Self-Care Counseling Research Articles

Perspectives on sexual and reproductive health self-care among women, healthcare providers, and other key informants: a mixed-methods study in South Africa and Zambia

Background“Self-care” for sexual and reproductive health (SRH) includes contraceptive methods and other supplies that people can use with or without the support of a healthcare provider. Self-administered tests, self-injection of injectable contraception, or self-removal of intrauterine devices (IUDs) can increase people’s access to and autonomy over their own SRH. Objectives of this study were to assess women’s current interest in and use of SRH self-care and explore key informants’ (KI) opinions of self-care, especially during the COVID-19 pandemic.MethodsData for this study came from female participants in the longitudinal Contraceptive Use Beyond ECHO (CUBE) study, and KIs, including healthcare providers, in South Africa and Zambia between September 2020 and June 2021. For this analysis, we used data from a participant phone survey (n = 537), and from in-depth interviews (IDIs) completed with a sub-sample of women (n = 39) and KIs (n = 36). Survey data were analyzed with descriptive statistics, and IDI data were analyzed using applied thematic analysis.ResultsFemale survey participants in South Africa were more interested in learning about emergency contraceptive pills, subcutaneous injectable contraception, and CycleBeads, while Zambian participants wanted more information and access to condoms. However, in IDIs in both countries, women described minimal experience with self-care beyond condom use. In the Zambian KI IDIs, COVID-19 led to increased self-care counseling on subcutaneous injectable contraception and HIV self-testing. KIs who do not counsel on self-care were concerned that women may harm themselves or blame the provider for difficulties. Two KIs thought that women could possibly self-remove IUDs, but most expressed concerns. Reported barriers to self-care included COVID movement restrictions, transport costs, lack of accessible pharmacies, women’s low awareness, and possible stigma.ConclusionsWomen surveyed reported interest in learning more about SRH self-care methods and resources, but in IDIs did not report extensive previous use besides condoms. KIs described some concerns about women’s ability to use self-care methods. Counseling on and provision of self-care methods and supplies may have increased during the COVID-19 pandemic, but ensuring that self-care is more than just a temporary measure in health systems has the potential to increase access to SRH care and support women’s autonomy and healthcare needs.

Barriers and facilitators for providing self-care advice in community pharmacies: a qualitative study

BackgroundCommunity pharmacies are easily accessible for self-care advice. Guidelines for providing self-care advice were introduced in several countries, including the Netherlands in the 1990s. Previous studies have indicated room for improvement in self-care advice in daily pharmacy practice.AimTo identify barriers and facilitators for providing self-care advice.MethodSemi-structured interviews were conducted face-to-face or online with pharmacists and pharmacy assistants using a topic guide based on the Theoretical Domains Framework. The interviews were audio-recorded and transcribed verbatim. The transcripts were deductively analysed to identify barriers and facilitators for self-care counselling. COREQ guidelines were followed.ResultsIn total, 13 pharmacists and 12 pharmacy assistants were interviewed to reach data saturation. In general, most themes addressed by pharmacists and pharmacy assistants belonged to similar domains. The following domains were frequently mentioned: environmental context and resources (e.g. priority for prescription drugs, privacy, collaboration with general practitioners, access to patients’ records), intentions (providing reliable advice), skills (communication, decision-making), knowledge (ready guideline knowledge), beliefs about consequences (patient safety), social influences (patient awareness of pharmacist role), reinforcement (lack of reimbursement for relatively time-consuming advice).ConclusionThis study identifies barriers and facilitators for evidence-based self-care advice. Pharmacists should first support pharmacy assistants by helping them keep their knowledge and skills up to date and creating suitable pharmacy preconditions to facilitate improvements in self-care counselling. Second, collaboration with general practitioners regarding minor ailments should be improved.

The Impact of Self-Care Counseling on Quality of Life in Pregnant Women with Gestational Hypertension

The Impact of Self-Care Counseling on Quality of Life in Pregnant Women with Gestational Hypertension

The effect of self-care counseling on health practices of adolescent pregnant women: a randomized controlled trial

