Symptoms in the Pharmacy (eBook)

A Guide to the Management of Common Illnesses and Disease Prevention

Alison Blenkinsopp, Martin Duerden, John Blenkinsopp (Autoren)

eBook Download: EPUB

2025 | 10. Auflage
1057 Seiten
Wiley (Verlag)
978-1-394-26632-6 (ISBN)

Infos

Community pharmacies are often the first source for information and advice when health problems arise. Increasingly patients are being referred to pharmacists by other health care professionals through Pharmacy First and similar schemes.

This book presents a decision-making framework along with 'red flags', 'when to refer' and evidence-based treatment recommendations. A unique feature is that case studies appear throughout, in which pharmacists, doctors, nurses, and patients describe assessment and treatment of a wide range of common problems.

Highlights of this substantially updated tenth edition are:

• The addition of seven major sections covering the initial Pharmacy First scheme in England: acute otitis media (AOM); impetigo; infected insect bites; shingles; acute sinusitis; sore throat; and uncomplicated urinary tract infection in women.
• A changed book title to reflect the increasing remit of community pharmacy in disease prevention, with extended content on topics such as blood pressure measurement and shingles vaccination.
• 'The consultation' expanded in a new chapter, including decisions about supplying antibiotics with a suggested framework to reflect antimicrobial stewardship.
• Pharmacy continuation of contraceptive pills and the Pharmacy Contraception service.
• Revisited and updated information on COVID-19 and long COVID in the light of the transition of COVID-19 to an endemic state.

Practicing and Foundation trainee pharmacists, as well as undergraduate pharmacy students and many other healthcare professionals, will find Symptoms in the Pharmacy: A Guide to the Management of Common Illnesses and Disease Prevention invaluable.

Alison Blenkinsopp, OBE, BPharm, FFRPS, PhD, Educational Consultant and Professor of the Practice of Pharmacy, UK.

Martin Duerden, BMedSci, MB BS, DRCOG, DipTher, DPH, FRCGP, is a recently Retired General Practitioner and NHS Medical Director.

John Blenkinsopp, MB ChB, BPharm, MRPharmS, trained both as a Pharmacist and a Doctor and is Chief Medical Officer for Avipero Ltd., UK.

Textauszug

Introduction and How to Use This Book

This book is a guide to managing common conditions, preventing ill‐health and providing clinical care in the primary care setting. Most, but not all, of the topics begin with the assessment and management of symptoms. The scope of the book reflects the widening role of community pharmacies in the National Health Service (NHS) in the United Kingdom (UK) and in many other countries.

Community pharmacies are now involved in first‐line care in many parts of the NHS, providing assessment, treatment and advice about many illnesses, conditions and symptoms. They are integrated into NHS referral systems and can access primary care records. Pharmacists are responsible for ensuring that their staff provide appropriate advice and recommendations.

Since the last edition of this book there have been important changes in health policy to strengthen the part played by community pharmacies in the assessment and management of common conditions, and in prevention.

This introduction has seven sections, which set out some principles for partnership working with patients and other health professionals, how patients can have increased access to medicines, and a summary of how we compiled evidence about treatment effectiveness. Throughout, we suggest how the reader might use this book. We explain the layout of the chapters that follow and explore future directions.

1. The evolving role of community pharmacists
2. Working in partnership with patients
3. Working in partnership with other health professionals
4. Increasing access to medicines
5. Effectiveness of treatments and how we have used information sources
6. Layout of the chapters
7. The future

THE EVOLVING ROLE OF COMMUNITY PHARMACISTS

Initial assessment and care by pharmacies has been enhanced through a national Pharmacy First (PF) NHS scheme in England, introduced in 2024, and similar schemes elsewhere in the UK. Treatments which are otherwise prescription‐only medicines (POMs) can be supplied in PF and other schemes via Patient Group Directions (PGDs) and in some cases, independent prescribing (see the Increasing access to medicines section later in this introduction), including antibiotics. PF is based on a set of clinical pathways using guidelines shared across primary care to enable consistent practice. See Table A for the scope of the PF scheme. Clinical examination of the ear is required for the Acute Otitis Media pathway, enhancing pharmacists' clinical skills. Ideally throat examination should be done for sore throat, although this is not mandatory under the scheme. Another element of advanced pharmacy care requiring enhanced clinical skills involves measuring blood pressure, including ambulatory monitoring, for the Blood Pressure Check Service. The integrated records that share the pharmacist's clinical findings, decision making, treatment supplied and advice provided require concise and focused input (for further detail see Chapter 1 The Consultation).

Patients can access the seven clinical pathways element via referrals from specified organisations, including general practice, urgent and emergency care settings, and NHS 111 (online and via telephone). In addition, patients can access the service by attending or contacting the pharmacy directly without the need for referral. The extent to which walk‐in access for pharmacist consultations can continue might be challenging, and some pharmacists offer walk‐in access for defined parts of the day. Appointments might become necessary if demand for the service necessitates them. As indicated in Table A, the scheme also allows for distance‐selling pharmacies to participate via remote assessment, with the exception of acute otitis media.

