Out From Behind the Bench: The Importance of Counseling Patients About Self-Care and Nonprescription Products

As people live longer, worklonger, and take a more activerole in their own health, theyneed to become better informed aboutself-care options. No health care professionalis better suited to help themthan the practicing pharmacist. Individualsmay find health informationoverwhelming and confusing. Thepharmacist has the expertise to screenthis information and apply it to eachindividual's needs. Consumers need toknow which self-care practices toadopt and how and why to do so, andpharmacists should incorporate thisconcept into their daily practices.

The involvement of health care practitionerswill increase people's abilityto understand the risks and benefits ofOTC remedies. According to a consumerpoll conducted by the NationalCouncil on Patient Information andEducation, almost as many individualsnow get their information about nonprescriptionmedicines from the massmedia (49%) as they do from healthprofessionals (57%).

The reason for this finding is notthat health professionals are unwillingto discuss OTC product use with theirpatients. In fact, 3 in 4 of the practitionerssurveyed said that they asktheir patients directly about OTC druguse most or all of the time. Just 27% ofhealth professionals said that they waitfor patients to volunteer informationabout their OTC medication use.

Self-care is anything patients undertakeon their own to identify, treat, orprevent disease. It includes but is notlimited to self-administration of nonprescriptionmedications. Althoughmost Americans over age 65 are likelyto visit a doctor, 54% said that theyprefer to treat themselves, 67% haveused an OTC in the past 6 months, and57% have used a dietary supplement inthe past 6 months.

The use of nonprescription or OTCmedications is widespread. Accordingto the survey, 3 in 5 Americans haveused at least one OTC medication inthe past 6 months. With more than100,000 products on the market, it iseasy to understand why patients canbecome overwhelmed with their OTCchoices. Many consumers feel thatOTC drugs are safe because they areavailable without a prescription. Thisfeeling is far from the truth. Nonprescriptionagents are powerful drugs.

The pharmacist is the health careprofessional with the most trainingconcerning nonprescription, OTCproducts. Talking with patients canhave a direct and measurable positiveimpact. Therefore, it is the pharmacist'sresponsibility to help patientsmake educated choices. Increasedpharmacist involvement in self-carecan improve adherence to drug therapies,resulting in improved efficacy. Italso can minimize the risk of druginteractions and negative side effects.Ultimately, pharmacists can guidepatients to wiser health care decisions.

The pharmacist is the triage expertwith regard to nonprescription products and self-care. Pharmacists haveknowledge specific to nonprescriptionagents, they know what type of informationthey should gather about theirpatients, and they know how to conveythat information to their patients.

The first step in the triage process isto assess, by interview and observation,the patient's physical complaintsor symptoms and medical condition.This step includes gathering patientspecificinformation, such as age, durationof condition, nature of condition,medical history, and concurrent medications.The next step is to differentiateself-treatable conditions from thoserequiring medical intervention. Apharmacist's last responsibility is toadvise and counsel patients on theproper course of action. There are 3possible courses of action: treat thepatient, not treat the patient, or referthe patient for medical care.

If self-treatment is appropriate, thepharmacist has these responsibilities:

• To aid in product selection
• To assess risk factors
• To counsel on the appropriate useof products
• To keep a profile
• To monitor for drug interactions,drug-disease interactions, allergies,and overuse of medications

If self-care is not appropriate, thepharmacist must encourage the patientto seek the proper medical care. Whenno treatment is necessary, it is thepharmacist's duty to explain why, withsome patience, the problem will goaway on its own.

Pharmacists can increase self-careand nonprescription counseling bytaking the following steps:

• Acquire a full working knowledgeof OTC drugs
• Gather information from patientsthrough the interview process
• Analyze information by consideringall product-related and patientrelatedfactors
• Counsel patients about any problemspresented

By following all of these steps, pharmacistscan help their patients makeinformed decisions.

Dr. Ferreri is a clinical assistant professor atthe University of South Carolina School ofPharmacy.