BackgroundPregnancy and childbirth at an early age are associated with potential risks and complications for adolescent mothers. Health practices are behaviors that can positively affect maternal and fetal health. This study aimed to investigate the effects of self-care counseling on health practices (main outcome), attitudes towards motherhood and pregnancy, and pregnancy symptoms (secondary outcomes) in adolescent pregnant women.MethodsIn this randomized controlled trial, 54 adolescent pregnant women admitted to the health centers of Bukan, Iran in 2020 were enrolled. Using randomized block design, the participants were randomly assigned to the counseling (n=27) and control (n=27) groups. Those in the intervention group attended 6 self-care group counseling sessions. The Health Practices Questionnaire-II (HPQ-II), Attitudes towards Motherhood and Pregnancy Questionnaire (PRE-MAMA), and Pregnancy Symptoms Inventory (PSI) were completed before and 4 weeks after the intervention.ResultsBased on the results of ANCOVA with controlled baseline values, after the intervention the mean health practices score of the participants in the intervention group was significantly higher than those in the control group (adjusted mean difference (AMD): 36.34; 95% CI: 34.69 to 37.98; P<0.001). The mean attitude towards motherhood score of the participants in the intervention group was significantly higher than those in the control group (AMD: 1.01; 95% CI: 0.06 to 1.96; P= 0.038). However, the mean pregnancy symptoms score of the participants in the intervention group was partially lower than those in the control group (AMD: -1.37; 95% CI: -4.32 to 1.58; P= 0.354).ConclusionSelf-care counseling sessions can improve the health practices of adolescent pregnant women and enhance their attitudes towards maternal role and pregnancy. Therefore, planners are recommended to organize self-care counseling programs for all pregnant women, especially for adolescent pregnant women.Trial registrationIranian Registry of Clinical Trials (IRCT): IRCT20120718010324N54. Date of registration: 2/3/2020. URL: https://en.irct.ir/user/trial/42571/view; Date of first registration: February 3, 2020.

Engaging consumers in wise use of over-the-counter medications in Taiwan: Development and evaluation of a structured medication counseling approach

ObjectiveTo evaluate the impact of a tailored Symptom Allergy Indication Direction Self-care (SAIDS) counseling by pharmacists on consumers’ correct understanding of over-the-counter (OTC) medication use. MethodsThis study used a time-based sampling of two independent cohorts at a single community pharmacy in Taiwan for two years beginning in December 2018. In the control cohort, participants received conventional counseling for the OTCs they selected. In the intervention cohort, participants received SAIDS counseling along with pointing out OTC package label instructions. A paper-and-pencil survey was administered face-to-face to evaluate participants’ understanding for the correct use of OTCs. Descriptive statistics and chi-square tests were used to evaluate the effect of the SAIDS approach on cohorts’ understanding of OTC use. ResultsCompared with conventional OTC counseling, participants reported better understanding regarding potential side effects of OTCs that they acquired (p < 0.001) and were more aware of strategies to cope with the associated side effects (p < 0.001). Conclusions and practice implicationsDespite the time constraints that pharmacists often can offer to each customer, the SAIDS counseling approach may refine the structure and effectiveness of pharmacists’ OTC counseling skills and thereby improve consumers’ understanding of their ailments and self-care medications in Taiwan.

A qualitative study of nurses’ experiences of self-care counseling in migrant patients with heart failure

ObjectivesThis study aims to enhance researchers’ and nurses’ understanding of how to best support migrant patients with heart failure in self-care management. Previous research on self-care in heart failure patients has highlighted its importance, particularly among migrant populations. Nurses play an important role in informing and engaging patients with chronic conditions like heart failure to support their active participation in self-care. However, nurses’ experiences of providing self-care counseling to migrant populations with heart failure have not been studied. MethodsA qualitative study was conducted. Nurses working with migrant patients with HF (n = 13) from different types of facility in Western Sweden were interviewed between October and December 2020. Data were collected using semi-structured interviews and analyzed using inductive thematic analysis. ResultsThe main theme that emerged from the interviews was the difficulty for nurses “to find balance” in self-care counseling. The nurses during self-care counseling had: “to accept challenges,” “to use creative strategies,” faced “problems related to health literacy,” and “to work according to their (the nurses’) obligations.” It was evident that nurses faced several challenges in counseling migrants in self-care, including language and cultural barriers, time resource constraints, low levels of health literacy, and experienced disharmony between the law and their professional norms. They perceived building caring relationships with their patients to be crucial to fostering health-promoting self-care processes. ConclusionsTo increase self-care adherence, nurses must become more sensitive to cultural differences and adapt self-care counseling to patients’ health literacy. The findings of this research support and challenge nurses in providing the best counsel to migrant patients with heart failure living in Sweden’s multi-ethnic society. Policymakers in the health care organization should act to facilitate mutual cultural understanding between all involved partners for patient-safe self-care counseling.

