Community Pharmacy Symptoms Diagnosis and Treatment 2021 5th Edition
Demand on healthcare professionals to deliver high-quality patient care has never been greater. A multitude of factors impinge on healthcare delivery today, including an aging population, more sophisticated medicines, high patient expectation and health service infrastructure, as well as adequate and appropriate staffing levels. In primary care, the medical practitioner role is still central in providing this care, but shifting the workload from secondary to primary care is placing greater demands on their time, resulting in new models of service delivery that increasingly involve other allied health professionals.
This is leading to a breakdown of the traditional boundaries of care among doctors, nurses and pharmacists. In particular, certain activities once seen as medical practitioner responsibility are now being performed by nurses and pharmacists as their scope of practice expands. The traditional role of supply-ing medicines safely and efficiently through the community pharmacy still exists, but greater patient-facing cognitive roles are now firmly established. Health prevention services are now routine; for example, smoking cessation, weight management and vaccination programmes. The pharmacy is now seen (by many governments) as a place where the general public can be managed for everyday healthcare needs without visiting a doctor. The most notable long-term global healthcare policy, which directly affects pharmacy, is the reclassification of prescription-only medicines to nonprescription status. In the UK, over 100 medicines have been deregulated since the first switches took place in 1983. More recent switches have included products from new therapeutic classes, allowing community pharmacists to manage and treat a wider range of conditions.
Further deregulation of medicines to treat acute illness from different therapeutic areas seems likely in the medium to long term, especially because healthcare professional opinion to acute medicine deregulation is broadly positive, and the impact on the general practice workload associated with dealing with minor ailments is high (representing 100–150 million GP consultations per annum). Pharmacists, more than ever before, need to demonstrate that they can be trusted with this additional responsibility. Therefore, pharmacists require greater levels of knowledge and understand-ing about commonly occurring medical conditions. They will need to be able to recognise their signs and symptoms and use an evidence-based approach to treatment.
This was, and still is, the catalyst for this book. Although other books targeted for pharmacists about diagnosis have been published, this text aims to give a more in-depth view of minor conditions and explains how to differentiate them from more sinister pathology, which may present in a similar way. The book is intended for all nonmedical healthcare staff, but especially for pharmacists, from undergraduate students to experienced practitioners.
It is hoped that the information contained within the book is both informative and useful.
Introduction
Community pharmacists are the most accessible healthcare professional. No appointment is needed to consult a pharmacist, and patients can receive free unbiased advice almost anywhere. A community pharmacist is often the first health professional from whom the patient seeks advice and, as such, provides a filtering mechanism whereby minor self-limiting conditions can be appropriately treated with the correct medication, and patients with more sinister pathology referred on to an appropriate practitioner for further investigation. On a typical day, a pharmacist practising in an ‘aver-age’ community pharmacy can realistically expect to help between 5 and 15 patients a day who present with various symptoms for which they are seeking advice, reassurance, treatment or a combination of all three.
Probably of greatest impact to community pharmacy practice globally is the increased prominence of self-care. Self-care is not new; people have always taken an active role in their own health. What is different now is the attitude towards self-care by policy makers, healthcare organisations, not-for-profit agencies and front-line healthcare workers. Health improvements have been seen in people adopting health-enhancing behaviours rather than just through medical intervention. This has led to self-care being seen in a broader con-text than just the way in which people deal with everyday illness. In the UK, the self-care forum (http://www. selfcareforum.org/) was established; its purpose is to promote self-care and to embed it in everyday life.
So what is self-care?
Fundamentally, the concept self-care puts responsibility on individuals for their own health and well-being. The World Health Organization defines self-care as ‘the ability of individuals, families and communities to promote health, prevent disease, and maintain health and to cope with illness and disability with or without the support of a health-care provider’.
Self-care has been described as a continuum (Fig. 1), startng with individual choices on health (e.g., exercising), moving through to managing their own ill health (e.g., self-medicating) either on their own or with help. As people progress along the continuum, more facilitation by others is required until a person needs fully managed care.
What is self-medication?
Self-medication is just one element of self-care and can be defined as the selection and use of medicines by individuals to treat self-recognised illness or symptoms. How these medicines are made available to the public vary from country to country, but all have been approved by regulatory agencies as being safe and effective for people to select and use without the need for medical supervision or intervention. In many countries (e.g. Australia, New Zealand, France, Sweden, Canada, UK), regulatory frameworks support the reclassification of medicines away from prescription-only control by having a gradation in the level of medicine avail-ability, whereby certain medicines can only be purchased at a pharmacy. These ‘pharmacy medicines’ usually have to be sold by the pharmacist or under his or her supervision. Over the last 4 decades, this approach to reclassification has seen a wide range of therapeutic agents made available to consumers, including proton pump inhibitors (US, EU-wide), orlistat (EU-wide), triptans (UK, Germany) and beta-2 agonists (Singapore, Australia).
Facilitated self-medication
Most purchases of nonprescription medicines are by the consumer alone, who uses product information from packaging to make an informed decision on whether to make the purchase. When consumers seek help at the point of purchase, this can be termed facilitated self-medication. Where medicines are purchased through pharmacies, staff are in a strong position to facilitate self-care decision making by consumers because, in most pharmacies, the transaction takes place through a trained counter assistant or the pharmacist. Limited research has shown that consumer purchasing decisions are affected by this facilitation. Nicholetal. and Sclaretal. both demonstrated that consumers (25% and 43%, respectively) altered their purchasing decision when proactively approached by pharmacy students. Furthermore, a small proportion of consumers did not purchase anything (13%and 8%) or were referred to their physician (1% and 4%). These studies highlight how the pharmacy team can positively shape consumer decisions and help guide them to arguably better alternatives.
Community pharmacy and self-care
Increasing healthcare costs, changes in societal lifestyle, improved educational levels, and increasing consumerism are all influencing factors on why people choose to exercise self-care. Of greatest importance are probably consumer purchasing patterns and controlling costs.
Consumerism
Changes in society have led people to have a different outlook on health and how they perceive their own health and ill health. Today, people have easy access to information; the Internet gives almost instantaneous access to limitless data on all aspects of health and care, which means that people across the globe have the means to query decisions and challenge medical opinion. This growing empowerment is also influenced by greater levels of education; having information is one thing, but being able to understand it and utilise it is another. This has proved challenging to healthcare systems and workers, having to move from traditional structures and paternalistic doctrines (e.g., ‘doctor knows best’)toa patient focused and centred type of care. This heightened public awareness about health, in the context of self-care, allows individuals to make informed choices and to recognise that much can be done by themselves. The extent of selfcare is no better exemplified than by the level of consumer self-medication. The use of nonprescription medicines is the most prevalent form of medical care in the world. Sales are huge, with the global market estimated to be worth 73 billion euros. Despite the enormous sums of money spent on nonprescription medicines, approximately only 25% of people reg-ularly purchase them (25% tend to seek medical attention, and 50% do nothing). The extent to which this happens varies from country to country and, in some markets, this is considerably higher; for example, South Africa and the United States, where 35% to 40% of people use over-the-counter (OTC) medications on a regular basis.
Many papers and commissioned reports have shown that access and convenience shape the purchasing patterns of consumers. These factors seem to be unaffected by country or time. Reports spanning 30 years have repeatedly concluded that these play an important part in consumer decision making. The element of convenience does have a country context; for example, in Western countries, this is primarily due to ease of access that negates the need for doctor seeking that is often associated with higher cost and increased time. In developing countries, ‘convenience’ is more associated with ‘need’ due to lower levels of health infrastructure and access to medical resources.
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