Presentation on theme: "Diagnosis and history taking in the pharmacy. Self-Care."— Presentation transcript:
Diagnosis and history taking in the pharmacy
Self-care can be broadly categorized based on the main purpose of practicing self-care into two main groups: Preventive Care: The main purpose is to prevent disease and promote health. Sickness Care: The main purpose is to treat self-diagnosed illnesses.
The number of health and beauty care (HBC) Products in the US in 2006.
Pharmacist Role in Patient Assessment in Community Pharmacies Every working day, people come to the community pharmacy for advice about minor ailments. For example, in the UK, in an average community pharmacy a minimum of 10 such requests will be received each day.
Members of the public present to pharmacists and their staff in three ways: Requesting advice about symptoms Asking to purchase a named medicine Requiring general health advice (e.g. about dietary supplements) The pharmacist’s role in responding to symptoms and overseeing the sale of over-the-counter (OTC) medicines is substantial and requires a mix of knowledge and skills in the area of diseases and their treatment. In addition, pharmacists are responsible for ensuring that their staff provide appropriate advice and recommendations.
Responding to a request for help with symptoms 1 Information gathering: By developing rapport and by listening and questioning to obtain information about symptoms, e.g. to identify problems that require referral; what treatments (if any) have helped before; what medications are being taken regularly; what the patient’s ideas, concerns and expectations are about their problem and possible treatment. 2 Decision making: Is referral for a medical opinion required? 3 Treatment: The selection of possible, appropriate and effective treatments (where needed), offering options to the patient and advising on use of treatment. 4 Outcome: Telling the patient what action to take if the symptoms do not improve.
Structuring the consultation Pharmacists need to develop a method of information seeking that works for them. There is no right and wrong here. Some pharmacists find that a mnemonic (reminder summarizing the measures to be taken) can be useful, although care needs to be taken not to recite questions in routine fashion without considering their relevance to the individual case.
Good listening will glean much of the information required. The mnemonic can be a prompt to ensure all relevant information has been obtained. Developing rapport (homework) is essential to obtain good information, and reading out a list of questions can be off-putting and counterproductive. W – Who is the patient and what are the symptoms? H – How long have the symptoms been present? A – Action taken? M – Medication being taken?
Indications for Medical Referral
General Rules-1 Who is the patient? You or absent? Why absent? If absent- uncertain about severity and nature of disease self-treatment unwise Child? Open-ended: ‘What is the problem?’ ‘How do you feel?’ Observe: ‘does the patient look ill?’ (body language, esp. babies)
General Rules-2 Any current or recent medicines? ( OTC and Rx) Later in the interview: Personal or family history, occupational or social habits (e.g. drinking, smoking, and exercise) The description of the illness can be expanded by asking more specific and structured questions SIT DOWN SIR!
A reminder of questions to ask about symptoms SSite or location IIntensity or severity TType or nature DDuration OOnset WWith (other symptoms) NaNnoyed or aggravated by SSpread or radiation IIncidence or frequency pattern RRelieved by
Site/Location e.g. Abdominal pain: ???appendicitis (Central pain, moving to the right iliac fossa) ????Renal colic (pain in the right or left loin or iliac fossa) ???Peptic ulcer (central or epigastric) ???Biliary colic (right hypochondrium)
Biliary Colic pain
Site/Location e.g. Headache Unilateral migraine Frontal migraine, sinusitis or tension Occipital tension, muscle spasm, or subarachnoid hemorrhage e.g. skin rash Localised reaction to a watchstrap Whole body allergy to an antibiotic
pimple Papule pustule blackheads whiteheads
Descriptive Dermatologic Terms
Intensity/severity Of e.g. skin rash, pain or bleeding from a wound Gives information not only about the likely diagnosis but also about the urgency of situation (monitor, give OTC or refer to doctor)
Type or nature e.g. abdominal pain Cramp like or colicky involvement of a hollow organ bowel or ureter ‘gnawing’ peptic ulcer Throbbing stabbing e.g. skin rash Flat or raised Single or multiple Blistering or dry
Duration Helps to differentiate conditions: e.g. migraine (few hours) from tension HA (few days or weeks) Helps to decide when to refer: e.g a baby with 3 days diarrhea doctor. A baby with few hours diarrhea may respond adequately to hydration with a simple electrolyte mixture
Onset Provides clues to its likely cause E.g. abdominal pain or diarrhea that starts soon after overindulgence in a restaurant E.g. Headache occurs on awakening after a long night reassurance, empathy and OTC drug
Accompanying symptoms Usually not volunteered by the patient Crucial to differentiate many symptoms e.g. productive cough with/without blood e.g. diarrhea with/without blood e.g. red eye with itching or with pain and photophobia
Aggravating Factors Valuable for some conditions: e.g. pain of peptic ulcer can be worsened by a heavy meal or alternatively by fasting- while pain of gallstones worsened by fatty meal e.g. headaches: raised ICP worse by lying down (mornings) while tension headaches maybe better in the mornings but worsen as the day goes by
Spread or radiation e.g. referred pain Appendicitis (central, radiates to the right iliac fossa), angina (radiates to arm or jaw), biliary colic (pain in the upper abdomen that is referred to the back and felt between the shoulder blades) Skin rash- single discrete lesion in one part of the body before spreading elsewhere, while others present in more generalized way
Incidence or frequency Sometimes the pattern is characteristic e.g. classic migraine: rarely occurs twice in same week, whereas cluster migraine occurs everyday, same time of the day for several weeks e.g. hayfever versus common cold: differentiate by months of the year
Relieving Factors e.g. pain of peptic ulcer-> relieved by small snacks e.g. migraine attack can be terminated by vomiting e.g. medicines relieve/diagnose: GTN can relieve anginal attack, while antacid can relieve reflux dyspepsia but NOT VICE VERSA!
Why clinicians must be familiar with OTC products? 1. Many OTC products are effective in treating common ailments and at less cost, 2. Many active ingredients contained in OTC drugs may worsen existing medical conditions or interact with prescription medication. E.g. antacids bind many drugs, thus reduce absorption. Cimetidine inhibits hepatic microsomal drug-metabolizing enzymes. 3. Misuse or abuse of OTC products may actually produce significant medical complications
Note: Many of the more potent OTC ingredients are hidden in products where their presence would not ordinarily be expected: Examples: 1. Alcohol (% ethanol) in cough syrups, cold preparations, and mouthwashes 2. Antihistamines in analgesics, menstrual products, sleep aids, 3. Aspirin & other salicylates: in antidiarrheals, cough/allergy preparations 4. Caffeine in analgesics, menstrual products and stimulants
5. Benzocaine in antitussives/lozenges, dermatologic preparations, hemorrhoidal products, toothache, cold sore and teething products 6. Sodium in analgesics, antacids and laxatives 7. Sympathomimetics in analgesics, asthma products, cough, cold and allergy preparations, hemorrhoidal products and sore throat products