Scotland has had a similar national PF service with electronic referral and records for several years.

National NHS pharmacy services for detecting undiagnosed hypertension and the initiation and reauthorisation of oral contraceptives are also now in place in England. Services to detect hypertension have been introduced, with formal monitoring of blood pressure control planned in the future. The provision of vaccinations, which increased with flu immunisation and COVID vaccines, has grown and looks likely to expand further. This new edition of the book reflects these preventive efforts and we have changed the title accordingly.

TABLE A Accessing Pharmacy First services in England

Pharmacists can manage seven conditions across various age ranges

Clinical pathway

Age range

Acute otitis media*

1–17 years

Impetigo

1 year and over

Infected insect bites

1 year and over

Shingles

18 years and over

Sinusitis

12 years and over

Sore throat

5 years and over

Uncomplicated urinary tract infections

Women 16–64 years

* Distance‐selling pharmacies will not complete consultations for acute otitis media.

UK programmes to train community pharmacists as Independent Prescribers (IPs) have been introduced with the ultimate intention of all community pharmacists being IPs (see the section Increasing access to medicines later in this chapter). The expansion of community pharmacist independent prescribing provides opportunities, for example initiation and alteration of antihypertensive treatment for newly detected hypertension as well as resupply/alteration of existing hypertension treatment.

Remote consultations with pharmacists by telephone and video have enhanced the role of, and increased access to, community pharmacies. Greater digital integration of community pharmacies with the wider NHS has enabled read and write access to primary care records, enhancing existing electronic referrals from general practitioners (GPs) in primary care and from NHS telephone triage services.

In this book, we recognise that members of the public present to pharmacists and their staff in a number of different ways and pharmacists require a mix of knowledge and skills in diseases and their treatment, as well as excellent consultation skills.

Types of presentation	Pharmacist portfolio of key skills

Asking to purchase a named medicine Requesting advice about symptoms/common conditions and appropriate treatment in person or remotely Requesting advice about minor injuries Requiring general health advice (e.g. about dietary supplements) Asking about effects/symptoms perceived to relate to prescribed medicines Asking for a measurement or test (e.g. blood pressure) A digital referral by NHS 111 or a healthcare professional

Differentiation between minor and more serious symptoms Applying clinical pathways in daily practice Prescribing – beyond OTC supply Listening skills Questioning skills Triage of minor injuries, first aid Treatment choices based on evidence of effectiveness Explaining skills Partnership working with patients Acting as a role model and training other pharmacy staff

WORKING IN PARTNERSHIP WITH PATIENTS

We refer to people seeking advice about symptoms as patients, although recognising that many will in fact be healthy people. We do this because we feel that the terms ‘customer’ and ‘client’ do not capture the nature of pharmacy consultations about health. In the past, pharmacists were seen as experts and patients as beneficiaries of pharmacists' information and advice. However, patients are not blank sheets or empty vessels; they have choices to make and are experts by experience in their own and their children's health. The following diagram illustrates some of the thoughts a patient may be having about their symptoms.

The pharmacist needs to take these factors into account during the consultation and enable patient participation by actively eliciting the patient's views and preferences. Many, but not all, patients will want to engage in decision‐making about how to manage their symptoms. Some will want the pharmacist to decide on their behalf. The pharmacist needs to find out what the patient knows and wants. Finding out the information source(s) used by the patient is important, and if the reliability of the information is poor, this may need to be pointed out, with advice on trustworthy sources. Patients' health literacy (their knowledge and understanding about health conditions and treatments) varies considerably and needs to be taken into account. Healthcare professionals can only truly learn how to work in partnership by listening to what patients have to say. The list provided in the following section comes from a study of laypeople’s ‘tips’ on how consultations could be more successful. Although the study was concerned with medical consultations, many of the tips are equally relevant to pharmacists’ response to patients’ symptoms.

How to make a consultation more successful from the patient’s perspective: tips from laypeople

• Introduce yourself with unknown patients.
• Keep eye contact.
• Take your time; do not show...

Produkt-Details

• Erscheint lt. Verlag: 3.2.2025
• Sprache: englisch
• Themenwelt: Medizin / Pharmazie ► Gesundheitsfachberufe
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete
• Schlagworte: Antibiotics • cardiovascular condition • earache • ear and eye condition • gastrointestinal condition • Impetigo • infected insect bite • OTC medicine • Pharmacy First service • relevant treatment guideline • Respiratory condition • shingles • skin condition
• ISBN-10: 1-394-26632-4 / 1394266324
• ISBN-13: 978-1-394-26632-6 / 9781394266326