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Patients who are not appropriate self-care candidates will need to be referred to a physician. The information that you gathered during the assessment step helps you determine this. The next part of the QuEST process is to establish that the patient is an appropriate self-care candidate. It is important to assess whether the patient has any underlying conditions, so as to avoid any drug-disease interactions. See Table 4 for examples of questions to ask the patient regarding current medications and coexisting conditions.
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The pharmacist should ask patients specifically about the nonprescription medications, herbal products, and supplements they are taking. The last 2 parts of the assessment process deal with current medications and coexisting conditions. Finally, the "R" stands for Remitting factors that might alleviate the problem. The "L" stands for Location of the problem, and the "A" stands for factors that may Aggravate or make the problem worse. The "O" stands for Onset, or when the patient started experiencing the problem. So, the pharmacist should find out what is bothering the patient and then assess the "C," or Characteristics, of the problem. This is where your clinical judgment should guide the situation. You may not need to ask the patient about every element outlined. In order to do this, APhA offers another mnemonic device, SCHOLAR (Table 3), to help you recall the types of questions you should ask to assess the patient's current complaint. Establishing a 1- to 2- minute limit is helpful. This assessment should not be an exhaustive history we do not have time for that in community practice. The first step is to make a quick assessment of the patient's current problem, medications, and coexisting conditions or disease states. This systematic process helps the pharmacist elicit information from patients and make decisions and recommendations about self-treatment. The QuEST process helps the pharmacist to Quickly and accurately assess the patient, Establish that the patient is an appropriate self-care candidate, Suggest appropriate selfcare strategies to the patient, and Talk with the patient about those strategies (Table 2). Close-ended questions are useful to clarify information gathered through open-ended questions.Ī process developed by the American Pharmacists Association (APhA) to help community pharmacists to counsel patients about nonprescription medications is the QuEST communication process. When counseling patients about self-treatment, it is necessary to find a balance between open- and close-ended questions. This counseling requires much more detail and probing questions on the part of the pharmacist. Close-ended questions, which start with the words will, can, do, or did, are to be used only if the open-ended questions do not get the response the pharmacist is trying to elicit, and are not as effective because they can be usually be answered with a simple "yes" or "no." The Indian Health Services method uses the "Three Prime Questions" (Table 1) for all new prescriptions.Ĭounseling patients about self-care and nonprescription drugs cannot follow the same format as for prescription drugs. These questions usually start with the words who, what, how, why, or where. Pharmacy school teaches us to ask open-ended questions when counseling patients about prescription medications, because doing so allows us to gather the greatest amount of information. Once those barriers are recognized, pharmacists can more effectively communicate with patients. Previous articles have addressed barriers to OTC counseling.
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Pharmacists can increase self-care and nonprescription counseling by taking the following steps: acquire a full working knowledge of OTC drugs gather information from patients through the interview process analyze information by considering all product- related and patient-related factors and counsel patients about problems presented. An increasing number of pharmacists, however, are now greeting patients in the pharmacy and initiating an assessment of the patient's self-care concerns and drug-related needs. Most of the time, patients initiate conversation with pharmacists. One of a pharmacist's greatest responsibilities is helping patients understand ways to treat themselves.