Patient-Counselling Case Series: 20 Type-2 Diabetes and Hypertension Patients at a Community Pharmacy

This mini-report documents a case series of 20 patients with type-2 diabetes mellitus and/or hypertension who were counselled at a community pharmacy during the 500-hour D.Pharm practical training required by the PCI ER-2020 regulations. Chronic-disease patients are the backbone of any neighbourhood pharmacy in India: they return every month for metformin, glimepiride, amlodipine or telmisartan, yet many of them are never told why the timing of a dose matters, how to recognise hypoglycaemia, or what to do when they miss a tablet.

Each patient is counselled with a structured one-page counselling sheet that covers the disease in simple words, each medicine's purpose, dose and timing, common side effects, what to avoid, lifestyle advice (diet, walking, salt and sugar), storage and when to see the doctor. Understanding is checked with the teach-back method, and a pill chart in the patient's preferred language (Kannada, Hindi or English) is handed over. At the next refill visit, usually after four weeks, the trainee records self-reported missed doses and asks the same teach-back questions again.

The report presents each case in a standard format — profile, medicines, problems identified, counselling given, follow-up — followed by a short summary table in Excel. It trains the core ER-2020 skill of patient counselling and links directly to Community Pharmacy and Management, Pharmacotherapeutics and Pharmacology.

Abstract

Twenty adult patients receiving treatment for type-2 diabetes mellitus and/or hypertension at a community pharmacy were counselled by a D.Pharm trainee using a structured counselling sheet, the teach-back method and a pictorial pill chart. Drug-related problems identified at the counter were recorded. At the next refill visit, understanding and self-reported adherence were reassessed. Findings are presented as a descriptive case series.

Introduction

Diabetes and hypertension are the two most common chronic conditions seen at Indian community pharmacies. Both need lifelong medication, and poor adherence leads to uncontrolled blood sugar and blood pressure, and eventually to heart attack, stroke and kidney disease. Doctors in busy OPDs often have only a few minutes per patient. The pharmacist, who meets the patient every month, can fill this gap by explaining the medicines clearly and checking understanding.

Existing practice

• Medicines are handed over with brief verbal instructions, often only "one in the morning, one at night".
• Patients are rarely asked to repeat instructions, so misunderstandings go unnoticed.
• Drug-related problems such as wrong timing of glimepiride or skipping amlodipine because of ankle swelling are not documented.

Proposed work

• Develop a structured counselling sheet for diabetes and hypertension.
• Counsel 20 consenting patients with teach-back and a pill chart.
• Record drug-related problems and the action taken (advice, referral to doctor).
• Reassess understanding and missed doses at the next refill.

Feasibility

• Technical: needs a counselling sheet, a pill-chart template and a quiet corner of the pharmacy.
• Economic: printing costs only.
• Operational: each session takes 10–15 minutes and can be scheduled during quieter hours.
• Ethical: verbal consent recorded on the sheet, no identity details in the report, supervision by the registered pharmacist and advice limited to the prescription — never changing therapy.

Patients with type-2 diabetes and hypertension depend on regular medication for years, but many do not know why each medicine is prescribed, when it should be taken, which side effects are expected, or what to do if a dose is missed. This leads to skipped doses, wrong timing (for example taking a sulfonylurea without food), unnecessary fear of side effects and avoidable complications.

Community pharmacies meet these patients more often than any other health professional, but counselling in most pharmacies is brief and undocumented. For a D.Pharm trainee, the training period is the right time to learn structured counselling and to record, case by case, what problems patients actually have and whether a short counselling session improves their understanding by the next refill visit.

In scope

• Adults (≥ 30 years) with type-2 diabetes and/or hypertension collecting refills at one community pharmacy.
• Counselling on prescribed medicines, lifestyle and storage; one follow-up at the next refill.
• Case-by-case documentation and a descriptive summary.

Out of scope

• Measuring HbA1c or doing laboratory tests.
• Changing or recommending changes to therapy — any concern is referred to the prescriber.
• Statistical testing of effectiveness; a case series of 20 describes, it does not prove.

Study design: prospective descriptive case series with a baseline counselling session and one follow-up.

Setting: a community pharmacy (fictional name Arogya Pharmacy) in a residential area of a city, serving patients from nearby clinics and a government urban primary health centre.

Sample size: 20 patients — enough to show a range of problems within the training period and small enough that each case can be written up properly. Case series in training reports usually include 10–30 cases.

Inclusion criteria: adults aged 30 years or more; on at least one oral antidiabetic or antihypertensive medicine for at least three months; able to communicate in Kannada, Hindi or English; willing to return for a refill within 4–6 weeks; verbal consent.

Exclusion criteria: patients on insulin only (needs device training beyond this study), pregnant women, patients with cognitive impairment without a caregiver, and patients who are health professionals.

Instrument: a two-part counselling case sheet — Part A (baseline): age group, sex, diagnosis, duration, medicines with dose and timing, five teach-back questions, missed doses in last 7 days, drug-related problems found, counselling points delivered, pill chart given; Part B (follow-up): the same five teach-back questions, missed doses in last 7 days, new problems, patient feedback.

Teach-back questions: (1) What is this medicine for? (2) When do you take it? (3) What side effect should you watch for? (4) What will you do if you miss a dose? (5) One lifestyle change you will make.

Procedure: week 1 — prepare sheet and pill chart, pilot on 2 patients; weeks 2–4 — baseline counselling; weeks 4–6 — follow-up at refill; week 6 — write-up.

Analysis: each case written in a standard format; summary table in Excel showing teach-back scores (0–5) and missed doses at baseline and follow-up, reported as counts and median.

Ethics: permission of the pharmacy owner and training supervisor; verbal consent noted on the sheet; no names, phone numbers or ID numbers in the report; all counselling supervised by the registered pharmacist.