i.e. clinical staging, social eligibility and CD4 counts

Effective

referrals to essential hospital services such as antenatal clinics for MTCT,

family planning

advice before and while on ART, STI or other specialized clinics

Recording

and reporting according to the established electronic and paper based system

Registration

and appointment systems for effective treatment continuation and

preventing missed

appointments

Referral

to community services such as HBC, social welfare and legal

support

In order to provide effective and quality HIV and AIDS Care and Treatment, service delivery needs to be organized in a manner to ensure efficiency, user friendliness, and regular, standardized follow up. Quality Improvement (QI) initiatives are a helpful tool in this regard

Organization of Care and Treatment Services

The organization of care and treatment services at (CTC) is, patient visit plan,

adherence management

and life style counseling, medical record system and reporting

1. Patient

visit plan

the initial clinic visit, a triage nurse will assess patient‘s needs, register basic

information on

reliable patient demographics and contact information, issue relevant forms such

as CTC1

, CTC2 and the TB screening tool, weigh the patient, and direct her/him to

relevant sites

o Patients who are recommended for and agree to initiate therapy will meet

with pharmaceutical

personnel for counseling and guidance on ARVs and other

related medicines

; they will discuss adherence, medication dosages and adverse

reaction management

o Patients will be scheduled for a follow-up appointment in two weeks, then monthly for

the first

six months, depending on assessment by the clinician and pharmaceutical personnel

on the

status of a patient on ART

o When patient is clinically stable, with good adherence for at least the first six months

or more

to ART regimen, and no history of drug toxicity or recurrent OI, s/he may be given

an appointment

of two months hence or more, as agreed between the clinician,

pharmaceutical personnel

and the patient.

o All patients are advised to come into the CTC immediately before their

condition deteriorates

prior to their next scheduled visit.

Adherence

Management and Lifestyle Counselling;

Adherence

to preventive therapies, TB treatment and ARVs are important factors in

ensuring better

health outcomes.

Patients

in long term therapy or prophylaxis, including ARV treatment, are

strongly encouraged

to identify an adherence/treatment assistant. This can be any person (e.g.

a family

member, friend, colleague, or community member) to support the patient

in complying

to prescribed medication.

Patients

also receive counseling and guidance on HIV/AIDS transmission risk

reduction, nutritional

and family planning advice, and adverse event management.

Psychosocial

needs such as social or legal support, disclosure of HIV status, mental

health, referrals

to HBC services and facilitation for joining PLHIV (People Living with

AIDS) support

groups will also be addressed during the counselling and guidance session.

In addition

, the patient will be screened for TB and other OIs for early identification,

treatment or

prophylaxis.

3. Medical

Records System

The

Patient Identification Card (CTC1), the Patient Record Form (CTC2), the

Registers (pre-ART

and ART), the Reporting Forms (for Cross-sectional and Cohort analysis), and

the referral

form have been designed for the purpose of patient identification, patient

monitoring and

programme monitoring

addition, an appointment book to facilitate scheduling and follow-up on lost patients

is included

in the patient monitoring system.

4. Reporting

Reporting

at the CTC should be done as follows using the appropriate reporting forms

and tools

:

Quarterly

Reports:

Programme

Monitoring

Key Point

Core goals for management of HIV in CTC are; maximal suppression of viral replication

and promotion

of immune reconstitution through combination antiretroviral therapy and

promoting long-term

adherence, avoiding drug interactions, minimizing toxic effects, simplifying

treatment regimens

, decreasing drug costs, managing comorbid conditions, and preventing transmission

of HIV

by achieving undetectable viral load

Patients

in long term therapy or prophylaxis, including ARV treatment, are strongly

encouraged to

identify an adherence/treatment assistant. This can be any person (e.g. a family

member, friend

, colleague, or community member) to support the patient in complying to

prescribed medication

Evaluation

What is CTC?

What

are the core elements of HIV prevention, treatment and support at CTC?

Reference

Clift PJ, Nixon E and Fisher M (2004) ‗Patients' involvement in the development of, and access

to, HIV

clinical services, care and treatment,‘ 15th International Conference on

AIDS Bangkok

, Thailand; International Conference on AIDS 15.

MOHSW (2008). HIV and AIDS Voluntary Counselling and Testing: Participant Manual. Dar

Salaam

, Tanzania: National AIDS Control Programme.

World Health Organization, (2007) Guidance on provider-initiated HIV testing and counselling

in health

facilities. Geneva,

United Republic of Tanzania, MOHSW, AIDS Control Programme, ( 2007) Guidelines on

HIV Testing

and Counseling in Clinical Settings.

Dar

Salaam, Tanzania:

PST 06102

:

Counselling and Guidance

Session

: Types of Counseling and Guidance provided

at VCT

, and PITC

Learning tasks

By the end of this session students are expected to be able to:

Describe

HIV Testing and Counseling Approaches in Tanzania

Explain

pre and post test counseling

Explain

prevention and disclosure counseling

Describe

bereavement counseling

HIV Testing and Counseling Approaches in

Tanzania

Different approaches to HIV testing and counseling exist in Tanzania as follow;

Client-Initiated

Counseling and Testing (VCT);

client voluntarily makes the decision

to learn

his/her HIV status and seeks for counseling and testing services out of his/her

own will

for the purpose of prevention of HIV infection and personal life decision making

Provider-Initiated

HIV Testing and Counseling (PITC);

HIV testing and

counseling which

is recommended by health care provider to person attending Health Care Facilities

as standard

component of medical care

Activity:

Buzzing

What are the

types of counselling and guidance provided at CTC?

Pre and Post Test Counseling

There are several types of counseling in relation to HIV Counselling and guidance. The

essence of

the different types of counseling and guidance is to provide guidance and counseling

in different

stages of HIV infection that the infected person and the relations go through.

The types

include: Pre-test counselling, post-test counselling, prevention counseling,

bereavement counseling

and disclosure Counseling

Pre-test counseling

Pre-test

counselling simply refers to counseling given to an individual prior to taking

an HIV

test.

is given to prepare the person for the HIV test and the implications of taking the test.

Post

Test Counselling

Post

test counseling simply refers to counselling given to an individual after an HIV test

is conducted

and is given irrespective of what the HIV test result is.

The

main goal is to help the client to understand and come to terms with his/her test

results and

to initiate adaptation to their seropositive or

seronegative

status.

Prevention and Disclosure

Counselling

Prevention Counselling

Prevention

counselling is similar to pre-test counseling as it provides an opportunity for

the counsellor/client

to negotiate and reinforce a plan to reduce or eliminate the risk of

HIV transmission

Prevention

counseling can also be given to relatives and significant others of an

infected person

so as to protect them from contacting the infection in the process of caring for

the PLWHA

Prevention and Disclosure Counselling

Disclosure Counselling;

Disclosure

of HIV status is advocated to reduce stigma among PLWHA.

