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Triage
the sorting of patients according to the urgency of their need of care
Pharmacist: Self Treatment
Assist in product selection, assess patient risk factors, counsel regarding proper drug use, maintain OTC's on patient profile, monitor for efficacy and toxicity, discourage "Quack" remedies, assess potential of OTC to mask symptoms of more serious condition
Recognize Bogus Therapy
Lack of medical credentials, appeal to easy answers, perception of nontoxicity, aura of natural medicine, absolute assurance, simplicity, sell direct to customer, using the internet, empowerment, overblown claims
Consequences of Bogus Therapy
Economic losses, direct hazards, indirect hazards
Analyzing OTC Information
Did the patient make the right Dx? Is the condition self-treatable? Are there any contraindications? Is an OTC product likely to benefit?
Problem Solving Model
Identify the Problem, gather pertinent information, identify exclusions for self-treatment, patient assessment and triage, identify alternate solutions, select optimal solution, prepare and implement a plan, provide patient education, evaluate patient outcome
QuEST/SCHOLAR-MAC
Quickly and accurately assess the patient, establish that the patient is an appropriate self-care candidate, suggest appropriate self-care strategies, talk with the patient
QuEST/SCHOLAR-MAC Symptoms
What are main and associated sxs?
QuEST/SCHOLAR-MAC Characteristics
What are the symptoms like?
QuEST/SCHOLAR-MAC History
Done so far? Happened before?
QuEST/SCHOLAR-MAC Onset
When did particular problem start?
QuEST/SCHOLAR-MAC Location
Where is the problem?
QuEST/SCHOLAR-MAC Aggravating factors
What makes it worse?
QuEST/SCHOLAR-MAC Remitting factors
What makes it better?
QuEST/SCHOLAR-MAC Medications
rx and non-rx, natural, herbals, generic
QuEST/SCHOLAR-MAC Allergies
medication and other with reaction
QuEST/SCHOLAR-MAC Conditions
other medical conditions
Interview Style
Open-ended vs. closed questions, medical jargon vs. everyday language, assumptions (You don't have...), asking questions in series?, control vs. spontaneity, clarification, nonverbal communication, listening skills, empathy, respect, consideration
Sign
Objective, what clinician observes or sees or measures
Symptom
Subjective, not observed by another person
Patient Scenario
A male in his early 50's asks the pharmacist for help with an itch. He is in obvious discomfort with visible lesions.
Patient Counseling/Triage Options
Educate everyone, no product, refer to MD, OTC product
When to refer
If symptoms are too severe to be endured by the patient without definitive diagnosis and treatment, if symptoms are minor but persistent and do not appear to be the result of some easily identifiable cause, if symptoms have repeatedly returned with no readily recognizable cause, if pharmacist is in doubt about patients medical condition
Key Points
Health care providers should use systematic cognitive processes to effectively address patients' self-care needs. The consistent and systematic patient care process helps providers be complete and concise when assuming responsibility for a patient's self-care needs. There are special drug-related needs associated with high-risk groups, such as infants and children, older persons, and pregnant and breast-feeding women.
