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…