Clients

prepared emotionally for the outcome of disclosing, they are helped to identify

who the

disclosure might be affect (e.g. spouse, children) and to be aware of potential

negative consequences

Health

workers must ensure that there is adequate support and preparation before and

after disclosing

PLWHA

may need support to disclose their status to loved ones and their loved ones

may need

support to cope with their feelings about the information.

Bereavement

counselling

Bereavement counseling

Bereavement

is a term that can be used to describe any event that includes loss, so this

could mean

losing a job or the death of someone you know. Bereavement can also be termed

as grief

Bereavement

in relation to HIV/AIDS could be grief over the loss of a dear one or

grief upon

learning one or a partner or a friend is HIV positive

Normal Grief Reactions

The normal grief reactions can include:

Feelings

: This can be expressed in the form of shock, anger, Sadness, guilt,

self reproach

, loneliness, helplessness, hopelessness, depression, numbness and feelings

of unreality

Physical

symptoms: Such as tightness in throat and chest, excessive sensitivity

to noise

, irritability, weakness, loss of appetite, insomnia, weight loss.

Behavior

: This can be manifested in the form of confusion, hallucination (seeing

or hearing

the deceased person), tearfulness, Absentmindedness, obsession to

belongings of

deceased person, irrational behavior

Potential Danger Signs in Grief Reactions

When

someone feels he/she is no longer of value as a person

Behavior

or personality changes that are inconsistent with clients normally

behavior pattern

When

client makes threats of self-destruction

Excessive

hostility

Complete

withdrawal and unwillingness to interact with other people

Appearance

of fleeing from reality

Stages of bereavement are;

Denial

:

first reaction that people have to the loss of a loved one or a diagnosis of

HIV, tend

to deny and may withdraw from usual social contacts.

Anger

;

There is the stage of anger at self, loved one, God, the world, the HIV

virus and

the world in general. Questions such as ―Why me?‖, ―Why did it happen

to him/her

?‘ are asked over and over again.

Bargaining;

this stage the grieving person may make bargains with God, asking, "If I

do such

and such, will you take away the loss?", ―I promise I'll be a better

person if

….‖ Hoping that the loss will disappear or magically be made right.

Depression;

this stage the person feels numb, although anger and sadness may

remain underneath

but the person feels tired and doesn‘t care any longer about

what happens

A

sense of hopelessness and helplessness washes over the person and leaves

him or

her unable to muster energy to do anything and everyday functioning may

also be

a problem.

Acceptance

;

this stage there is a sense of resignation, when anger, sadness and

mourning have

tapered off.

The

person simply accepts the reality of the loss and lets‘ go, but memories

still remain

It is not a pleasant feeling but rather a feeling of being ready for whatever may come.

Key Points

There are several types of counseling in relation to HIV Counselling and guidance, The

essence of

the different types of counseling and guidance is to provide guidance and counseling

in different

stages of HIV infection that the infected person and the relations go through.

 Counsellors should counsel and guide the client by listen actively without judging or trying

to guide

the person on how to grieve, showing compassion and empathy should be the

counsellors primary

tool in helping client as well as to guide client to be able to adjust to life after loss

Evaluation

What are the types of counseling and guidance provided at CTC?

What

are stages of HIV positive bereavement?

Reference

MOHSW (2008). HIV and AIDS Voluntary Counselling and Testing: Participant Manual. Dar

Salaam

, Tanzania: National AIDS Control Programme.

World Health Organization, (2007) Guidance on provider-initiated HIV testing and counselling

in health

facilities. Geneva,

United Republic of Tanzania, MOHSW, AIDS Control Programme, ( 2007) Guidelines on

HIV Testing

and

Counseling

in Clinical Settings. Dar

Salaam,Tanzania

:

PST 06102

:

Counselling and Guidance

Session 12

: Pharmaceutical Personnel at CTC

Learning tasks

By the end of this session students are expected to be able to:

Explain

concept of the role of pharmaceutical personnel at CTC

List

role of pharmaceutical personnel at CTC

Explain

role of pharmaceutical personnel at CTC

Identify

Steps for providing counselling and guidance to patients at CTC for medicinal use

Concept of the Role of Pharmaceutical Personnel at CTC

Patient counseling and guidance about medications at CTC; involve providing

medication information

orally or in written form to the patients or their representative or providing

proper directions

of use, advice on side effects, storage, diet and life style modifications, it involves

a one-to-one

interaction between a pharmaceutical personnel and a patient or care giver.

Pharmaceutical

personnel and patient need to come to a common understanding about

their respective

roles and responsibilities.

may be necessary to clarify for patients that Pharmaceutical personnel have an

appropriate and

important role in providing education and counselling and patients should

be encouraged

to be active participants.

Pharmaceutical

personnel provide optimal management of medication for chronic

diseases such

as diabetes, asthma, hypertension, HIV/AIDS etc. The collaboration of

healthcare professionals

, such as physicians and Pharmaceutical personnel, can help to ensure

that patients

properly take their medications as prescribed and avoid any harmful effects

In addition to a current knowledge of pharmacotherapy, Pharmaceutical personnel need

to have

the knowledge and skills to provide

Effective

and accurate patient education and counseling.

They

should know about patients‘ cultures, especially health and illness

beliefs, attitudes

, and practices.

They

should be aware of patients‘ feelings toward the health system and views of

their own

roles and responsibilities for decision-making and for managing their care.

What are the

roles of pharmaceutical personnel at CTC?

Role of Pharmaceutical Personnel at CTC

Role of pharmaceutical personnel in the management of HIV/AIDS and related problems in

the CTC

are:

Selecting

and reviewing therapy i.e. general principles, resistance to

antiretroviral drug

, management of drug interaction, complementary or alternative medicines,

general promotion

and maintenance of health

Tailoring

treatment for specific populations i.e. women, pediatric patients, patients with comorbidity, patients with co-infections with hepatitis virus, marginalized patients

groups, immigration

and indigent population

Counselling

patients i.e. counseling and educating on adherence issues. Monitoring response

to therapy

i.e. managing adverse drug reaction and therapeutic drug monitoring and

professional networking

and collaborations

Role of Pharmaceutical Personnel at CTC

1. Selecting

and reviewing therapy,

General

principles

Pharmaceutical

personnel working at CTC should be familiar with current

treatment principles

so that they can effectively manage and optimize pharmacotherapy for

HIV infected

individuals, they should also be familiar with recommendations on

prophylaxis and

treatment of opportunistic infections that occur in conjunction with HIV infection

Resistance

to Antiretroviral Drugs

Resistance

to antiretroviral is a major cause of treatment failure, it is therefore

important for

pharmaceutical personnel to understand the mechanisms of and factors

contributing to

development of drug resistance.

