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Counseling: Where Does The Profession Stand?

The question of counseling: what is the issue? Where does the profession stand? What is the status of the legal and regulatory requirements associated with this aspect of pharmacy practice? What is the impact for those individuals that practice in managed care environments? It might be amazing to many practitioners that the issue of pharmacists providing oral counseling to patients is still a topic being discussed on multiple levels. In fact, this is quite a "hot" topic for many pharmacists. So what are the status and concerns that a prudent and ethical practitioner must consider concerning counseling?

In mid-September, a National Symposium on Oral Counseling by Pharmacists about Prescription Medicines was held to discuss the pharmacist's role in promoting effective verbal counseling. The goal of this symposium was to develop a series of strategies to motivate pharmacists, patients, payors, administrators, and other stakeholders to support oral counseling. Participants who represented different perspectives developed a consensus list of critical barriers to verbal counseling and appropriate strategies for removing these barriers. It is anticipated that if the strategies are implemented, the pharmacy profession should be able to reach the goals established by the Secretary of Health and Human Services in Public Law 104-180, US Dept. of HHS, 1996.

Even today, there are still several barriers to pharmacists' providing oral counseling to patients. Patients do not demand or expect counseling by a pharmacist, no matter how they receive their medications. Many pharmacists still feel they do not possess the clinical and/or communication skills necessary to provide effective counseling.

For those pharmacists that do make the effort to counsel, there still is not a consistent foundation to support the provision of medication information to patients. Pharmacists open themselves up to potential malpractice and violation of various regulations due to the lack of standardized practice for medication counseling. In addition, there is no consistency to evaluating the quality or measuring the various counseling endeavors. A frequent question asked by pharmacists regarding medication counseling is, "how much information is enough?" Should pharmacists recite the entire USPDI monograph on a medication or select specific information from this publication? Are pharmacists liable if they neglect to mention a side effect and something happens to the patient? Unfortunately, because standards do not exist, pharmacists are caught between what is considered ethical practice and what is legal.

So the question remains: where does the profession stand on counseling? Pharmacy is still wrestling with this issue, wanting to meet two important obligations: the legal aspects of practice and the ethical standards by which we practice. It is positive to know that conferences such as the one held in September are occurring to address these issues. It is to be hoped that part of the outcome will be consistent, measurable practice standards for pharmacists to utilize as they care for their patients. Patient counseling is not practice-setting specific. This issue is as crucial for those practicing in managed care sites as it is for colleagues in community pharmacies. It will take the combined efforts of the entire profession to meet these practice expectations.

Bob Beardsley, R.Ph., Ph.D.
Professor and Associate Dean
College of Pharmacy
University of Maryland
Baltimore, MD

Diane B. Ginsburg, M.S., R.Ph.
Clinical Assistant Professor
Division of Pharmacy Practice and Administration
College of Pharmacy
The University of Texas at Austin
Austin, TX