COMMUNITY PHARMACY 6TH EDITION BY
PAUL RUTTER
,CONTENT
Making a diagnosis 1
Skills needed to facilitate clinical
1 reasoning
2
9
3 Respiratory system 17
4 Ophthalmology 55
5 Ear conditions 81
6 Central nervous system 103
7 Women’s health 133
8 Gastroenterology 167
9 Dermatology 223
10 Musculoskeletal conditions 293
11 Paediatrics 321
12 General Health 351
13 Specific product requests 369
19
,xii Introduction
Introduction
Community pharmacists are the most accessible Self-medication is just one element of self-care and can be
healthcare profes- sionals. No appointment is needed defined as the selection and use of medicines by
to consult a pharmacist, and patients can receive free, individuals to treat self- recognized illness or symptoms.
unbiased advice almost anywhere. A com- munity How these medicines are made available to the public
pharmacist is often the first health professional a varies from country to country, but all have
patient seeks advice from and as such provides a
filtering mechanism whereby patients with minor self-
limiting conditions can be appro- priately treated with
the correct medications and patients with more
serious or chronic pathology referred on to appropriate
prac- titioners for further investigation. On a typical
day, a pharmacist working in an ‘average’
community pharmacy can realistically expect to help
between 5 and 15 patients a day who present with
various symptoms for which they are seeking advice,
reassurance, treatment or a combination of all three.
Probably of greatest impact to community
pharmacy practice globally is the increased
prominence of self-care. Self-care is not new; people
have always taken an active role in their own health.
Health improvements have been seen in people
adopting health- enhancing behaviours rather than
just through medical interven- tion. This has led to
self-care being seen in a broader context than just the
way in which people deal with everyday illness. In
the United Kingdom, the Self Care Forum (-
selfcareforum. org) was established whose purpose is
to promote self-care and embed it in everyday life.
What is self-care?
Fundamentally, the concept of self-care puts
responsibility on indi- viduals for their own health
and well-being. The World Health Organization
(WHO) defines self-care as ‘the ability of individuals,
families and communities to promote health, prevent
disease, and maintain health and to cope with
illness and disability with or without the support of
a health-care provider’.
Self-care has been described as a continuum (Fig.
1), starting with individual choices on health (e.g.,
taking exercise) and moving through to managing
their own ill health (e.g., self-medicating) either on
their own or with help. As people progress along the
continuum, more facilitation by others is required
until a person needs fully managed care.
What is self-medication?
, been approved by regulatory agencies as safe
and effective for people to select and use without
the need for medical supervision or intervention. In
many countries, regulatory frameworks support
reclassification of medicines away from
prescription-only control by having a gradation in
the level of medicine availability, whereby certain
medicines can only be purchased at a
pharmacy. These nonprescription medicines
usually have to be sold either by a pharmacist or
under a pharmacist’s supervision. This approach
to reclassification has seen a wide range of
therapeutic agents made available to consumers,
including proton pump inhibitors, orlistat,
triptans and beta-2-agonists.
The majority of purchases for nonprescription
medicines are by consumers alone using
product information from packaging to make
informed decisions on whether to purchase
them. When consumers seek help at the point of
purchase, it can be termed ‘facilitated self-
medication’. When medicines are purchased
through pharmacies, staff are in a strong
position to facilitate self-care decision making by
consumers because in most phar- macies,
transactions take place through trained counter
assis- tants or pharmacists. Limited research has
shown that consumer purchasing decisions are
affected by this ‘facilitation’. Nichol et al., 1992.
and Sclar et al., 1996. both demonstrated that
consumers (25% and 43%, respectively) altered
their purchasing decisions when proactively
approached by pharmacy staff. These studies
highlight how the pharmacy team are able to
positively shape consumer decisions and help
guide them to arguably better alternatives.
The catalyst for change in pharmacy services was
heralded by the publication of the Nuffield Report
in 1986, which recommended ‘extended’
pharmacy roles in response to concerns over an
exces- sively educated workforce to principally
dispense prescriptions. These recommendations
were furthered with the publication of the
Pharmaceutical Care Report in 1992. It advocated
a new model of community pharmacy practice,
with the pharmacy acting as a health hub
offering a wide range of nondispensing-related
services that promoted health and well-being.