Pharmaceutical personnel at CTC can play an important role in preventing

the development

of drug resistance by ensuring

selection

of potent antiretroviral regimens;

monitoring

and reinforcing the need for strict adherence;

screening

for and managing drug–drug interactions;

anticipating

and effectively managing adverse effects, as a means to

increase adherence

; providing appropriate education about the relationship between

nonadherence

and development of resistance

aggressively

managing treatment failure by switching therapy to prevent

further accumulation

of resistance mutations

Management of Drug Interactions

Patients

are now living longer and experiencing co-morbidities such as

cardiovascular disease

, hyperlipidemia, hypertension, diabetes mellitus, gastrointestinal

conditions, osteoporosis

, renal disease, and non–AIDS-related cancers, which may be manifestations

of long-term

toxic effects of the antiretroviral, increasing age, or the virus itself.

Pharmaceutical

personnel should be aware of the types and mechanisms of drug

interactions if

they are to manage such interactions effectively

Interactions

between antiretroviral and other drug classes have not been

exhaustively elucidated

, so pharmaceutical personnel at CTC need to be aware of the

pharmacological and

pharmacokinetic characteristics of specific agents to identify or predict potential

drug interactions

Management of Drug Interactions

Pharmaceutical personnel at CTC must utilize current sources of information to make

an accurate

assessment, in situations of suspected or potential drug interactions, close

clinical,

virological

, and therapeutic drug monitoring is necessary.

some instances, dose adjustments may be beneficial in optimizing the clinical

response, including

viral suppression, other management options include altering dosing frequency

or replacing

one agent with another drug that has lower potential for interaction

Pharmaceutical Management cycle

Complementary or Alternative Medicine

The

concomitant use of CAM with antiretroviral is common, patients need to be

reminded that

, in contrast to conventional medications, the large majority of CAM products are

not licensed

and are not required to meet the standards for efficacy, safety, bioavailability,

and stability

that are required for conventional medications before they can be marketed,

Herbal

remedies are classified as dietary supplements, and manufacturers do not have

to prove

the safety and effectiveness of dietary supplements before marketing them.

Pharmaceutical

personnel can play a crucial role by providing reliable information

about CAM

to help patients who visit at CTC to understand the potential risks, benefits,

and uncertainties

regarding specific products of interest.

When

indicated, potential interventions include offering therapeutic

alternatives, evaluating

the risk of drug interactions, recommending therapeutic drug monitoring,

and ensuring

optimal adherence with combination antiretroviral therapy

General Promotion and Maintenance of Health

With

the evolution of HIV infection into a chronic manageable disease, patients who

are receiving

stable combination antiretroviral therapy may be seen less frequently.

Pharmaceutical

personnel, especially those practicing in ambulatory or community

settings, can

play a significant role in this aspect of care. They can help to ensure that patients visit

at CTC

are up to date on routine vaccinations and immunizations, advise on proper diet

and nutrition

, and provide counselling on personal health and safety issues such as

Sun

protection,

Routine

oral hygiene,

Safer

sex practices,

Management

of erectile dysfunction,

Prevention

of falls, and

Smoking

cessation.

2. Tailoring

Therapy for Specific Populations

a. Women

Women and families living with HIV pose unique challenges for

pharmaceutical personnel

. The HIV-infected woman who may be caring for her infected partner

and/or children

often requires additional support from all members of the health care team.

Women

of child-bearing age, choosing a regimen that is safe during pregnancy

is paramount

importance, as the life expectancy of HIV-infected individuals

improves, issues

of fertility and risk reduction when planning pregnancy will become

more common

Pharmaceutical

personnel at CTC should be comfortable discussing methods

of contraception

and need to be aware of drug interactions with hormonal

contraceptives, and

to ensure all pregnant women, regardless of their viral load or CD4 cell

count, should

be offered treatment with combination antiretroviral to prevent

vertical transmission

of HIV

b. Pediatric

Patients

utero,

intrapartum

, and potentially postpartum exposure of a neonate born to an

HIVpositive

mother places the neonate at risk of prenatal acquired HIV

Pharmaceutical

personnel must continue to lobby to have pediatric dosing guidelines

and formulations

made available when new antiretroviral are marketed for the

adult population

Pharmaceutical

personnel working at CTC has a role of careful calculating a

pediatric doses

of antiretroviral which based on weight, body surface area, and/or age

c. Patients

with Comorbidities

o Comorbidities are common among HIV-infected patients, with consumption of alcohol,

use of tobacco products and illicit substances, low body mass index, low socioeconomic

status, and co infection with HCV being some of the contributing factors

o The success of combination antiretroviral therapy, yielding high rates of viral

suppression and immune recovery, means that patients with HIV are living longer,

o The pharmaceutical personnel at CTC can play a role in monitoring use of ARV‘s and

those over-the-counter medications that can contribute to hepatotoxicity and

nephrotoxicity, such as acetaminophen and

nonsteroidal

anti-inflammatory drugs

d. Patients

with Co infection with Hepatitis Virus

o Hepatitis B virus (HBV) and HCV share common routes of transmission with HIV, and

co infection is frequent, management of patients with such co infections may involve

multiple agents having possible interactions and significant adverse effects.

o Pharmaceutical personnel at CTC should be aware of key drug interactions if

simultaneous treatment of HCV and HIV infection is required, for example,

didanosine

stavudine

, and

zidovudine

should be avoided with

pegylated

interferon and ribavirin

because of increased risks of mitochondrial toxicity and anemia, these interactions

illustrate the complexity of treating HIV and HCV

coinfection

o Pharmaceutical personnel working at CTC have a key role in ensuring the safety of

therapy and assisting with adherence challenges to optimize treatment response to both

HIV and HCV therapies and to maintain overall quality of life for patients during the

course of HCV treatment

e. Marginalized

Patient Groups

o Marginalized members of society, such as people who use various substances, people

who are homeless, and those with psychiatric disorders, may have additional needs.

o Pharmaceutical personnel at CTC with his or her team need to screen for potentially

harmful drug interactions between antiretroviral and recreational drugs such as ecstasy

