PHAR409

Introduction to Community Pharmacy and Self-Care

• Global healthcare policy emphasizes self-care.
• Community pharmacies manage numerous minor illnesses.
  
• Reduces doctor workload, allowing focus on complex care.
  
• Expansion of non-prescription medicines aids self-care.
  
• Positive impact seen in Government-endorsed schemes like Minor Ailment Schemes in the UK.
  
• Limited research on community pharmacy’s impact on patient outcomes.
  

Community Pharmacy Performance

• Pharmacists manage more conditions with non-prescription medicines.
• Early research focused on auditing questioning behavior and advice given.
  
• Criticism of pharmacist performance, with poor results in consumer organization investigations.
  
• Studies show inconsistent performance and poor recommendations in many cases.
  
• Findings indicate pharmacists often make recommendations without assessing symptoms.
  

The Role of Mnemonics in Pharmacy Practice

• Mnemonics are widely used but have limited effectiveness.
• Over-reliance on mnemonics can lead to missed vital information.
  
• Common mnemonics include WWHAM, ENCORE, ASMETHOD, and SIT DOWN SIR.
  
• Mnemonics provide a basic framework but lack depth and flexibility.
  
• Critical information on lifestyle, social factors, and family history often omitted.
  

WWHAM Mnemonic Analysis

• WWHAM: Who, What, How long, Action taken, Medication being taken.
• Positive: Basic information gathering.
  
• Negative: Lacks depth, no consideration of patient’s general appearance, lifestyle, or family history.
  
• Not recommended for establishing a differential diagnosis.
  

Other Mnemonics - ENCORE, ASMETHOD, SIT DOWN SIR

• ENCORE: Explore, No medication, Care, Observe, Refer, Explain.
• Positive: Observing patient appearance.
  
• Negative: Minimal contribution to differential diagnosis.
  
• ASMETHOD: Age, Self or someone else, Medication, Extra medicines, Time persisting, History, Other symptoms, Danger symptoms.
  
• Positive: Detailed questioning.
  
• Negative: Lacks depth in social/lifestyle factors and family history.
  

Clinical Reasoning Steps

• Clinical reasoning is essential for professional autonomy.
• Involves recognizing cues and analyzing data.
  
• Key steps include:
  
• 1. Use epidemiology to shape thoughts.
  
• 2. Consider the person’s age and sex.
  
• 3. Observe general appearance.
  
• 4. Apply hypothetico-deductive reasoning.
  
• 5. Utilize pattern recognition.
  
• 6. Conduct physical examinations.
  
• 7. Implement safety netting.
  

Epidemiology in Clinical Reasoning

• Understand common conditions based on presenting complaints.
• Example: Coughs are most commonly viral infections.
  
• Shape questions based on the most probable conditions.
  

Age and Sex in Clinical Reasoning

• Certain conditions are more common in specific age groups and sexes.
• • Example: Chronic bronchitis is rare in children but common in the elderly.
  
• Use this knowledge to guide questioning and diagnosis.
  

General Appearance of the Patient

• Observe if the patient looks well or poorly.
• Physical appearance can indicate the severity of the problem.
  
• Example: An active child is likely healthier than a quiet, lethargic one.
  

Hypothetico-Deductive Reasoning

• Form hypotheses based on initial information.
• Ask targeted questions to confirm or eliminate potential conditions.
  
• Example: For suspected allergic conjunctivitis, ask if the eyes itch.
  

Pattern Recognition in Clinical Reasoning

• Experienced clinicians recognize patterns in symptoms.
• Familiarity with common presentations aids in quick diagnosis.
  
• Novices rely more on analytical models, while experts use pattern recognition.
  

Conducting Physical Examinations

• Physical exams increase diagnostic accuracy.
• Example: Viewing an eardrum can provide more information than a description.
  
• Pharmacists should be trained to perform basic examinations.
  

Safety Netting in Clinical Practice

• Safety netting involves planning for uncertain outcomes.
• Conditional referrals: Specific advice on when to seek further medical help.
  
• Warn patients about potential warning symptoms.
  

Summary of Clinical Reasoning

• Doctors use a mix of hypothetico-deductive reasoning, pattern recognition, and physical exams.
• Pharmacists need to shift clinical reasoning from subconscious to conscious practice.
  
• Gaining clinical experience and feedback is crucial.
  

Differential Diagnosis Example - Headache

• A 35-year-old female patient, Mrs JT, asks to speak to the pharmacist about getting some painkillers for her headache. She appears smartly dressed and in no obvious great discomfort but appears a little distracted.
  

• STEP ONE: Use epidemiology to shape your thoughts
• STEP TWO: Take account of the person’s age and sex
• STEP 3: The general appearance of the patient
• STEP FOUR: Hypothetico-deductive reasoning
  

Differential Diagnosis Example - Headache

Importance of Consultation and Communication Skills

• Critical for differential diagnosis in community pharmacy.
• Dependence on questioning and patient interaction.
  
• Models like the Calgary-Cambridge model provide structured consultation frameworks.
  

Calgary-Cambridge Model Overview

Structured into:

• Initiating the session.
  
• Establishing rapport.
  
• Identifying reasons for consultation.
  
• Gathering information.
  
• Providing structure.
  
• Building the relationship.
  
• Explanation and planning.
  
• Closing the session.
  

Applying the Calgary-Cambridge Model

• Initiating the session: Establish purpose and initial rapport.
  
• Gathering information: Use open and closed questions effectively.
  
• Building the relationship: Show empathy, listen actively.
  

Effective Questioning Techniques

• Ask the right questions at the right time.
  
• Open-ended questions for detailed information.
  
• Closed-ended questions for specific details.
  

Active Listening and Non-Verbal Cues

• Listen actively to patient responses.
  
• Pay attention to non-verbal cues like body language and facial expressions.
  
• Reflect and clarify to ensure understanding.
  

Communicating Diagnosis and Plan

• Clearly explain the diagnosis and treatment plan.
  
• Use simple, jargon-free language.
  
• Confirm patient understanding and address concerns.
  

Building Patient Trust and Rapport

• Trust is crucial for effective communication.
  
• Show respect, maintain confidentiality.
  
• Be approachable and supportive.
  

Common Pitfalls in Consultation

• Over-reliance on mnemonics.
  
• Failure to listen actively.
  
• Ignoring non-verbal cues.
  
• Rushing the consultation process.
  

Improving Consultation Skills

• Practice active listening and effective questioning.
  
• Continuously seek feedback and reflect on performance.
  
• Participate in training and professional development.
  

Integrating Clinical Reasoning in Daily Practice

• Shift from subconscious to conscious clinical reasoning.
  
• Use patient feedback and follow-ups to improve diagnostic skills.
  
• Continuously build clinical experience and knowledge.
  

Conclusion and Future Directions

• Emphasize the importance of clinical reasoning and communication skills.
  
• Encourage continuous learning and professional development.
  
• Highlight the role of community pharmacists in improving patient outcomes through effective diagnosis and consultation.