Intro to theraputics

QuEST

• 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

SCHOLAR

• Symptoms:  What are the main and associated symptoms?

• Characteristics:  What is the situation like? Is it changing?

• History: What has been done so far? Has it happened before? 

• Onset: When did it start?

• Location: Where is the problem?

• Aggravating Factors: What makes it worse?

• Remitting Factors: What makes it better?

MAC

• Medications:  prescription/non-prescription, complementary and alternative products

• Allergies:  to medications or substances; include reaction experienced

• Conditions:  coexisting health conditions

SOAP

• Subjective:  “Here’s what the patient is telling me…”

• Objective:  “Here’s what I’ve gathered about the patient…”

• Assessment:  “Here’s what I think about this patient’s care…”

• Plan:  “Here’s what I’m going to do for this patient…”

Collect:

• You are looking to generate a relevant history.

  • Comprised of subjective and objective information

    • Subjective = from patient report

    • Objective = from trusted source of information (i.e. chart/record)

      • Don’t always assume charted information is correct!

• The questions you ask are key to collecting enough of the right information.

Assess:

• So you have some information…

  • Is the patient sick? How sick? Can you help?

    • Huge assessment piece for pharmacists…medications!

      • Are they causing illness? Or another/different medication needed?

  • What does the patient want? 

    • Can they afford your recommendation? Will they understand it?

  • Are there red flags? Do you need someone else to help?

Plan:

• Recommendation:  do this.

  • Did you consider what the patient wanted? (cost, flavor, dosage form...)

• Goals of Therapy:  I want this to happen.

  • Complete resolution, improvement, or prevention

• Clear Expectations:  this should take “x” amount of time. 

  • If longer…do this. Seek additional help? Or come back?

Implement:

• Communication is a/the key component of the implementation step!

  • Here is where you educate the patient…

    • Recommendation, goals of therapy, expected outcome

      • Do this if our plan doesn’t work.

    • If medications are involved in plan, counsel on…?

• A method to ensure the patient understands:

Follow-Up:  Monitor and Evaluate:

• Lack of follow-up can destroy all your hard work up to this point.

  • Some situations may not require follow-up (i.e. self-care encounters).

    • However, the role of the pharmacist often involves making sure that plans are made and implemented by the patient.

• Approximately 20% of patients seen for primary care are lost to f/u.

  • More than 20% of patients living with HIV go 12+ mos. without f/u.

    • Around 38% of new VTE patients on new OAC have no f/u by 3 months.

The Core

• Collaborate:  patients, caregivers, other healthcare providers

• Communicate:  active listening, demonstrating empathy

  • Avoid leading questions (this is true, right?)

  • Beware nonverbal modes of communication (voice tone, facial expression)

  • Is the patient comfortable sharing in the physical space they’re in?

• Document:  continuity of care, legal justification, billing/reimbursement

  • Seldom done in self-care/community setting

Pediatrics:

• Newborn Infants:  0 – 27 days

• Infants and Toddlers:  28 days – 23 months

• Children:  2 – 11 years

• Adolescents:  12 – 18 years

Geriatrics:

• Technically defined as 65 years and older.

  • Though…some patients at 65 may be healthier than others at 35.

• Geriatric patients are also experiencing many changes…

  • Weight, organ function, cognitive capacity

    • Not all of these have to be attributed to age.

• Many medications for many disease states

  • Or just…many medications for…?

Pregnancy:

• Balance between health of mother and health of unborn infant.

  • Many medications cross the placenta to some extent.

• Is the patient pregnant, possibly pregnant, or of reproductive capability?

  • One of the few times you have the license to ask about pregnancy…

• Safety of medication can depend upon trimester of pregnancy.

  • Safe in trimester one does NOT mean safe in trimester three.

Lactating

• Medications can affect the mother and child in different ways.

  • Pass through milk to infant, increase/decrease milk supply

• Again, ask!

  • Do NOT assume recently pregnant patients are now breastfeeding.

• Use your resources!

  • LactMed is a free database, peer-reviewed

Seven Pillars of Self-Care