Expanding Student Knowledge and Confidence on Dietary Supplements Through Mock Patient Consultations

Introduction: As dietary supplements are widely used in the United States, student pharmacists should be prepared to assess their appropriateness for self-care. The purpose of this project was to assess the impact of mock patient consults regarding common dietary supplements on second-year (P2) Doctor of Pharmacy (PharmD) students. Methods: This activity was part of a required course, Self-Care I. Twenty-four groups of 4 to 5 students were created, with each assigned a unique patient vignette. Students had 10 minutes to speak on the phone with their “patient” to obtain needed information in order to make an appropriate recommendation in the form of a 2 to 3-minute recorded oral response. Anonymous, voluntary pre- and post-project surveys assessing perceived dietary supplement knowledge, patient counseling skills, and attitudes about the activity were conducted during class through Google Forms. The Wilcoxon Signed-Rank Test was used to determine differences in mean 10-point Likert scale score between pre- and post-test for each survey question, with significance if p < 0.05. Results: Significant differences were found between pre- and post-survey Likert scale means. Reported confidence in using the QuEST/SCHOLAR-MAC approaches to self-care counseling increased by 45% from baseline. Perceived student knowledge on dietary supplements increased by 44%. Self-rated counseling abilities of students increased by 87% for glucosamine/chondroitin, 28% for melatonin, 39% for red yeast rice, 38% for fish oil, and 42% for cranberry regarding their use in particular cases. Conclusions: The activity provided students with realistic exposure to questions about dietary supplements that patients ask community pharmacists.

Effect of self-care counselling on depression and anxiety in women with endometriosis: a randomized controlled trial

BackgroundConsidering the prevalence of endometriosis and consequent depression and anxiety as well as the resultant effects on the body, mind, and quality of life of patients, this study aimed to determine the effects of self-care counselling on depression and anxiety (primary outcome) and on quality of life (secondary outcome) among women with endometriosis.MethodThis randomized controlled clinical trial was conducted on 76 women with endometriosis who were treated at Al-Zahra Teaching and Treatment Center of Tabriz within the 2015–2019 period. The random blocking method was employed to divide the patients into intervention (counselling) and control groups. In the intervention group, seven self-care group counselling sessions were held on a weekly basis. The control group received routine care. A sociodemographic questionnaire, Beck Depression Inventory, Spielberger State-Trait Anxiety Inventory (STAI) and the SF-36 Quality of Life Questionnaire were completed by the researcher through an interview before and 4 weeks after the intervention.ResultsThere was no significant difference between the intervention and control groups in terms of sociodemographic characteristics (p > 0.05). After the intervention, the mean scores of state anxiety (mean difference: − 0.12, 95% confidence interval: − 9.6 to − 14.4, p < 0.001) and trait anxiety (mean difference: − 10.9: 95% confidence interval: − 9.1 to − 12.7, p = 0.001) were significantly lower in the counselling group than those of the control group. The mean score of depression was lower in the counselling group than in the control group; however, it was not significant (p = 0/565). The mean score of quality of life for physical health (mean difference = 17.2, 95% confidence interval: 13.8 to 20.5, p < 0.001) and for mental health (mean difference = 12.0, 95% confidence interval: 9.0 to 14.9, p < 0.001) were significantly higher in the counselling group than in the control group.ConclusionSelf-care counselling affects the anxiety and quality of life of women with endometriosis. Therefore, in addition to other therapies, this method is proposed to improve quality of life and mental health of patients with endometriosis.Trial registrationIRCT Registration Number: IRCT 20111219008459 N13, registered on February 10, 2019 (https://irct.ir/user/trial/35915).

Improvement of student confidence and competence through a self-care skills multi-course integration

IntroductionOur goal was to evaluate the impact of integrating self-care concepts in class, a pharmacy practice laboratory, and an introductory pharmacy practice experience on student confidence and competence in self-care counseling. MethodsTwo cohorts of first-year professional pharmacy students were taught self-care topics using team-based learning (TBL) pedagogy. Students then applied their knowledge in two different settings: a patient-counseling simulation in a pharmacy practice laboratory and a real patient encounter at a pharmacy practice site. Students were evaluated on their performance at both settings using a validated rubric as well as on their self-reported confidence before and after the classroom engagement and after the counseling practice. Wilcoxon signed-rank and Friedman tests were used to examine pre-post changes and changes across all three assessments. ResultsReported student confidence levels rose after classroom learning and again after the real patient encounter. Student improvement was mirrored in rubric scores from the pharmacy practice laboratory simulation as well as from the pharmacy practice site encounter. ConclusionsThis research showed that integration of self-care topics across three different settings improved student confidence and competence in self-care counseling, demonstrating the value of providing multiple opportunities for students to apply knowledge and practice skills. Further research is needed to apply this longitudinal structure of learning to other classes in the pharmacy curriculum.