Subsequent UK policy doc- uments have reflected
a need to shift from dispensing to nondis- pensing
services, in particular advocating a role in health
promotion,
21
PAUL RUTTER
,CONTENT
Making a diagnosis 1
Skills needed to facilitate clinical
1 reasoning
2
9
3 Respiratory system 17
4 Ophthalmology 55
5 Ear conditions 81
6 Central nervous system 103
7 Women’s health 133
8 Gastroenterology 167
9 Dermatology 223
10 Musculoskeletal conditions 293
11 Paediatrics 321
12 General Health 351
13 Specific product requests 369
19
,xii Introduction
Introduction
Community pharmacists are the most accessible Self-medication is just one element of self-care and can be
healthcare profes- sionals. No appointment is needed defined as the selection and use of medicines by
to consult a pharmacist, and patients can receive free, individuals to treat self- recognized illness or symptoms.
unbiased advice almost anywhere. A com- munity How these medicines are made available to the public
pharmacist is often the first health professional a varies from country to country, but all have
patient seeks advice from and as such provides a
filtering mechanism whereby patients with minor self-
limiting conditions can be appro- priately treated with
the correct medications and patients with more
serious or chronic pathology referred on to appropriate
prac- titioners for further investigation. On a typical
day, a pharmacist working in an ‘average’
community pharmacy can realistically expect to help
between 5 and 15 patients a day who present with
various symptoms for which they are seeking advice,
reassurance, treatment or a combination of all three.
Probably of greatest impact to community
pharmacy practice globally is the increased
prominence of self-care. Self-care is not new; people
have always taken an active role in their own health.
Health improvements have been seen in people
adopting health- enhancing behaviours rather than
just through medical interven- tion. This has led to
self-care being seen in a broader context than just the
way in which people deal with everyday illness. In
the United Kingdom, the Self Care Forum (-
selfcareforum. org) was established whose purpose is
to promote self-care and embed it in everyday life.
What is self-care?
Fundamentally, the concept of self-care puts
responsibility on indi- viduals for their own health
and well-being. The World Health Organization
(WHO) defines self-care as ‘the ability of individuals,
families and communities to promote health, prevent
disease, and maintain health and to cope with
illness and disability with or without the support of
a health-care provider’.
Self-care has been described as a continuum (Fig.
1), starting with individual choices on health (e.g.,
taking exercise) and moving through to managing
their own ill health (e.g., self-medicating) either on
their own or with help. As people progress along the
continuum, more facilitation by others is required
until a person needs fully managed care.
What is self-medication?
, been approved by regulatory agencies as safe
and effective for people to select and use without
the need for medical supervision or intervention. In
many countries, regulatory frameworks support
reclassification of medicines away from
prescription-only control by having a gradation in
the level of medicine availability, whereby certain
medicines can only be purchased at a
pharmacy. These nonprescription medicines
usually have to be sold either by a pharmacist or
under a pharmacist’s supervision. This approach
to reclassification has seen a wide range of
therapeutic agents made available to consumers,
including proton pump inhibitors, orlistat,
triptans and beta-2-agonists.
The majority of purchases for nonprescription
medicines are by consumers alone using
product information from packaging to make
informed decisions on whether to purchase
them. When consumers seek help at the point of
purchase, it can be termed ‘facilitated self-
medication’. When medicines are purchased
through pharmacies, staff are in a strong
position to facilitate self-care decision making by
consumers because in most phar- macies,
transactions take place through trained counter
assis- tants or pharmacists. Limited research has
shown that consumer purchasing decisions are
affected by this ‘facilitation’. Nichol et al., 1992.
and Sclar et al., 1996. both demonstrated that
consumers (25% and 43%, respectively) altered
their purchasing decisions when proactively
approached by pharmacy staff. These studies
highlight how the pharmacy team are able to
positively shape consumer decisions and help
guide them to arguably better alternatives.
The catalyst for change in pharmacy services was
heralded by the publication of the Nuffield Report
in 1986, which recommended ‘extended’
pharmacy roles in response to concerns over an
exces- sively educated workforce to principally
dispense prescriptions. These recommendations
were furthered with the publication of the
Pharmaceutical Care Report in 1992. It advocated
a new model of community pharmacy practice,
with the pharmacy acting as a health hub
offering a wide range of nondispensing-related
services that promoted health and well-being.
Subsequent UK policy doc- uments have reflected
a need to shift from dispensing to nondis- pensing
services, in particular advocating a role in health
promotion,
21
