Engaging patients with cold and flu: putting theory into practice

Around 1.2 million health visits occur in UK community pharmacies each day and, with more than 9,500 healthy living pharmacies across England, each interaction with a patient should be viewed as an opportunity for a health-promoting intervention^[1]
. However, engaging in a consultation with a patient about their cold or flu symptoms can be difficult, especially if they appear to be in a hurry or are simply asking for a product and are not seeking additional advice from the pharmacy team. These are barriers to meaningful collaboration between the patient and community pharmacy^[2]
.

This article builds on the approach outlined in a previous article, ‘Making consultations matter’, and demonstrates how to apply consultation skill theory in everyday practice while providing examples that demonstrate the five consultation stages of the patient journey for cold and flu.

Understanding the patient’s priorities

Every consultation should centre around the patient and their priorities. The approach outlined in this article involves speaking directly to the patient; however, it is important to note that the person engaged in the consultation may not be the patient but a representative (e.g. a parent, carer or partner). Therefore, if the patient is not present during a consultation, the pharmacy team will need to adapt its approach to suit the situation.

Engaging the whole pharmacy team

Members of a community pharmacy team include pharmacists, pharmacy technicians, preregistration trainees, pharmacy students and non-registered members of the team. In practice, non-registered members of the community pharmacy team may be referred to as counter staff, pharmacy assistants or similar.

For consistency, non-registered team members (excluding pharmacy students and preregistration trainees) will be referred to as pharmacy team members (PTMs).

Using the consultation pathway

The Pharmaceutical Journal has developed a cold and flu consultation pathway (see A5 card insert ′Cold and flu consultation pathway for community pharmacy’) which provides a useful summary of the different stages of a consultation, highlighting the theory and practical applications in cold and flu conversations.

This consultation pathway should be used by each member of the pharmacy team when conducting cold and flu consultations in order to promote a consistent standard of care. Patients may present at any of the stages along the consultation pathway — for example, patients seeking advice about symptoms will present at stage 1, whereas patients who self-select a product will present at stage 5 — but pharmacy team members should cover all stages of the pathway during the consultation to ensure appropriate product selection and to check patient understanding and acceptance of the agreed management plan. It may be necessary to move between stage 3 and stage 4 when outlining the management options in order to facilitate informed and shared decision making between the patient and the pharmacy team.

Stage 1: Initiating the consultation

The first stage during any consultation, including those relating to cold and flu, aims to establish rapport and identify the reason(s) for the patient presenting to the pharmacy. The PTM conducting the consultation should start by introducing themself and their role.

Stage 2: Gathering information

By asking a combination of open and closed questions, the PTM can further explore the patient’s problem or symptoms; and understand their ideas, concerns, expectations and how the problem is affecting their quality of life.

Be sure to take into account certain patient groups whose management may require additional consideration. This includes older people, people who are pregnant or breastfeeding, and people who have been diagnosed with a long-term condition.

Patients presenting with cold or flu symptoms with worsening or no improvement in their condition after seven days should be referred to either a GP or an NHS urgent treatment centre. Likewise, patients who are immunocompromised (e.g. patients on chemotherapy or who are diagnosed with HIV); are experiencing chest pain, shortness of breath or difficulty breathing; have blood in their sputum; or have an unusual rash should be referred to an NHS urgent treatment centre or an A&E department.

Stage 3: Shared decision making

All management decisions should be made, when possible, in collaboration with the patient and should be based on the information they have provided throughout the consultation. 

Pharmacy teams should work together with patients to put them at the centre of decisions about their treatment, and to provide the necessary support and advice to help them make appropriate decisions in this area. Stage 3 is where the pharmacy team has the opportunity to provide detailed information on symptom management, appropriateness of antibiotics, the product options available and other patient-specific factors to allow them to make a fully informed decision about their own care.

However, to succeed this regard, it is important that pharmacy team members regularly check their understanding of what the patient is telling them. Likewise, patient understanding and acceptance of the management plan should also be verified during the consultation.

Stage 4: Patient education

There are specific messages that should be provided to patients during cold and flu consultations to ensure that patients are aware of how to use the products they buy. These include:

• The correct dosage and administration;
• What to expect in terms of symptom relief;
• When to expect improvement in symptoms;
• Any red flags to watch out for;
• What to do if there is no improvement or if an adverse reaction is experienced;
• Any non-pharmacological management options, including self-care measures;
• When to ask for advice or to return to pharmacy;
• Signposting to any relevant services or websites;
• Checking patient awareness of the nearest NHS walk-in centre.

A reminder of this information, including relevant self-care and public health messages, is included in the cold and flu consultation pathway. Normal symptom durations and red flags are outlined on the pharmacy poster developed as part of this campaign.

If a patient presents to the pharmacy again, still feeling unwell after completing the recommended treatment course specified on the product’s packaging, exercise professional judgement as to whether referral, continuation or cessation of that specific management option should be considered. Take into account contributing factors, such as adherence and the appropriateness of the administered product to treat the symptoms being experienced by the patient.

A list of trustworthy written and electronic resources to refer patients to is available in the cold and flu consultation pathway.

Stage 5: Closing the consultation

Check that the patient understands and is happy with the agreed management and treatment plan. Ensure that the patient has had the opportunity to ask questions and provide reassurance that they should contact the pharmacy if they have any further concerns.

Asking the patient to repeat the instructions reinforces the product administration instructions. This final stage also reinforces the next steps and the availability of the pharmacy as the first port of call for healthcare and medicines advice.

Citation: 
The Pharmaceutical Journal, September 2019. doi: 10.1211/PJ.2019.20207035