Reconsidering the role of community pharmacy in colds and flu

Every year during cold and flu season (October to March), many patients consider the pharmacy to be the first stop when feeling unwell from cold and flu symptoms. The Pharmaceutical Journal conducted a survey of community pharmacists from April to May 2019, and 34% of respondents (n=371) indicated that 6-10 patients visited community pharmacies daily for cold and flu advice or to buy an over-the-counter (OTC) product to help relieve their symptoms[1].

With tens of thousands of cold and flu consultations every day, it’s no surprise that there is wide variation in practice across the industry.[1]. This results in subsequent differences in patient experience and inconsistent expectations of community pharmacy.

A 2017 Ipsos MORI survey asked more than 1,700 people aged 15 and over what they would do if they had a respiratory tract infection. Only 34% would consider an over-the-counter medication and only 11% would seek advice from the pharmacy. For patients who said they would go to a GP, NHS walk-in center or out-of-hours health service, just under 40% of patients said they would would expect to receive an antibiotic[2].

With many patients expecting to receive an antibiotic for a respiratory tract infection, there is a need for pharmaceutical teams to consider their role in antimicrobial stewardship (AMS) in the context of colds and flu. This role goes beyond simply challenging the inappropriate prescribing of antimicrobials; it should include reshaping the patient’s perceptions of cold and flu management[3]. Pharmacists should encourage their teams to reinforce public health messaging around infection prevention and self-care for colds and flu, and they should strongly discourage patients from automatically seeking antibiotics. To have a positive impact on antimicrobial resistance rates, this change must start early in the patient journey – at first presentation.

Although colds and flu are common ailments, their associated complications can be serious or fatal. Even with widespread use of the flu vaccine[4]there are on average 600 flu-related deaths in the UK each year[5].

It is essential that consistent self-care messages are delivered by pharmacy teams to promote community pharmacy as an accessible point of service and first port of call for minor ailments.

The role of pharmacy in the self-care program

Conditions that can be self-managed lead to around 57m GP consultations and 3.7m accident and emergency (A&E) visits each year, costing the NHS £2.3bn[6],[7].

With the increase in the number of consultations and the difficulty in meeting the demands and expectations of patients, there is a desire to transfer more care from hospitals to the community. As a result, people are finding it increasingly difficult to get GP appointments and waiting times are increasing[8].

A survey of 5,011 UK adults aged 18-75, conducted by Self Care Nation in 2016, found that most people are aware of the impact of their use of NHS services. Yet more than a third of survey respondents have seen a GP for a minor ailment that they could have treated either on their own or with the advice of a pharmacist.[9]
. Additionally, 92% of respondents felt it was important to take responsibility for their own health to ease the burden on the NHS, but only 29% visited a pharmacy more than once a month, usually to pick up a new prescription.[9].

Since 2016, several campaigns have aimed to make the know-how of pharmacists and their teams known to the general public.[10]. There is now a shift towards self-care and an emphasis on promoting the appropriate use of antibiotics and how they support the AMS role of community pharmacists and their teams.

The development of primary care networks, as well as increasing NHS 111 referrals to the community pharmacy through the NHS Emergency Medicines Advanced Supply Service and Minor Illness Digital Service, could provide the impetus for community pharmacy to engage with patients on self-care. It can also give the community pharmacy the opportunity to demonstrate how they can help patients manage minor acute illness.[11].

Involve the patient in decision making

Since self-care will be essential to future cold and flu management, any decision should be made in collaboration with the patient, taking into account their priorities and lifestyle. It is necessary for patients to be informed of the duration of symptoms and to be aware of the steps to be taken if their symptoms worsen or do not improve within the time frame discussed.[1]. Pharmacological and non-pharmacological options for self-care should be outlined alongside red flag symptoms that would require resubmission or referral.

As patients will be involved and empowered in decision-making about their own care, this provides an opportunity for community pharmacy to discuss SHI. To do this, pharmacists and pharmacy teams need to understand the connection between effective management of patients with cold and flu symptoms and effective AMS. The training materials produced in the following parts of this campaign will help bridge the gap between the pharmacy team and patients to help ensure that a consistent level of care is provided across the sector. This will be achieved by outlining how the pharmacy team should approach cold and flu consultations, whether patients present for advice or after self-choosing a product. Emphasis is placed on aligning the sector with other public health messages related to the AMS role of pharmacy (eg, infection control and discouraging inappropriate prescribing and requests for antibiotics).

To advance

Now is the time to challenge existing behaviors within community pharmacy and consider self-care, infection prevention, and symptomatic relief in managing cold and flu symptoms in the context of SMA. . This will ensure a consistent standard of patient care for cold and flu consultations across the sector.

As drug experts, community pharmacists must recognize the importance of updating their knowledge and developing their team as needed, focusing on quality rather than quantity of training.

Using a “train the trainer” approach, The Pharmaceutical Journal has developed a content package as part of the cold and flu partnership with GSK, which aims to help pharmacists working in several independent community pharmacies implement a consistent approach and standard of care for consultations with patients presenting for ask for advice on how to manage cold and flu symptoms, or after selecting an over-the-counter product.

The training materials will be divided into three parts and will be published in early October 2019:

part one

  • An overview of consulting skills, techniques and frameworks.

Second part

  • Consultation approaches for colds and flu;
  • Define the roles and responsibilities of each team member;
  • Focus on developing practical skills.

part three

  • Detailed training approaches for the whole team;
  • How to implement a training program and the new normal within your pharmacy.

The Pharmaceutical Journal, September 2019, online. doi:10.1211/PJ.2019.20206985

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