Lecture 1: Practitioner's Role in Self Care

What is self care?

Diagnosis, treatment, and prevention (DTP) of one’s own illness WITHOUT having professional expertise

What is self care made up of?

FULL spectrum of care:

• prevention + wellness strategies

• diagnosis + screening

• measures for treatment or relief of symptoms

What is the FDAs role in self care?

• safety

• recalls

• ADE monitoring

• labeling

• quality

OTC meds are available WITHOUT prescription because of the FDA regulation balancing access and safety

What is the OBRA (Omnibus Budget Reconciliation Act) mandate?

Does it apply to both prescription and OTC drugs?

mandates pharmacists to OFFER to counsel on PRESCRIPTION drugs

OBRA only applies to prescription drugs, pharmacists do not have to offer to counsel OTC meds

How far can a person go in self care before needing medical help?

healthy living + minor ailments:

• Daily choices

• Lifestyle

• Self-managed ailments

• MINOR ailments

When should patients no longer be relying on self care but instead turn to a medical professional?

Long term conditions + In Hospital Care:

• acute conditions

• compulsory psychiatric care

• major trauma

How much money is saved by having drugs be OTC?

146 billion

95 billion for not having to book appointments +

52B for or not having to process prescriptions

Nonprescription vs Prescription:

• nonprescription drug market represents about 44.3 billion or ____% of the total pharmaceutical volume in the US

• the estimated number of US FDA approved nonprescription drug products is well over _______, including _____ active ingredients that cover more than ____ therapeutic uses

OTC = 60% of all drugs

over 100,000 OTC drugs

400 active ingredients

700 uses

Why would someone opt for self care instead of reaching a medical professional?

1. PATIENT (convenient, fast, confidence in solving ur own problems)

2. ECONOMIC (lower costs, less time away from work)

3. HEALTHCARE (limited access, long wait)

4. PRODUCT (available, direct, familiar brand names, easy to understand labels)

5. SOCIAL/ CULTURAL (recommendations, social media, cultural beliefs)

What are the components of the Pharmacists Patient Care Process?

CAPIF

Collect

Access

Plan

Implement

Follow Up (monitor + evaluate)

inner circle = communicate + document + collaborate

The following are components of which part of the Pharmacist Patient Care Process (PCCP)?

• Symptoms + Severity

• Onset + duration

• Measured tried and their success

Collect

What part of the Pharmacist Patient Care Process (PCCP) does this scenario represent?

25 YO female presents with burning sensation in her chest which has occurred twice a week for the past month after eating spicy food. She tried acids with minimal relief.

Collect

The following are components of which part of the Pharmacist Patient Care Process (PCCP)?

Is self care appropriate or is a referral warranted?

Any exclusions to self-care?

Assess

What part of the Pharmacist Patient Care Process (PCCP) does this scenario represent?

You classified a patient as having heartburn. There are no exclusions to self care (ex. the patient isn’t pregnant and symptoms have lasted < 3 months) so self care is appropriate at this time

Assess

The following are components of which part of the Pharmacist Patient Care Process (PCCP)?

Recommend non pharmacological measures -/+ OTC products

Determine tx goals

Plan

What part of the Pharmacist Patient Care Process (PCCP) does this scenario represent?

recommend a patient to eat smaller meals more frequently and to avoid spicy trigger foods, and start a course of an OTC PPI

Plan

The following are components of which part of the Pharmacist Patient Care Process (PCCP)?

• execute the plan and educate the patient of specific self-care tools

Implement

What part of the Pharmacist Patient Care Process (PCCP) does this scenario represent?

Instruct the patient to take a daily PPI for 2 weeks and incorporate previously listed non-pharmacologic measures

Implement

The following are components of which part of the Pharmacist Patient Care Process (PCCP)?

• Determine monitoring parameters to reevaluate patient and begin PPCP again

Follow up: monitor + evaluate

What part of the Pharmacist Patient Care Process (PCCP) does this scenario represent?