(3,4-methylenedioxy-N-methylamphetamine or MDMA), γ-

hydroxy

-butyrate (also

known as GHB), phencyclidine (also known as PCP), and ketamine

o Pharmaceutical personnel at CTC should support patients seeking methadone

maintenance therapy and/or needle exchange programs, methadone maintenance services

have yielded positive outcomes, including improved adherence and

virological

suppression

f. Immigrant

and Indigent Populations

o HIV-infected patients from endemic countries present distinctive challenges to the HIV

pharmaceutical personnel career

o When they visit at CTC they may have different beliefs about HIV treatment or financial

difficulty in paying for medications, they may present with opportunistic co infections

endemic to their home countries, they may have difficulty accessing services, and/or

they may suffer from post-traumatic stress disorders related to horrific events or

conditions experienced before they move to a new country.

o Pharmaceutical personnel at CTC need to be sensitive to these issues when discussing

and managing HIV therapy. Being able to communicate with patients in their native

language may reduce some barriers. The use of reliable, trustworthy, medically

knowledgeable interpreters is imperative to ensure that patients adequately understand

their complex medication regimens.

o Many cities have medical clinics that specialize in caring for immigrant populations,

pharmaceutical personnel should try to familiarize themselves with these organizations

so that they are ready to refer clients when the need arises.

3. Patient

Counselling

a. Counselling

and Patient Education

HIV

Patient crosses many boundaries related to sex, age, race, culture,

socioeconomic status

, language, and lifestyle choice,

Pharmaceutical

personnel working at CTC need to be aware of these issues and take

into account

the communication style and literacy level of each patient when they

are providing

counselling.

The

ultimate goal is to develop a more personal and trusting relationship at CTC, so

that the

patient feels comfortable and cared for and is willing to discuss any and all

issues regarding

his or her diseases and treatment in a confidential, non-judgmental,

non punitive

relationship with the pharmaceutical personnel.

The

pharmaceutical personnel at CTC is one of the referral source for other support

and educational

tools that may be of interest and use to the patient, such as websites

with drug

information or other patient-related information and community support groups.

b. Adherence

Issues

Medication

adherence is a crucial factor affecting the extent and duration of response

to combination

antiretroviral therapy, poor adherence to both HIV therapy

and prophylactic

regimens against opportunistic infection may have lasting

consequences for

the HIV-positive patient including:

Increased

viral load,

Development

of resistance,

Reduced

efficacy of future combination therapy,

Increased

risk of hospital admission,

Increased

progression to AIDS,

Decreased

survival.

Pharmaceutical personnel at CTC can play an important role in assessing readiness to

begin combination

antiretroviral therapy, providing education about the medications

and expectations

of treatment, helping patients tailor drug regimens to their lifestyle,

and managing

adverse effects

Pharmaceutical

personnel working at CTC should ensure patient‘s knowledge of

medication names

and prescribed dosing regimen, including attention to dietary requirements,

and whether

there may be a pattern to any non adherence, for example, on weekends or

when daily

routines

Pharmaceutical

personnel can support adherence by helping to anticipate and

identify barriers

to adherence and strategizing with patients to find solutions that will work for them

4. Monitoring

Response to Therapy

a. Managing

Adverse Drug Reactions

Adverse

drug reactions to antiretroviral occur frequently and are a major reason

for discontinuing

or changing therapy,

Almost

all organ systems can be affected by combination antiretroviral

therapy, including

the gastrointestinal system, heart, bone, kidneys, and liver, adverse events

may present

as severe and/or serious events, which are relatively infrequent, or as less

serious but

more common events.

Pharmaceutical

personnel and his or her team at CTC should work on to find out

the causative

of ADR and once a potential causative drug is identified, management

may include

addition of a new drug to treat the adverse effect, discontinuation of the

suspect drug

, and/or substitution with another less toxic but equally effective agent.

b. Therapeutic

Drug Monitoring

Therapeutic

drug monitoring involves measurement of drug concentrations in the

plasma and

subsequent adjustment of doses to achieve therapeutic concentrations, exists of a relationship between exposure to antiretroviral and

virologic

response and, in

more limited

instances, between drug exposure and toxicity.

Therapeutic

drug monitoring is therefore used to optimize the efficacy and, in

certain cases

, to minimize the toxic effects of antiretroviral.

Pharmaceutical

personnel who working at CTC should collaborate with therapeutic

drug monitoring

team for antiretroviral to monitor specific patient populations like

pediatrics, pregnancy

, aging, hepatic impairment, and obesity to explore if there is changes

in pharmacokinetic

parameters that can affect absorption, metabolism, and clearance

of drugs

5. Guiding

Transitions of Care

a. Prevention

of Errors

Patients

living with HIV/AIDS are under the care of multiple health care providers

in various

settings, and medication errors occur frequently in individuals with

HIV/AIDS, often

as a result of faulty communication at the interfaces of care, such as admission

to and

discharge from hospital.

Antiretroviral

prescribing errors included prescribing an incorrect drug, incorrect

doses or

dosing frequencies, drug–drug interactions, omission of a needed drug, and

duplicate therapy

Antiretroviral

errors also occur in the ambulatory setting, including specialized

clinics (CTC

) and may occur as a result of actions by both patients and health care providers.

Pharmaceutical

personnel who working at CTC should co-operate with prescribers‘

to reduce

or to eliminate completely medication errors.

b. Medication

Reconciliation

Medication

reconciliation, the process of obtaining the most accurate list of

all medications

that a patient is taking and comparing this list against the

physician‘s admission

, transfer, and/or discharge orders, can help to identify discrepancies and

thus can

significantly reduce the incidence of errors.

Medication

reconciliation is a shared responsibility but pharmaceutical personnel

should be

strongly consider leadership in this area, because they can be an

instrumental component

of the process.

Pharmaceutical

personnel should provide advice regarding dosage adjustments

to address

drug interactions or organ insufficiencies, can suggest alternatives if

current therapies

or formulations are unsuitable or contraindicated, and can ensure that

complete regimens

are prescribed, including co-medications, problems that a

computerized physician

order entry system is unlikely to be able to identify or help resolve.

C:Seamless

Care

Seamless

care is the desirable continuity of care delivered to a patient in the health

care system

across the spectrum of caregivers and their environments, traditionally; seamless care initiatives have focused on the patient‘s transfer from acute care back to

the community

However

, valuable patient information regarding past medication use, adherence,

and use

of nonprescription medications can be provided by community practitioners

to specialty

practitioners.

Without

a seamless care process, incomplete communication regarding adjustment

of combination

antiretroviral therapy or initiation and discontinuation of medications

may lead

to unrecognized and undermanaged drug interactions or adverse effects.

Pharmaceutical

personnel should provide professional advice to HIV Patients,

their family

or other caregivers, and their physicians if any treatment changes are

being considered

being involved in the many aspects of medication assessment and

review, pharmaceutical

personnel should help to mitigate error rates and reduce harm

through medication

reconciliation and seamless care programs, thus helping patients to

achieve the

optimal benefits of combination antiretroviral therapy.

