Patient Assessment and Consultation in Self-Care and Nonprescription Medications

Introduction to Patient Assessment and Consultation

Overview

Patient assessment and consultation are critical components of pharmacy practice, especially in the context of self-care and nonprescription medications. Pharmacists must utilize effective communication skills, understand social determinants of health, and systematically assess patient needs to ensure safe and effective therapy.

Communication Skills in Patient Encounters

Essential Communication Skills

• Questioning Skills: Use open-ended questions to gather information and closed-ended questions for clarification. Avoid leading questions to prevent bias.

• Listening Skills: Practice active listening and pay attention to nonverbal cues.

• Empathetic Responding: Listen, identify, and understand patient concerns to build trust and rapport.

Self-Care Communication Tips

• Know your surroundings and remove physical barriers.

• Smile, maintain eye contact, and speak clearly.

• Remain calm, be patient, and explain the process to the patient.

• Have resources readily available for reference.

Communication Barriers and Accommodations

• Visual Impairment: Provide information in large print or audio format.

• Hearing Impairment: Use written communication or sign language interpreters.

• Language Barriers: Utilize translation services or bilingual staff.

• Cultural Differences: Show cultural sensitivity and adapt communication style.

• Health Illiteracy: Use simple language and visual aids.

Social Determinants of Health (SDOH)

Impact on Self-Care

Social determinants of health are conditions in the environments where people are born, live, learn, work, play, and age that affect health outcomes and risks. These factors can significantly impact a patient's ability to engage in self-care.

• Economic Stability: Affects ability to afford medications and healthcare services.

• Education Access and Quality: Influences health literacy and understanding of medical instructions.

• Health Care Access and Quality: Determines availability of medical advice and products.

• Neighborhood and Built Environment: Impacts access to pharmacies and safe environments for health management.

• Social and Community Context: Shapes support systems and cultural attitudes toward self-care.

Approaches to Culturally Diverse Patient Care

LEARN Model

• Listen: Hear the patient’s perspective.

• Explain: Share your own perspective.

• Acknowledge: Recognize differences and similarities.

• Recommend: Suggest treatment options.

• Negotiate: Agree on a treatment plan.

Patient Explanatory Model (PEM) – 4 C’s

• What do you call the problem?

• What do you think caused the problem?

• How do you cope with the problem?

• What concerns do you have?

Purpose and Process of Patient Assessment

Goals of Assessment

• Determine a patient’s drug-related needs.

• Prioritize goals of therapy.

• Identify drug-related problems.

Drug-Related Needs of Patients

• Each medication must have an appropriate indication.

• Drug therapy must be effective and safe.

• Untreated indications should be addressed.

• The treatment plan must be one with which the patient can comply.

Systematic Patient Consultation Process

Steps in Patient Consultation

• Gather information

• Identify the problem

• Determine exclusions for self-treatment

• Identify possible solutions

• Select the optimal solution

• Prepare and implement a plan

• Educate the patient

Patient-Specific and Medication-Specific Variables

• Patient-Specific: Age, gender, medication history, medical conditions, allergies, social history, economic status, patient preference.

• Medication-Specific: Dosage forms, active/inactive ingredients, adverse effects, potential interactions, efficacy, flavor, price.

Assessment Methods: QuEST, SCHOLAR-MAC, and PQRSTA

QuEST Process

• 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-MAC

• Symptoms

• Characteristics

• History

• Onset

• Location

• Aggravating factors

• Remitting factors

• Medications

• Allergies

• Conditions

PQRSTA

• Precipitating

• Quality

• Relief

• Site and Severity

• Temporal factors

• Associated symptoms

Pharmacists’ Patient Care Process

Model Overview

The Pharmacists’ Patient Care Process is a systematic approach to patient-centered care, integrating assessment, planning, implementation, and follow-up.

• Collect

• Assess

• Plan

• Implement

• Follow-up: Monitor and Evaluate

Patient Triage and Referral

Triage Options

• Send to emergency department or call 911

• Refer to physician or other medical care

• Continue prescription therapy

• Recommend nonprescription therapy

• Do not provide pharmacologic treatment

When to Refer

• Symptoms are too severe or require a definitive diagnosis

• Symptoms are minor but persistent with no clear cause

• Symptoms repeatedly return with no clear cause

• Pharmacist is in doubt about the patient’s condition

Product Recommendations and Counseling

Key Counseling Points

• Active ingredient(s), purpose, uses, warnings, directions, and other information

• Monitoring parameters, duration of therapy, onset of action

• Nonpharmacologic therapy and follow-up process

• When to seek additional medical care and what to expect

Resources for Nonprescription Product Information

• DailyMed

• Manufacturer websites

• Retail websites (use cautiously)

• The actual product packaging

Documentation in Patient Care

Importance and Methods

• Documentation provides evidence, supports follow-up, and is necessary for reimbursement.

• Methods include electronic databases and paper forms or charts.

Medication Therapy Management (MTM) and Nonprescription Products

Comprehensive Medication Review (CMR)

• Should include prescription medications, immunizations, nonprescription medications, herbal products, and dietary supplements.

Case Studies: Application of Patient Assessment

Case 1: Young Woman with Cold Symptoms

• Assessment using PQRSTA: Stuffy nose, sore throat, congestion, started yesterday, no other medical problems, takes birth control and multivitamin.

• Recommendation: Decongestant (pseudoephedrine), NSAID or acetaminophen for sore throat, assess alcohol use, avoid unnecessary combination products.

Case 2: Man with Knee Pain and Stomach Irritation

• Assessment using PQRSTA: Knee pain (achy, stiff), stomach irritation (burning after eating), uses ibuprofen and Zantac, has high cholesterol, takes Lipitor and multivitamin.

• Recommendation: Assess alcohol use, consider switching from ibuprofen to acetaminophen, refer to physician for stomach irritation, discuss diet and smoking status.

Appendix: Nonprescription Medication Consultation Form

The Nonprescription Medication Consultation Form is a structured tool for collecting patient information, assessing symptoms, and documenting outcomes and follow-up.

Example Sections:

• Patient information and condition being treated

• Chronic medical conditions and current medications

• Symptom analysis (PQRSTA)

• Outcome and follow-up documentation