Cold and flu: we need a sector-wide standard for helping patients to self care

Symptoms of cold and flu are among the most common presentations within community pharmacy, and as winter approaches, the number of people seeking the advice on these symptoms from the pharmacy increases.

In most cases, symptoms of cold and flu are self-limiting and improve within a few weeks, but pharmacists and their teams still have a vital role in supporting patients to self-manage their symptoms. They can advise on therapies to help with associated cold symptoms, such as a sore throat or nasal congestion, and reinforce the message that antibiotics are redundant for most seasonal ailments. This is exemplified by the sore throat test-and-treat pilot in Wales, which uses point-of-care tests, alongside clinical assessment, to help patients understand when antibiotics may be inappropriate^[1]
. In addition, influenza immunisation through community pharmacy continues to be an important aspect of our winter preparations; supporting patients to stay well during this period.

The pharmacist’s role is not restricted to the impact they can have on a patient in the pharmacy, but also the GP waiting room, acute care settings and the prescribing of antibiotics. It is not a new concept that pharmacists can offer quality advice and reassurance to those who have symptoms of cold and flu; however, there are still patients who are conditioned to visit their GP first, instead of their pharmacy. A study in 2018 found that GPs see around 89 extra patients per week during the flu season^[2]
, the majority of whom could have been expertly managed by pharmacists or their teams. Better self care of minor ailments, such as colds and flu, could provide substantial healthcare savings along with potential benefits for GPs and patients.

Promoting self care

The self-care agenda has emerged in an NHS that must support an ageing population with increasing healthcare needs. It is rooted in empowering people to take control of their own health, helping them to become more aware of how they can take care of themselves — both proactively and reactively. Changes to the community pharmacy contractual framework in England, announced in July 2019, along with the expansion and extension of the minor ailment service in Scotland by 2020^[3]
, will help embed the role of pharmacists and their teams in supporting self care further into pharmacy practice, and reinforce their role outside of the dispensary.

The availability of P medicines is especially advantageous for patients who have cold and flu symptoms

As well as expert advice, pharmacists and their teams have pharmacy (P) medicines to support them in effective self-care consultations with patients. P medicines provide an opportunity to offer patients bigger pack sizes, higher strengths and unique ingredients, alongside the expertise of pharmacists and their teams. This is particularly beneficial when considering the deprescribing agenda for self-limiting conditions, which is now widely in play^[4]
. The availability of P medicines, alongside expert advice in the community pharmacy, is especially advantageous for patients who have cold and flu symptoms, as they can be offered more efficacious medicines to suit their needs without having to visit their GP.

Setting the standard for self care

At Boots, we see the emerging importance of self care and the benefits patients can reap during a conversation with a member of our pharmacy team. These conversations also afford pharmacy teams the opportunity to convey important public health messages to encourage patients to change their behaviours.

We set out with the ambition of creating a new consultation model to liberate colleagues and empower patients. We wanted to put a patient-centred approach at the heart of these consultations and reinforce the mantra of ‘pharmacy first’. An innate driver for this model was raising the profile of self-care conversations among our colleagues and external pharmacy stakeholders, in addition to creating a consistent, high-quality approach.

One of the catalysts for our ambition was the
Which? report, published in 2013, which asked whether the public could trust their local pharmacist’s advice. It suggested that some pharmacies were failing when it came to self-care conversations. Since 2013, we have focused on these conversations and how we can raise their standard.

Patients want to understand their health options and take more control over them; they do not necessarily want to be told what to do. We reviewed how to manage patients with product-led requests in a different way, without compromising patient safety. This was in response to a change in shopping behaviour over the past decade, which translates to fewer symptom-led requests versus product-led requests. Around 75% of patients come into the pharmacy with product-led requests, while the remaining 25% make requests for advice^[5]
. We wanted to take a less paternalistic approach to these conversations and empower patients in their own healthcare choices. We created a framework, similar to WWHAM (Who is the patient? What are the symptoms? How long have the symptoms been present? What action has been taken? Are they taking any other medications?), to ensure that a patient’s selected medicine is appropriate for them without needing to ask too many questions. Subsequently we devised a new healthcare consultation model that comprised of simple key steps to allow colleagues to take a holistic approach to self-care consultations.

The model was introduced across all Boots pharmacies in the UK in 2016, which involved training for more than 24,000 pharmacy colleagues. Following the consultation model allows pharmacy teams to give advice that enables the safe and appropriate use of medicines, and highlights when patients need to escalate their symptoms if they do not improve.

We regularly undertake simulated patient visits to understand how the consultation model is being used and to measure quality of consultations, and have found that since its launch, the standard and consistency of self-care conversations has improved.

Feedback from colleagues and patients has been positive; colleagues were encouraged by the focus on self care in our strategy. The launch of the consultation model involved a change in behaviour for pharmacy colleagues and we want to continue focusing on this; continually adapting to the needs of patients, as well as to feedback from colleagues who use the consultation model every day.

Training for a consistent high-quality approach

We are currently developing another training intervention that supports pharmacy teams to take a more health-literate approach to self-care consultations, with a view to collaborating with pharmacy academics and publishing our results. It is estimated that around 61% of adults in England may struggle to understand the text and numerical health information they are given^[6]
, but high levels of health literacy are associated with better patient experience, increased self-care practices and overall better health outcomes^[7]
. Pharmacists and their teams have an important role to play in adjusting to different health literacy capacities by applying patient-centred communication skills during their self-care consultations. This is fundamental to patients understanding the information they’re provided and feeling invested and engaged to manage their own health.

Standardising the approach we take to self-care consultations will establish expectations of quality, but we need to balance standardisation and consistency with autonomy and authenticity. Our consultation model is not intended to be rigid; instead it acts as a framework that allows colleagues to shape their consultations, while ensuring patients are counselled appropriately on how to use their medicines.

Working together

We need sector-wide collaboration to share best practice on self care and to promote the availability of a broadly standardised self-care consultation service.

With a healthcare system focused on patient outcomes, self-care consultations must not be overlooked. We need to measure patients’ satisfaction, comprehension of information, health outcomes and their knowledge of self care while also being adaptive to their needs. This is how we can evolve as a profession and discover new ideas for improving patient care.

Citation: 
The Pharmaceutical Journal, September 2019. doi: 10.1211/PJ.2019.20207025