6. Scholarly

and Professional Activities

a. Drug

Information

about HIV changes rapidly, making it a challenge for both patients

and health

care providers to stay current, in terms of patient education,

pharmaceutical personnel

need to tailor information to the degree of understanding and education of

the individual

patient.

Some

patients who visit CTC may have no knowledge whatsoever about HIV,

whereas others

may have a good understanding about their prescription and

nonprescription medications

and may access treatment information from sources such as the internet

and HIV/AIDS

associations.

Pharmaceutical

personnel who working at CTC should be able to collect general

drug information

resources to consult, and it is important to recognize the advantages

and limitations

of these various references

b. Research

The

treatment of HIV infection involves a steady cycle of development, testing,

and approval

of new drugs, therapy is complicated by incomplete knowledge of

new antiretroviral

entering the market, since licensing trials often fall short of answering

all questions

about a drug‘s rational use in clinical practice.

There

are many opportunities for pharmaceutical personnel who working at CTC to

get involved

in research, as they can identify key gaps in the evidence-based

literature, define

important new research questions, and contribute to the generation of new

drugrelated

knowledge in the field of HIV therapeutics.

Many

types of research can be conducted by pharmaceutical personnel specializing

in HIV

, including but not limited to case reports of adverse drug reactions; studies

of adherence

patterns and methods of support, drug use patterns and prescribing

practices, therapeutic

drug monitoring, pharmacokinetics, pharmacodynamics, drug interactions, health economics, drug policy development, quality of life, and

pharmacoepidemiology

; health

services research; and interventional trials on the management of HIV or

HIVrelated

complications.

C. Professional

Networking and Collaboration

Centers

specializing in HIV care like CTC are often concentrated in large, urban

settings, and

because of overall disease characteristics and population demographics, the

number of

pharmaceutical personnel working in HIV-related care is relatively small

compared with

the number practicing in other common specialties, such as cardiovascular

care, nephrology

, or diabetes.

Establishing

professional networks allows pharmaceutical personnel in small or

isolated practices

to exchange ―clinical pearls‖ and practice insights with colleagues, to

share new

information, to develop common educational projects and tools, and to

pool resources

and data to conduct research that otherwise might not be achievable on

a smaller

scale.

What are the steps for providing counselling and guidance to patients on medicinal use at CTC?

Steps for Providing Counselling and guidance on Medicine Use

to Patients

at CTC

Steps in the patient education, guidance and counselling process will vary according to

the health

system‘s policies and procedures, environment, and practice setting. Generally,

the following

steps are appropriate for patients receiving new medications or returning for

refills

Establish caring

relationships with patients as appropriate to the practice setting and stage

in the

patient‘s health care management. Introduce yourself as pharmaceutical

personnel, explain

the purpose and expected length of the sessions, and obtain the patient‘s

agreement to

participate. Determine the patient‘s primary spoken language.

Assess the patient‘s knowledge about his or her health problems and medications,

physical and

mental capability to use the medications appropriately, and attitude toward the

health problems

and medications. Ask open ended questions about each medication‘s purpose

and what

the patients expects and ask the patients to describe or show how he or she will

use the

medication

Patients

returning for refill medications should be asked to describe or show how they

have been

using their medications. They should also be asked to describe any problems,

concerns, or

uncertainties they are experiencing with their medications

Provide information

orally and use visual aids or demonstrations

fill patients‘ gaps

in knowledge

and understanding. Open the medication containers to show patients the

colours

, sizes

, shapes, and markings on oral solids.

For

oral liquids and

injectables

, show patients the dosage marks on measuring

devices. Demonstrate

the assembly and use of

administration

devices such as nasal and oral

inhalers. As

a supplement to face-to-face oral communication, provide written handouts to help

the patient

recall the information.

If a patient is experiencing problems with his or her medications, gather appropriate data

and assess

the problems. Then adjust the

pharmacotherapeutic

regimens according to

protocols or

notify the prescribers.

o Verify patients‘ knowledge and understanding of medication use. Ask patients to describe

or show

how they will use their medications and identify their effects. Observe

patients‘ medication-use

capability and accuracy and attitudes toward following

their

pharmacotherapeutic

regimens and monitoring plans.

Key points

Pharmaceutical personnel and patient need to come to a common understanding about

their respective

roles and responsibilities.

may be necessary to clarify for patients that Pharmaceutical personnel have an appropriate

and important

role in providing education and counselling and patients should be encouraged to

be active

participants.

Pharmaceutical

personnel working at CTC should be familiar with current treatment

principles so

that they can effectively manage and optimize pharmacotherapy for HIV-infected

individuals, they

should also be familiar with recommendations on prophylaxis and treatment

of opportunistic

infections that occur in conjunction with HIV infection

Evaluation

What are role of pharmaceutical personnel at CTC?

What

are the stages for providing counseling to patients on the use of medicines at CTC?

Reference

Henderson KC,

Hindman

J, et al (2011)Assessing the effectiveness of pharmacy-based

adherence interventions

on antiretroviral adherence in persons with HIV. AIDS Patient

Care

STDs.Canada

Ma A, Chen D,

Chau

F,

Saberi

P. (2010) Improving adherence and clinical outcomes through

an HIV

pharmacist‟s

interventions. AIDS

Care.New

York

American Society of Health-System Pharmacists. ASHP(2013)statement on the

pharmacist‟s

role

in the

care of patients with HIV infection. Am J Health

Syst

PST 06102

:

Counselling and Guidance

Session 13:

Co-ordination of Health Workers at CTC

Learning tasks

At the end of this session, students are expected to be able to

:

Explain concept of the co-ordination of health workers at CTC

Identify services provided by staff within CTC

Explain impact of health care workers on HIV and AIDS Programmes at CTC

Concept of the Co-ordination of Health Workers at CTC

Caring for HIV/AIDS patients requires health care workers (HCWs) to have good knowledge of the issues, cultural differences in HCWs, combined with professional ethics and personal beliefs, could also result in conflicting attitudes, leading to difficulties related to looking after people affected by HIV/AIDS

For CTC services to function well, adequate and trained staff need to have clearly outlined roles and responsibilities, since HIV and AIDS is now a manageable chronic disease, the principles of chronic disease management must be followed.

Team approaches involving a patient, a family care giver and a healthcare team i.e. consisting of at least a triage nurse, a doctor and a treatment/adherence pharmaceutical personnel to ensure the building of an ongoing relationship between patient and the health care team for life-long care.

