Over-the-counter counseling (or OTC counseling) refers to the counseling that a

pharmacist A pharmacist, also known as a chemist (Commonwealth English) or a druggist (North American and, archaically, Commonwealth English), is a healthcare professional who prepares, controls and distributes medicines and provides advice and instructi ...

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 prescr ...

(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 to actively management of illness when it occurs. Individuals engage in some form of self-care daily with foo ...

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 A prescription drug (also prescription medication or prescription medicine) is a pharmaceutical drug that legally requires a medical prescription to be dispensed. In contrast, over-the-counter drugs can be obtained without a prescription. The rea ...

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 (American English), medical practitioner (Commonwealth English), medical doctor, or simply doctor, is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through the ...

. 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 In medicine, comorbidity - from Latin morbus ("sickness"), co ("together"), -ity (as if - several sicknesses together) - is the presence of one or more additional conditions often co-occurring (that is, concomitant or concurrent) with a primary ...

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 Gastroesophageal reflux disease (GERD) or gastro-oesophageal reflux disease (GORD) is one of the upper gastrointestinal chronic diseases where stomach content persistently and regularly flows up into the esophagus, resulting in symptoms and/ ...

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 is the identification of the nature and cause of a certain phenomenon. Diagnosis is used in many different disciplines, with variations in the use of logic, analytics, and experience, to determine "cause and effect". In systems enginee ...

. 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 Omeprazole, sold under the brand names Prilosec and Losec, among others, is a medication used in the treatment of gastroesophageal reflux disease (GERD), peptic ulcer disease, and Zollinger–Ellison syndrome. It is also used to prevent upper ...

lansoprazole Lansoprazole, sold under the brand name Prevacid among others, is a medication which reduces stomach acid. It is used to treat peptic ulcer disease, gastroesophageal reflux disease, and Zollinger–Ellison syndrome. Effectiveness is similar ...

, and

esomeprazole Esomeprazole, sold under the brand name Nexium among others, is a medication which reduces stomach acid. It is used to treat gastroesophageal reflux disease, peptic ulcer disease, and Zollinger–Ellison syndrome. Effectiveness is similar to ...

, whereas the UK approves the OTC use of omeprazole, esomeprazole, pantoprazole, and

rabeprazole Rabeprazole, sold under the brand name Aciphex, among others, is a medication that decreases stomach acid. It is used to treat peptic ulcer disease, gastroesophageal reflux disease, and excess stomach acid production such as in Zollinger– ...

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 type 2 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. It is one of eight B vitamins. It is required by animals, which use it as a cofactor in DNA synthesis, in both fatty acid and amino acid metabolism. It ...

to treat or prevent diabetic

peripheral neuropathy Peripheral neuropathy, often shortened to neuropathy, is a general term describing disease affecting the peripheral nerves, meaning nerves beyond the brain and spinal cord. Damage to peripheral nerves may impair sensation, movement, gland, or or ...

Cancer

While there are currently no OTC medications available for the treatment of

cancer Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. These contrast with benign tumors, which do not spread. Possible signs and symptoms include a lump, abnormal bl ...

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 Paracetamol, also known as acetaminophen, is a medication used to treat fever and mild to moderate pain. Common brand names include Tylenol and Panadol. At a standard dose, paracetamol only slightly decreases body temperature; it is inferio ...

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 to chemo and sometimes CTX or CTx) is a type of cancer treatment that uses one or more anti-cancer drugs (chemotherapeutic agents or alkylating agents) as part of a standardized chemotherapy regimen. Chemothe ...

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, 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 large impact on quality of life. It has been identified as an important issue in geri ...

. 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 Kegel exercise, also known as pelvic-floor exercise, involves repeatedly contracting and relaxing the muscles that form part of the pelvic floor, now sometimes colloquially referred to as the "Kegel muscles". The exercise can be performed many ti ...

, 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

. 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