Over-the-counter Counseling
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Over-the-counter counseling (or OTC counseling) refers to the counseling that a
pharmacist A pharmacist, also known as a chemist in English in the Commonwealth of Nations, Commonwealth English, is a healthcare professional who is knowledgeable about preparation, mechanism of action, clinical usage and legislation of medications in ...
may provide on the subject of initiating, modifying, or stopping an
over-the-counter Over-the-counter (OTC) drugs are medicines sold directly to a consumer without a requirement for a prescription from a healthcare professional, as opposed to prescription drugs, which may be supplied only to consumers possessing a valid pres ...
(OTC) drug product. OTC counseling requires an assessment of the patient's
self-care Self-care has been defined as the process of establishing behaviors to ensure holistic well-being of oneself, to promote health, and actively manage illness when it occurs. Individuals engage in some form of self-care daily with food choices, ...
concerns and drug-related needs. The types of drugs that are involved in OTC counseling are, for example, used to treat self-diagnosable conditions like heartburn, cough, and rashes, though prescription drugs and professional diagnoses are also relevant to the recommendation process.


Purpose

The aim of OTC counseling is to empower patients to take control of their healthcare-related needs for conditions that do not require an appointment with a
medical doctor A physician, medical practitioner (British English), medical doctor, or simply doctor is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through the study, diagnosis, prognosis ...
. This benefits the healthcare system by reducing unnecessary physician visits. The pharmacist can also use OTC counseling to ensure the highest likelihood of success for the patient's self-care attempt and minimize the risk of any drug-related problems. Although OTC drugs are generally regarded as safe for use without a prescription (by definition), medication errors still occur. For example, patients sometimes misuse OTC products by taking larger than recommended doses, in order to bring about symptomatic relief more quickly, or even intentionally abuse them for unlabeled indications. Even when a patient is instructed not to use OTC products without speaking with their
primary care physician A primary care physician (PCP) is a physician who provides both the first contact for a person with an undiagnosed health concern as well as continuing care of varied medical conditions, not limited by cause, organ system, or diagnosis. The term ...
, patients can still fail to identify products as OTC medications worth avoiding.


Technique

A pharmacist can use both open-ended questions (that start with the word ''who'', ''what'', ''how'', ''why'' or ''where'') as well as close-ended questions (that start with the word ''will'', ''can'', ''do'' or ''did'') which are to be used only if the former do not get the appropriate response in order to obtain relevant information about a patient's potential needs for treatment or potential drug-therapy problems. Pharmacists ask patients about comorbidities to avoid any drug-disease state contraindications.


Formal frameworks

Although OTC counseling does not necessarily involve the use of a formal framework, various frameworks have been proposed:


QuEST

The QuEST approach has been described as both "short" and "systematic." It takes the form of the following: * ''Qu'' : Quickly and accurately assess the patient (via SCHOLAR) * ''E'' : Establish appropriateness for self-care * ''S'' : Suggest appropriate self-care strategies * ''T'' : Talk with the patient


SCHOLAR

* ''S'' : Symptoms * ''C'' : Characteristics * ''H'' : History * ''O'' : Onset * ''L'' : Location * ''A'' : Aggravating factors * ''R'' : Remitting factors


SCHOLAR-MAC

As above, with the following addition: * ''M'' : Medications * ''A'' : Allergies * ''C'' : Conditions


WWHAM

The WWHAM method is not strict; there is no requirement that the OTC counseling follow the exact order of the mnemonic. It takes the form of the following: * ''W'' : Who is the patient * ''W'' : What are the symptoms * ''H'' : How long have the symptoms been present * ''A'' : Action taken * ''M'' : Medication being taken


ASMETHOD

The ASMETHOD has been attributed to the London pharmacist, Derek Balon. It takes the form of the following: * ''A'' : Age/appearance * ''S'' : Self or someone else * ''M'' : Medication * ''E'' : Extra medicines * ''T'' : Time persisting * ''H'' : History * ''O'' : Other symptoms * ''D'' : Danger symptoms


ENCORE

The ENCORE method helps pharmacists focus intently on the patient's presenting symptoms while considering the appropriate OTC recommendation. It takes the form of the following: * ''E'' : Explore :*''N'' : Nature of the symptoms :*''O'' : Obtain the identity of the patient :*''C'' : Concurrent medications :*''E'' : Exclude the possibility of a serious disease :*''O'' : Other associated symptoms * ''N'' : No medication; consider a non-pharmacological approach as appropriate * ''C'' : Care :*''G'' : Geriatric patient :*''P'' : Pediatric patient :*''P'' : Pregnant women :*''L'' : Lactating mothers * ''O'' : Observe :*''O'' : Other tell-tale signs of the condition :*''D'' : Demeanor of the patient :*''D'' : Dramatization by the patient * ''R'' : Refer :*''P'' : Potentially serious case of the disease :*''P'' : Persistent symptoms (or failure of previous therapy) :*''P'' : Patients at increased risk (e.g. diabetic patients with a wound on the underside of the foot) * ''E'' : Explain your recommendation