Regularly scheduled visits minimize drug depletion at home; this is enabled by records that are easy to retrieve, and disciplined observance of appointment schedules.

Weekly CTC team meetings to discuss bottlenecks and case studies will help to build team spirit, while quarterly staff meetings between heads of relevant units involved in HIV care such as

CTC, TB, VCT, PRCH, STI, HBC, Pharmacy, Laboratory and In-patient units

will help to build better internal cooperation and patient referrals

Council Health Management Team (CHMT) members must conduct regular at least quarterly supportive supervision visits to assess efficiency and effectiveness of service delivery, and identify where mentoring by experts from supervising hospitals or health programmes should be put in place.

Activity:

Buzzing

What are the services provided by staff within CTC?

The National Standard Operating Procedures manual outlines the following services to be provided by available staff within CTC:

Registration and appointments management; filling of CTC1 and CTC2 basic information; height, weight, Blood Pressure (BP), (Body Mass Index(BMI)), pulse rate and temperature

Triage: assessment of immediate medical needs, TB screening questionnaire, support and referring the patient to the next relevant unit or staff at the CTC

Clinical management

Patient

ART preparedness and adherence counselling

All elements of PHDP

Data collection and management

Referral management within the hospital, and with relevant institutions and community organizations

Impact of Health Care Workers on HIV and AIDS

Programmesat

CTC

HIV and AIDS programmes have had a direct impact on health care workers (HCW) at CTC into;

Recruitment of HCW at CTC

Distribution and retention of HCW at CTC;

Attrition of HCW at CTC

a. Recruitment

of health workers at CTC

Recruitment in this context includes all measures and processes used to prepare and deploy HCWs into the HIV and AIDS programmes; for instance, HCW like doctors, pharmaceutical personnel, nurses

etc

who shifted from their normal activities to HIV and AIDS programmes, they must effectively recruited into HIV and AIDS care.

HIV and AIDS programmes create greater demand for HCWs, in response to which there have been efforts to recruit additional staff, including new cadres, the additional staff may be from the existing stock of HCWs, or could be from outside the system, depending on the country involved

. Distribution

and retention of HCW at CTC;

Exploring impact, opportunity and lessons from, HIV/AIDS service programmes on HCW distribution and retention

There is specific HCW retention strategies including financial and non-financial incentives, in scale up for HIV and AIDS services

Specific workplace challenges and wider issues in retaining health workers in the context of HIV/AIDS at CTCs especially in high burden countries are solved

Health worker get HIV/AIDS treatment and prevention programmes including infection prevention and control measure (IPC) and post exposure prophylaxis (PEP)

HIV and AIDS drive deployment policies skills mix, task shifting and their relationship to the rest of the health system to improve distribution and retention HCW

c. Attrition

of health workers at CTC

Employment impact opportunity and lessons from, HIV and AIDS

programme

HCW resignation, illness ,absenteeism, premature retirement, death and emigration all cause Attrition of health care workers at CTC

AIDS/HIV treatment and prevention

programme

to HCW mitigate attrition of health care workers at CTC

Strategies to address higher demand for HIV and AIDS services resulting stress, frustration, burn-out hence there is a need to mitigate attrition of HCW

HIV and AIDS driven improvement in working conditions and how they mitigate HCW attrition

Key

points

For CTC services to function well, adequate and trained staff, need to have clearly outlined roles and responsibilities, since HIV and AIDS is now a manageable chronic disease, the principles of chronic disease management must be followed.

The National Standard Operating Procedures manual outlines the

different services

to be provided by available staff within

CTC

Review questions

What are the services provided by health workers at CTC?

What are the impacts of health workers on HIV/AIDS

programme

References

Essengue

M-S (2003) ‘

Assessment of human resources for scaling up HIV/AIDS/ART country programmes,

’ Duty travel report from site visits in Rwanda. Geneva: WHO, Department of Human Resources for Health.

MOHSW (2009).

Provider Initiated HIV Testing and Counselling: Trainer’s

Manual.

Dares

Salaam, Tanzania: National AIDS Control

Programme

Uebel

KE, Nash J and Avalos A (2007) ‘

Caring for the Caregivers: Models of HIV/AIDS Care and Treatment Provision for Health Care Workers

in Southern Africa,’

Journal of Infectious Diseases

196

(Supplement)

:

UNAIDS (2007)

Monitoring the Declaration of Commitment on HIV/AIDS: Guidelines on construction of core indicators, 2008 reporting

. Geneva: UNAIDS.

PST

06102

:

Counselling and Guidance

Session 14:

Adherence in the Treatment

Learning tasks

At the end of this session, students are expected to be able to

:

Give Introduction to adherence in the treatment

Describe difference between adherence, compliance and concordance in the treatment

Describe importance of adherence in the treatment

Explain reasons for non-adherence in the treatment

Explain methods of improving adherence in the treatment

Activity:

Buzzing

What is adherence in the treatment?

Adherence

in the treatment

Adherence: is defined as the extent to which a patient takes medication in the way intended by a health care provider,

This

is include, patients taking all medications at the correct time, in the appropriate quantities and in line with additional instructions regarding food or drug interactions

Medicines play an important role in medical care and effectiveness of treatment depends on both the efficacy of medication and patient adherence to the therapeutic regimen.

Adherence in the

treatment ….

Adherence to medication is essential to achieve the best possible pharmacotherapy outcomes.

Evidence

shows that non-adherence medications result in higher health care costs, longer hospitalization, and increased morbidity and mortality.

Adherence in the

treatment …

A

medication

is the most frequent intervention within healthcare systems

worldwide.

Achieving

the best possible outcome of medication for the quality of life of patients should be the primary aim of all health professionals involved in the medication process, as well as carers and patients, depending on their abilities and capacities

Adherence is a major issue for long term medication in chronic diseases, between 1/3 to ½ of medicines prescribed are not taken as intended, this affects: Patients’ health leading to decreased quality of life, complications, preventable hospitals admissions and

mortality/morbidity

Adherence in the

treatment ….

Non-adherence in the society increased healthcare cost/government spending, untreated diseases expose the society to potential problems such as infectious diseases like TB/HIV, psychiatric diseases

e.t.c

Medication non adherence can be divided into four categories:

Primary non adherence

Secondary non adherence

Unintentional non adherence

Intentional non adherence

1. Primary

non adherence

: is when a patient does not fill an initial prescription;

2. Secondary

non adherence

: is when a patient does not refill a prescription on time.

3. non

adherence

: occurs when a patient simply forgets to take medication or is careless in some way as to miss a scheduled dose;

4. Intentional

non adherence

: is a decision of not taking the medication, and may be the most important aspect of non adherence that must be addressed, with some estimates showing that up to 80 percent of non adherence may be intentional

Differences between adherence, compliance and concordance

In contrast, compliance and adherence relate to the medicine-taking behavior of the patient.

