For many disease states, treatment begins well before the first physician visit. Unlike conditions such as hypercholesterolemia or normal pressure hydrocephalus— whose diagnosis requires test and studies that only a health care professional can order—diseases or symptoms such as gastroesophageal reflux disease (GERD), pain, or constipation often begin with patient self-recognition.
In most cases, once they “diagnose” themselves, patients run to the aisles of their local pharmacy in search of relief. In some cases, the patient winds up with ineffective treatments, and the symptoms end up lasting for a prolonged period before the sufferer finally visits a health care professional for appropriate diagnosis and treatment. This oft-replayed scenario presents unique opportunities: the pattern of OTC medication purchases can signal a potentially serious clinical situation, offering a chance to intervene with recommendations for a more appropriate treatment.
OPPORTUNITIES TO KNOW
To begin, there are increasing opportunities to know which OTCs patients are taking. For example, as a result of health care reform, patients who wish to deduct the cost of their OTC purchases from their Health Savings Accounts (HSA) must now provide a prescription. Prior to this change, patients simply had to collect their receipts; now, prescribers are required to be in the know on their patients’ use of OTCs.
Pharmacies are also getting into the act; increasingly, they are able to know their customers’ OTC use through Loyalty Cards. While it’s not clear how this information is currently used, it could clearly help pharmacists direct patients to appropriate care. For example, if a patient is using laxatives excessively, the pharmacist might suggest he or she visit a healthcare provider for a complete evaluation and for treatment.
NEED TO KNOW
Patients’ OTC use is just one opportunity for knowledge. Providers involved in patientcentered medical home (PCMH) models of care will be required to house a complete medication profile for their patients. Some care models call for this medication profile to be so “complete” as to include all OTC as well as complementary and alternative medications (CAM). Much of this information will be captured through office visits that include patient “brown bags”—which involves patients bringing all of their medications, including OTCs and CAMs, to their physician to capture in their record and review.
The practicality of this knowledge recently became clear after the FDA reviewed the enormous number of unintended acetaminophen overdoses. Many of these resulted when patients did not realize the lethal effect of taking prescription pain medications in combination with OTC acetaminophen in total quantities in excess of 4 g per day. The lack of physician involvement in this dosing has proven to have deadly consequences.
OPPORTUNITIES FOR APPROPRIATE TREATMENT
Armed with this knowledge about a patient’s use of OTCs, healthcare providers can prescribe appropriate treatments—in the provider’s office, a PCMH, or even Convenient Care Clinics (CCC). CCCs may provide a frontline opportunity, since they often reside in the pharmacy just feet from where the OTCs are available. Patients could be directed with aisle reminders that the CCC services are available often at the same cost as the OTC and for much more effective treatment.
In the end, the point at which a patient reaches for an OTC often represents the very start of the problem as well as the beginning of the opportunities. These opportunities can be maximized through first knowing the OTCs one’s patients are taking and then having the patients progress through the appropriate clinical pathway. These steps are necessary to ensure that patients are treated in the most clinically efficient and effective manner rather than being caught in an ineffective and dangerous loop of OTCs.
Richard G. Stefanacci, DO, MGH, MBA, AGSF, CMD, is chief medical officer of The Access Group. He can be contacted at rstefanacci@theaccessgp.com.
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