If the patient is still experiencing symptoms without improvement after 2 weeks, refer to a medical provider for further evaluation

follow up: monitor + evaluate

What can pharmacists do to ensure proper communication?

• introduce yourself and your role

• use words patients can understand

• active listening

• ask open ended questions

• encourage patients to ask questions

• respect cultural beliefs + individual preferences

What are some physical data that pharmacists can gather?

pulse rate

respiration rate

heart sounds

age

weight

The FDA mandates the use of a standard ______ format for all OTC products.

What are the sections available on the “Drug Facts” section?

Which part of the drug facts has been replaced by “ask your pharmacist or physician”?

label

• active ingredients / inactive ingredients

• uses

• warnings

• when to use/ not use / stop use / ask doctor before use

• directions

• pregnant / children

drug INTERACTIONS has been changed to ask your pharmacist or physician

What does QuEST stand for?

Quickly access

Establish self-care appropriateness

Suggest Care

Talk to the patient

When do we use SCHOLAR MAC and what does it stand for?

used to assess

Symptoms

Characteristics (how are the symptoms)
History

Onest
Location
Aggravating factors (what makes worse)
Remitting factors (what works)

Medications (prescriptions + OTCs)
Allergies
Coexisting health conditions

What is the most common counseling that pharmacists get do with their patients, what about the least likely to come out in conversation?

most common: product selection for specific symptoms

least common: side effects + safety considerations

when should patients NOT try self care?

1. symptom characteristics or other disorder factors are beyond the scope of self-treatment

2. patient specific factors preclude (prevent) treatment with nonprescription medications

3. patients health status or history precludes self-treatment EVEN if a nonprescription medication is indicated for the disorder

4. if nonprescription medications are not indicated for the disorder

5. previous tx with nonprescription medications was ineffective after an adequate trial

when should pharmacists refer patients to physicians?

• symptoms too severe to be endured by the patient without definitive diagnosis and treatment

• symptoms are minor but PERSISTENT and do not appear to be the result of some easily identifiable cause

• symptoms have REPEATEDLY RETURNED with no readily recognizable cause

• the pharmacist is in doubt of the patients medical condition

What are some special populations and how can we be more inclusive towards them?

Deaf:

• write or print info

• be close so they can read your lips

• speak slowly and low pitched

Blind:

• introduce yourself

• tone of voice

• obtain permission to touch

what are some complications to be mindful of with old age?

1. impaired vision

2. hearing loss

3. cognitive impairment / memory loss

4. reluctance to share health information

Pediatrics:

how old are the following age groups?

1. premature

2. neonate

3. infant

4. toddler

5. preschool/ early childhood

6. middle school

7. adolescence

1. premature= gestational age less than 36 weeks

2. neonate= first month of life

3. infant= 1-12 months

4. toddler= 1-3 years

5. preschool/early childhood = 3-6

6. middle school

7. adolescence = 13-18 years old

What should you be mindful of in terms of pediatric doses?

• why are fever, vomiting, and diarrhea great risks to children?

• _____ doses inappropriate, elixirs and syrups have high _____

• flavor medications

children are more susceptible to fluid loss

solid

sugar

What is a common reason for why children get incorrect dosing of ibuprofen and Tylenol?

using household teaspoons to measure doses (teaspoons can range from 2.5-7.8ml)

USE ORAL SYRINGE! pharmacist MUST explain how to use dosing device

Who has the final word to reclassify a prescription —> OTC?

What three questions must be answered for this organization to allow the switch?

FDA

1. Can the patient adequately self diagnose the clinical abnormality

2. Can the clinical abnormal condition be successful self treated?

3. Is the treatment product safe and effective for consumer use, under conditions of actual use?

Name a couple of conditions that can now be treated over the counter:

1. sleeplessness

2. smoking cessation

3. overactive bladder

4. allergies

5. heartburn

6. diarrhea

7. yeast infections

Standardized tool that helps patients compare products and use them safely

drug facts label