Compliance and adherence can be estimated using prescription claims records, pharmacy dispensing data, validated survey instruments or electric pill counters, as well as direct measures such as serum drug levels

However, the definition of concordance implied that the prescriber and patient should come to an agreement about the regimen that the patient will take

Important of Adherence in the Treatment

Treatment adherence is generally regarded as an important factor in achieving optimal outcomes across many disease

states.

the treatment of chronic disease like HIV, Cancer and tuberculosis, poor adherence to treatment has the potential to impact outcomes on multiple levels.

The health system in where pharmaceutical personnel practices is integral to achieving the ultimate goal of improved patient health, because medication adherence is an important contributor to improved patient health, health care systems must evolve in a way that emphasizes its importance.

Therefore the importance of adherence in the treatment are:

To decrease morbidity and mortality in the community and reduce health cost

Help to improve effectiveness of medicines

Strengthen relationship between patients and health workers

Lessening number of

hospitalities

Reasons for Non-adherence in the Treatment

Medication non-adherence is a serious problem with possible life-threatening consequences.

Patients

frequently are unable to recognize their own adherence issues, especially for chronic medications

Reasons for non-adherence to prescribed medicines are commonly divided into 5 intersecting categories;

Patient variables.

Treatment regimen.

Disease characteristics.

Patient provider relationship.

Clinic setting

Patient Variables

Sociodemographic factors

i.e

. age, gender, race/ethnicity, income, education, literacy, housing status, insurance status

Psychosocial factors

i.e

. mental health, substance use, social climate and support, knowledge and attitudes about disease and its treatment.

Common predictors of non-adherence include depression/psychiatric morbidity, active drug or alcohol use, stressful life events, lack of social support, and the inability to correctly identify the drug regimen or describe the relationship between adherence and drug resistance

Treatment Regimen

Factors related to the treatment regimen include:

The number of pills prescribed, the complexity of the regimen

. dosing frequency and food instructions, the specific type of medicines dispensed, the short- and long-term medication side effects.

The complexity of the regimen and side effects caused by it are clearly associated with non-adherence, the impact of once-daily regimens on adherence behavior, amid great hope for a beneficial effect

Disease Characteristics

Disease characteristics include the stage and duration of infection, associated opportunistic infections, and disease-related symptoms, there is a relationship between disease-related symptoms and non-adherence.

Patient-Provider Relationship

Patient-provider relationship characteristics that may affect adherence include;

The

patient's overall satisfaction and trust in the provider and clinic staff, the patient's opinion of the provider's competence, the provider's willingness to include the patient in the decision-making processes

The affective tone of the relationship

. Warmth, openness and cooperation, the concordance of race/ethnicity between patient and provider and the adequacy of referrals

Patient-Provider Relationship

May

affect adherence include;

The patient's overall satisfaction and trust in the provider and clinic staff, the patient's opinion of the provider's competence, the provider's willingness to include the patient in the decision-making processes

The affective tone of the relationship

. Warmth, openness and cooperation, the concordance of race/ethnicity between patient and provider and the adequacy of referrals

Clinical

Setting

Absence

of ongoing primary care, unavailability of transportation and childcare, unpleasantness of the clinical environment, inconvenience in scheduling appointments, lack of confidentiality and dissatisfaction with prior experience in the health care system all has been associated with non-adherence.

Adjustable factors that impact adherence should be attended to, if possible, prior to starting medicines, and in a proactive and ongoing way throughout therapy, clinicians working with patients on medicines need an accurate and relatively simple method of assessing adherence in order to support its vital role in treatment outcomes.

Clinical setting and service delivery factors such as poorly motivated, unfriendly, inconvenient appointments and inadequate counseling leads to non-adherence

Factors contributing to non-adherence

Forgetting to take the medicine

Affordability

Concern about safety or effectiveness

Fear of or experiencing adverse effects

Confusion over the directions

No longer feeling unwell or not feeling any different

Feeling that they cannot manage with the number of medicines they should take

and how to coordinate them

Having dexterity challenges

Simply being too unwell

Methods of Improving Adherence in the Treatment

The best way to improve adherence is to involve patients in decisions making about prescribed medicines and to support adherence – patient

centered

care which include:

Good

communication

, there must be good communication between patients and pharmaceutical personnel so that patient needs can be identified and attended

b. Patient’s

capacity assessment

, By considering patient ability and capacity, if he/ she agrees, families and careers’ should have the opportunity to be involved in decisions about treatment and

care

C.

Provide

knowledge of the disease and medication prescribed

, pharmaceutical personnel should help client to understand disease, drug, treatment benefits, side effects and what to do if experienced, how to use, what to do if a dose is missed, duration of treatment and information’s should be both oral/written .

D. Pharmaceutical

personnel should be empathizing,

provide information easy to understand

and free from jargon and provide pictorial representations, symbols and large prints

E. Involve

patients in decision making

, healthcare provider should adapt their consultation style so that patients are given the opportunity to be involved in the decision making process

. Simplify regimen:

reduce

polypharmacy as far as possible, use of combination products, shorter duration of treatment and providing guidance on device use e.g. inhalers)

. Reduce

side effects of dispensed medicines:

Prescriber should consider to selecting treatment with lower levels of side effects or concerns for long term use and address problems that could be linked with physical difficulties

. provide

counseling and instruction

on the usage of medicines including child resistant containers, inhalers, blister packs, small tablets difficult to handle and provide liquid formulations for the patients who have swallowing problems.

Refer SIMPLE acronym in the process of improving adherence

S=Simplify the regimen.

I=Impart knowledge.

M=Modify patient beliefs and human behavior.

P=Provide communication and trust.

L=Leave the bias.

E=Evaluate adherence.

Key

points

Non adherence with the prescribed treatment regimen is a real problem that results in treatment failure and consequently, increased morbidity and mortality.

Patients need to be supported, not Blamed, the consequences of poor adherence to long-term therapies are poor health outcomes and increased health care costs, improving adherence also enhances patient safety.

Adherence is an important modifier of health system effectiveness, improving adherence might be the best investment for tackling chronic conditions effectively

Review questions

What is adherence in the treatment?

What are the reasons for non-adherence in the treatment?

References

Patel NC,

Crismon

ML, et al. (2005) Drug adherence: Effects of decreased visit frequency on adherence to clozapine therapy.

Pharmacotherapy. Kenya

Murphy DA,

Marelich

WD, et al. (2004) Predictors of antiretroviral adherence.