SIT DOWN SIR

* ''S'' : Site or location of a sign/symptom * ''I'' : Intensity or severity * ''T'' : Type or nature * ''D'' : Duration * ''O'' : Onset * ''W'' : With (other symptoms) * ''N'' : Annoyed or aggravated by * ''S'' : Spread or radiation * ''I'' : Incidence or frequency * ''R'' : Relieved by


Subject areas


Proton-pump inhibitors

For the selection of OTC proton-pump inhibitors (PPIs), pharmacists must first determine whether or not a patient is likely to benefit from self-care for the treatment of their acid reflux symptoms. Examples of exclusions to self-care treatment of acid-reflux symptoms include a positive family history of gastrointestinal cancers, since their symptoms may reflect a more serious, underlying condition, and patients that present with so-called "alarm symptoms," which require a prompt evaluation by a
diagnostician Diagnosis (: diagnoses) is the identification of the nature and cause of a certain phenomenon. Diagnosis is used in a lot of different disciplines, with variations in the use of logic, analytics, and experience, to determine " cause and effect". ...
. The available PPIs labeled for OTC use varies by country. As of October 2015, in the United States, available OTC proton-pump inhibitors include omeprazole, lansoprazole, and esomeprazole, whereas the UK approves the OTC use of omeprazole, esomeprazole, pantoprazole, and rabeprazole.


Dietary supplements

Whether or not pharmacists should be involved with selling dietary supplements, which are not approved for the treatment or prevention of any disease or disorder, is the subject of much ethical debate. However, a 2009 review of the literature found that the common perception was that pharmacists should be involved in the OTC counseling process for dietary supplements where dietary supplements are sold. As experts in drug therapies that cause vitamin depletion, there are several recommendations that pharmacists commonly make. For example, pharmacists sometimes advise patients on long-term
metformin Metformin, sold under the brand name Glucophage, among others, is the main first-line medication for the treatment of type2 diabetes, particularly in people who are overweight. It is also used in the treatment of polycystic ovary syndrome, ...
therapy to supplement with
vitamin B12 Vitamin B12, also known as cobalamin, is a water-soluble vitamin involved in metabolism. One of eight B vitamins, it serves as a vital cofactor (biochemistry), cofactor in DNA synthesis and both fatty acid metabolism, fatty acid and amino a ...
to treat or prevent diabetic
peripheral neuropathy Peripheral neuropathy, often shortened to neuropathy, refers to damage or disease affecting the nerves. Damage to nerves may impair sensation, movement, gland function, and/or organ function depending on which nerve fibers are affected. Neuropa ...
.


Cancer

While there are currently no OTC medications available for the treatment of
cancer Cancer is a group of diseases involving Cell growth#Disorders, abnormal cell growth with the potential to Invasion (cancer), invade or Metastasis, spread to other parts of the body. These contrast with benign tumors, which do not spread. Po ...
in the United States, there are specific OTC recommendations that apply to cancer patients that do not apply to the general population. Even a common OTC medication like acetaminophen may pose a risk to cancer patients by masking the presence of fever, which is an important sign of a serious side effect of some
chemotherapy Chemotherapy (often abbreviated chemo, sometimes CTX and CTx) is the type of cancer treatment that uses one or more anti-cancer drugs (list of chemotherapeutic agents, chemotherapeutic agents or alkylating agents) in a standard chemotherapy re ...
regimens called febrile neutropenia.


Upper respiratory tract infections

During OTC counseling, pharmacists differentiate between self-care appropriate upper respiratory tract infections, like the
common cold The common cold, or the cold, is a virus, viral infectious disease of the upper respiratory tract that primarily affects the Respiratory epithelium, respiratory mucosa of the human nose, nose, throat, Paranasal sinuses, sinuses, and larynx. ...
, and potentially devastating infections like the flu.


Urinary incontinence

Pharmacists can offer non-pharmacological, behavioral counseling for patients with
urinary incontinence Urinary incontinence (UI), also known as involuntary urination, is any uncontrolled leakage of urine. It is a common and distressing problem, which may have a significant effect on quality of life. Urinary incontinence is common in older women ...
. This includes teaching patients about the important behavioral interventions that can reduce their symptoms and improve quality of life. This can include recommending daily Kegel exercises, and instructing patients on the proper technique. In addition, pharmacists can provide resources for patients to learn more about how to control their symptoms. In terms of medications, pharmacists can help patients identify medications that may be worsening or causing their urinary incontinence, or offer recommendations for prescription medications for patients to take to their physicians.


Comparison to prescription drug counseling

OTC counseling patients about self-care and non-prescription drugs does not follow the same format as counseling for prescription drugs. A pharmacist who counsels for a prescription drug can view a patient's profile, which includes their current list of concurrent medications and allergies to medications. However, an OTC counseling session may occur in the aisle of the store, forcing pharmacists to elicit the necessary information from patients directly.


References

{{Reflist Pharmacy