The QuEST for Improved OTC Recommendations Erika L. Kleppinger, PharmD, BCPS, CDE Associate Clinical...

The QuEST for Improved OTC Recommendations

Erika L. Kleppinger, PharmD, BCPS, CDE

Associate Clinical Professor

Auburn University

Harrison School of Pharmacy

Disclosure/Conflict of Interest

• Programming offered by Auburn University Harrison School of Pharmacy shall exhibit balance, providing the audience information of different perspectives from which to develop an informed professional opinion.

• I , Erika Kleppinger, have no actual or potential conflict of interest in relation to this program.

Objectives

• Utilize the QuEST process in consulting with self-treating patients.

• Conduct a patient interview utilizing the SCHOLAR-MAC format.

• Effectively counsel patients seeking self-treatment for various conditions.

Consulting with Self-Treating Patients

An Overview of QuEST

Why Focus on OTC Recommendations?

• Use of OTC products is widespread• Americans buy about 5 billion OTC drug products

each year (FDA, 1999)• OTC medicines account for about 60% of all

medications used in the US (Drug Information Journal, 1994)

• Consumers self-treat 4 times more health problems than doctors (FDA, 1997)

• Adults 65 and older consume 33% of all nonprescription medicines in the US (APhA, 2000)

Fact Sheet: The use of over-the-counter medicines. www.bemedwise.org/press_room/sep_2003_fact_otc.pdf

National Council on Patient Information and Education

• Surveys conducted in 2001 & 2003• 59% of Americans have taken at least 1

nonprescription medication in the last 6 months• Most common reasons for taking OTC products

• Pain (78%)• Cough/cold/sore throat (52%)• Allergy/sinus problems (45%)• Heartburn/indigestion (37%)• Constipation/diarrhea/gas (21%)• Minor infections (12%)• Skin problems (10%)

The Attitudes and Beliefs about the use of OTC Medicines: A Dose of Reality

“Self-Care in the New Millennium” Survey

• Consumer Healthcare Products Association• Survey conducted in 2001• 73% of patients would rather attempt to treat their

own condition than go to a physician• >80% were satisfied with nonprescription

medicines used

Self-Care in the New Millennium: American Attitudes toward Maintaining Personal Health and Treatment

Why Focus on OTC Recommendations?

• Patients are overwhelmed by choices• 1000+ active ingredients used in more than

100,000 OTC products for 80+ therapeutic categories

• Talking with patients can have a direct, positive impact on self-treatment

Consumer Health Products Association (CHPA), 2001

• Typically draw own conclusions about symptoms• Often seek alternatives to prescription medications

• Non-prescription medications• Herbal products• Other remedies

• Pharmacists must perform similar functions as a primary care provider

Self-Treating Patients

• Gather and evaluate information about the patient’s problem

• Differentiate between self-treatable conditions and conditions requiring medical interventions

• Advise and counsel patients about course of action

Pharmacist Responsibilities

• 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

Communication Skills

• Effective questioning• Active listening• Reflective responding• Impression management

• Quickly and accurately assess the patient• Ask about current complaint (SCHOLAR)• Ask about medications and other products• Ask about current medical problems• Ask about drug allergies

Qu

Questioning the Patient

• Use both open-ended and closed-ended questions

• Resist the urge to start teaching or treating

• Utilize SCHOLAR-MAC for symptom complaints

• Nonverbal communication• Distance• Body posture• Eye contact• Facial expressions• Gestures

Open vs. Closed-Ended Questions

OPEN-ENDED QUESTIONS CLOSED-ENDED QUESTIONS

• WHO• WHAT• WHEN• WHERE• WHY• HOW

• DO • CAN• DID• DOES• WILL• HAVE• ARE• WOULD• COULD

Sequence of Questions

• General open-ended questions• “How may I help you today?”• “Tell me what brings you to the pharmacy today?”

• Specific open-ended questions• “How would you describe the pain?”• “When did you first notice the rash?”

• Closed-ended questions• “How would you describe your pain – sharp, dull,

or throbbing?”• “Are you allergic to any medication?”

Questions to Avoid

• Leading questions• “You’re feeling better now, aren’t you?”• “You don’t smoke, do you?”

• Multipart questions• “Do you have any trouble sleeping, and how

about coughing?”

SCHOLAR-MAC

• Symptoms and associated symptoms

• Characteristics/ Course

• History of symptoms in past

• Onset• Location• Aggravating factors• Relieving factors

• Medications• Allergies• Conditions

(medical)

Example Case

• CC: “I have a really itchy rash”• 29 y/o woman is in your pharmacy looking for

something to help an itchy rash on her legs. She went hiking 2 days ago and thinks she may have been exposed to poison ivy.

• She would like something to relieve her symptoms but is concerned since she is 4 months pregnant.

Example Case• S: What kinds of symptoms have you been having?• C: Could you describe the rash for me? Has the rash

changed at all?• H: How have you treated these symptoms in the

past?• O: When did you first notice the rash?• L: Where is the rash located? Has the rash spread?• A: What makes the rash worse?• R: What makes the rash better?

Example Case

• M• What prescription medications do you take?• Do you regularly use any non-prescription

medications?• Do you take any herbal products or supplements?

• A• Do you have any medication allergies?

• C• What current medical conditions do you have?

• Establish that the patient is an appropriate self-care candidate• No severe symptoms• No symptoms that persist or return repeatedly• No self-treating to avoid medical care

E

• Suggest appropriate self-care strategies• Medication• Alternative treatments• General care measures

S

• Talk with the patient• About medication actions, administration, and

adverse effects• About what to expect from treatment• About appropriate follow-up

T

• Reasons for self-treatment• Description of the medication/treatment

• Name• Mechanism of action• Expected effect

• Proper administration• Dose and dosage schedule• Route of administration• Duration of therapy

• Adverse effects• Other important information

Counseling Points

• A 29-year old woman visits your pharmacy seeking relief from an itchy rash on her legs.

Example Patient Scenario…