AIDS

Care.British

Osterbery

L,

Blaschke

T. (2005)

Adherence to Medication.

NEJM Sweden

Caballero MJ, et al. (2008)

Self-Reported Adherence to Treatment and Quality of Life in Mild to Moderate

Acne.

Dermatol

; British

PST 06102

:

Counselling and Guidance

Session 15

: Compliance in the Treatment

Learning tasks

At the end of this session, students are expected to be able to

:

Give introduction to compliance in the treatment

Describe importance of compliance in treatment

Explain reasons for non-compliance in the treatment

Explain methods of improving compliance

Explain methods of assessing compliance

Activity:

Buzzing

What is compliance in the treatment

Compliance in

Treatment

filling up and complete an action or process and fulfilling the promise to a desirable, requested conditions specific to act in

conformity.

Compliance

can mean ‘accord agreement of amicable relations that has conformity.

Poor compliance to treatment of chronic diseases is a worldwide problem of striking magnitude., average of 50% in most diseases and excessive non-compliance accounts for a significant percent of admissions in patients with heart

failure

The consequences of poor compliance to long-term therapies are

poor

health outcomes and

increased

health care costs,

Increasing

the effectiveness of compliance interventions may have a far greater impact on the health of the population than any improvement in specific medical treatments, a multidisciplinary approach towards compliance is needed

Types of patients based on the acceptance of diagnosis and treatment initiation, patients are categorized into four types

Non compliers

: those who do not accept diagnosis and need treatment.

Partial compliers

: those who accept diagnosis and treatment but cannot fulfill the recommended actions sufficiently to reach targeted improvements in their health.

Over compliers

: those who take recommended actions in excess of targeted improvements (these patients are rare).

Adequate compliers

: those who follow health advice adequately to improve or control their disorder

Importance of Compliance in Treatment

Taking your medicine as prescribed or medication adherence is important for

controlling

chronic conditions,

treating

temporary conditions, and

overall

long-term health and well-being.

A

personal connection with your health-care provider or pharmaceutical personnel is an important part of medication compliance

F

actors

determined to have the most important effect on patient compliance with dispensed

medications

Understanding of medical directions

Involvement in the Process

Compliance reminders

Activity:

Buzzing

What are the reasons for non-compliance in the treatment?

Non-compliance

in the Treatment

Non-compliance, failure or refusal to comply, in medicine, the term non-compliance is commonly used in regard to a patient who does not take a prescribed medication or follow a prescribed course of

treatment

A

person who demonstrates non-compliance is said to be non-compliant

Reasons for Non-compliance in the Treatment

a. The

nature of patient’s illness:

Patients

suffering from schizophrenia has high incidence of non-compliance, due to distorted reality & lack of insight do not recognize

their illness

and need for treatment, similarly in chronic disorders like hypertension, tuberculosis

etc

b. Therapeutic

regime:

Multiple

drug therapy like 5-6 prescribed drugs taking at different timings ,taking tablets with same color, size and shape cause more confusion and skip doses also technical difficulty in using inhalers

c. Duration

of treatment:

Compliance

is inversely proportional to duration of treatment, in a long term therapy, low compliance is observed as in bronchial asthma and hypertension

d. Frequency

:

Increased

frequency of drug administration causes more disruption of normal routine or work schedule, hence many patients forget or inconvenienced or embarrassed

E. Adverse

events,

Some

patients are non-compliant due to adverse events. Some drugs like Anti-Hypertensive agents, Anti depressants or Anti psychotics cause sexual dysfunction which is frequently implicated for non compliance

F. Taste

of medication

Can

be the cause for noncompliance especially in children. Failure to comprehend the importance of therapy, as patient has limited knowledge about the illness, become non compliant if beliefs and expectations are not met with, poor understanding of instructions also contributes to non compliance

G

. Taste

of medication,

Can

Other Non compliance to treatment

Increased

, or decreased sensitivity to drugs,

Frequent change of prescriptions( prescription cascade),

Living alone,

Lack of social support system,

Difficulty in opening the medication container that has flip off type of lid

Going to pharmacist/chemist due to physical problems like (osteoarthritis)

Cognitive impairment,

Impaired mobility or dexterity,

Swallowing problems,

Financial issues like, Low income and high cost of medications,

Everyday inconvenience in carrying and taking of medicines

Methods of Improving Compliance

I

nclude

health

education to increase retention of the regimen,

self-monitoring

of medication habits,

tailoring

medication taking to other daily habits and

treatment

contracts

O

ther

methods

The patient can be supervised while taking the

drug

for

example, during treatment in hospital, by parents giving medicines to their children, visitors giving drugs to relatives, and a district pharmaceutical personnel giving medicines to elderly people

Single

dose treatment

syphilis,

Improving the

palatability of

medicines

flavouring medicines for

children

Blister calendar

packs

for oral contraceptives or better blockers help p to remember to take the drug

By simplifying therapeutic regimens,

reducing

the number of tablets and reducing the frequency of

administration..

By educating the patient,

patient education on the nature of their condition and the necessity and aims of treatment

Methods of Assessing Compliance

Tablet

counting

Recording devices

Measuring the concentration of the drug in body fluids

Measuring the pharmacological effect

Measuring a marker substance added to the drug

Key

points

Compliance: Is filing up and complete an action or process and fulfilling the promise to a desirable, requested conditions specific to act in conformity,

Methods

to improve compliance to medication include

health

education to increase retention of the regimen,

self-monitoring

of medication habits,

tailoring

medication taking to other daily habits and

treatment

contracts,

Review questions

What are the reasons for non-compliance?

What are the important of compliance?

References

MoHSW (2005)

National guidelines for the clinical management of HIV and AIDS

, Dar

Salaam

Hubley

, J. (1993).

Communicating Health. An action and guide to health and health

Promotion.

1st Edition. British

Angotti

N, et al. (2009)

Increasing the acceptability of HIV counseling and testing with

three C’s: convenience, confidentiality and credibility. Thailand

MM,

Ostermann

J, Crump JA, (2010).

Characteristics of HIV voluntary counseling and testing clients before and during care and treatment scale-up

.Moshi, Tanzania.

Jones A. J (1951),

Principles of Guidance and Pupil Personal work

. New York. McGraw Hill

← View topic-by-topic index

PDF / OFFLINE NOTES

Unataka kutumiwa notes hizi kupitia WhatsApp?Kwa notes zilizopangiliwa vizuri kwa kusoma offline au PDF, bonyeza kitufe hapa chini. Ujumbe wenye Level, Semester, Module na Topic utaandaliwa moja kwa moja.TUMIWA NOTES WHATSAPP

WhatsApp: 255620339260