W2Lec1 Assessing and advising

PHAR1035 Assessing and Advising Patients

Instructor Information

• Instructor: Katherine Baverstock

• Institution: RMIT University

Learning Objectives

• Discuss the positive reasons for pharmacists to assist patients with self-management of conditions.

• Describe essential skills for effective patient consultations.

• Differentiate between product-specific and symptom-based requests for Over the Counter (OTC) medicines.

• Understand the role of protocols in structuring consultations.

Reasons for Promoting Self-Management

• Self-Limiting Conditions: Many illnesses resolve on their own and primarily require symptom relief.

• OTC Medicines: Effective for managing self-limiting conditions with pharmacist guidance.

• Financial Aspect: Approx. $4 billion is spent annually on self-care items.

• Consumer Engagement: Increased consumer autonomy leads to a trend in self-care.

• Access to Information: Higher health literacy among consumers.

• Advancements in OTC Products: More effective medicines available, including down-scheduling of S4 to S3 medicines.

Tensions in Pharmacy Practice

• Income Sources: Majority of income from product sales rather than pharmacy services.

• Retail vs. Healthcare: Emphasis on profitability can conflict with patient health priorities.

• Evidence-Based Recommendations: Always recommend based on the best available evidence for patient outcomes.

Key Skills Required for Pharmacists

• Effective Questioning: Essential for understanding patient needs.

• Listening Skills: Critical for accurate problem assessment.

• Symptom Differentiation: Identify minor vs. serious symptoms.

• Clinical Decision-Making: Ability to evaluate treatment options effectively.

• Product Knowledge: Knowledge of appropriate treatment choices.

Clinical Decision Making

• Initial Interaction: Decisions often based on limited initial information (patient’s statements and non-verbal cues).

• Hypothesis Formation: Develop hypotheses based on received information.

• Testing Hypotheses: Ask targeted questions to narrow down possible diagnoses.

• Differential Diagnosis: Arrive at a well-informed diagnosis through questioning.

Working in Partnership with Patients

• Active Consultations: Engage patients to understand their preferences.

• Decision-Making Preferences: Assess whether patients want to participate in decisions about their care.

• Effective Communication: Both verbal and non-verbal communication is necessary for building rapport.

Structuring Your Consultation

• Consultation Protocols: Utilize structured protocols to guide consultations. Common protocols include:

  • (W)WHAM

  • What-Stop-Go

  • CARE-R

• Cautions: Rigid use can lead to missed information if not actively listening to the patient.

• Recommended Protocol: "The Script" as a reliable guide for consultations.

Our Protocol - “The Script”

1. Introduce yourself and set the scene.

2. Identify who the request is for. (is the medication for you or someone else?)

3. Determine the nature of the problem. (Funnel Question)

4. Rule out contraindications (e.g., pregnancy, allergies).

5. Recommend an appropriate product based on patient needs and preferences.

6. Provide usage advice and explain expected treatment duration and next steps if unresolved.

7. Suggest lifestyle measures that may assist recovery.

8. Check patient understanding of advice.

Product-Based Requests

• Initial Inquiry: Determine if the patient is a first-time or returning user of the product.

• Questioning Explanation: Explain the reasoning behind your inquiries to ease patient concerns.

• Follow-Up Questions: Adjust questions based on previous use, asking about effectiveness and experiences.

• Red Flags: Frequent requests for certain OTC products could indicate a need for a medical assessment (referal).

Symptom-Based Requests

• Information Gathering: Collect information to make informed decisions about symptoms presented.

• Developing Rapport: Engaging the patient through active listening and questioning.

• Identifying Referrals: Recognize issues that may require referral to other health professionals.

• Past Treatments: Inquire if any treatments have been attempted and their outcomes.

• Patient Expectations: Understand patients' expectations and concerns regarding their treatment options.

Diagnosing & Treatment Steps

• Urgency Assessment: Identify if urgent referral is necessary and understand referral points for OSCEs.

• Effective Treatments: Suggest appropriate treatments and provide clear advice on usage.

• Outcome Management: Discuss what actions to take if symptoms don't improve and confirm understanding on treatment administration.

Using Protocols

• Benefits of Structured Protocols: Helps ensure critical information is obtained and assists in ease of conversation.

• Methodical Questioning: Establishes a systematic approach, helpful for novice practitioners.

• Naturalness Over Time: Initial rigidity will evolve into a more natural flow with practice.

Building Your Consultation “Train Tracks”

• Analogy: View the consultation process as a train on tracks; strength comes from consistent practice.

• Practice Consistency: Weak tracks can lead to derailment under stress; regular practice reinforces confidence and competency.

• Moral of the Story: Dedication to practice is essential for mastery in patient consultations!