P2521Exercise-Based Cardiac Rehabilitation in post myocardial infarction patients with mid-range ejection fraction

Abstract Heart failure is a major cause of morbidity, mortality and re-hospitalizations and is highly prevalent in myocardial infarction survivors. Cardiac rehabilitation based on exercise training and heart failure self-care counseling have each been shown to improve clinical status and clinical outcomes. We designed our study with aim to evaluate the usefulness of exercise based in house cardiac rehabilitation/ secondary prevention program in patients with heart failure with mid-range ejection fraction (HFmrEF) after myocardial infarction. Patients and methods Out of 2753 patients who were admitted to our three weeks in- hospital secondary prevention program – exercised based cardiac rehabilitation, we analyze a total of 219 patients who were admitted early after coronary revascularization (percutaneus coronary interventions or coronary bypass surgery) with HFmrEF. The majority of patients were males (68%). Risk factors and co morbidities were noted. Patients were selected for exercise training after six minute walking test or exercise stress test (cardiopulmonary dominantly to evaluate unexpected exertional dyspnea). After 3 weeks in house cardiac rehabilitation the patients were re-tested. Results The major comorbidities in our patient population were as follows: hypertension, diabetes and dyslipidemia. Six minutes walking test was performed and the total distance walked ranged from 120 to 480 meters and the beginning of the program. Patient had 7 -days a week training program. After the 3 weeks in hospital exercise rehabilitation the improvement in the test was ∼32%. Cardiopulmonary test showed also improvement of functional capacity.We noted several rhythm disturbance complications by telemetry (VES, SVES). None had acutisation of heart failure (with peripheral edema and congestion). All patients fulfilled cardiac rehabilitation program. Conclusions Supervised multidisciplinary cardiac rehabilitation program, including an individualized exercise component is effective and can improve functional status and exercise tolerance in patient with HFmrEF after myocardial infarction.

Development and validation of the self-care counseling rubric (SCCR) to assess student self-care counseling skills

IntroductionTo describe the development and validation of the self-care counseling rubric (SCCR) to assess student self-care counseling skills. MethodsOver two years of implementation, a comprehensive rubric was developed and revised for faculty to use. Students were assessed using the rubric in weekly, simulated patient encounters on self-care topics already taught in didactic material. The rubric underwent analysis for validation. Simulated encounters were recorded to assess inter-rater reliability. ResultsThe internal consistency (Cronbach's alpha) of the original SCCR and revised SCCR were 0.81 and 0.85, respectively. The mean intraclass correlation of the original SCCR and revised SCCR was 0.27 and 0.66, respectively. ConclusionsThe developed instrument demonstrated good reliability in assessing student self-care counseling performance. The revised SCCR can be an efficient and effective approach to track student competence in self-care counseling.

STARZ-DRP: A STRUCTURED FRAMEWORK FOR TEACHING COMMUNITY PHARMACISTS TO COUNSEL SELF-CARE CUSTOMERS

Objective: Aim of this study is to take a look at the community pharmacists’ (CPs) self-rating confidence of advocating self-care customers using before and after attending a STARZ-DRP training workshop.Methods: CPs (n=231) in the state of Penang had been invited via e-mail to engage in a STARZ-DRP training workshop. CPs had been trained to assess individual features and analyse the facts and figures before formulating a triage action plan. A self-administered questionnaire to evaluate CPs’ self-confidence to performing self-care counselling had been handed out before and after the workshop.Results: Twenty CPs (8.7%) had responded to the invitation via e-mail. It was noted that CPs’ self-rating confidence to performing self-care counselling making use of STARZ-DRP as a framework were improved in all domains reflected in the questionnaire. Among significant improvements (p&lt;0.05) noted were making triage decision, consistently assessing individual features, and identifying actual or potential origins of the medical problem.Conclusion: CPs’ self-confidence to performing self-care counselling making use of STARZ-DRP as a framework to advocate self-care customers is enhanced after turning up at the training workshop. It reflects the future use of STARZ-DRP as a potential framework to help out CPs to formulate a triage action plan for self-care customers.

Students' Satisfaction with a Web-Based Pharmacy Program in a Re-Regulated Pharmacy Market.

In response to the shortage of pharmacists in Northern Sweden, a web-based Bachelor of Science in Pharmacy program was established at Umeå University in 2003. In 2009, the Swedish pharmacy market was re-regulated from a state monopoly to an open market, but it is unknown what impact this has had on education satisfaction. The objectives of this study were to examine the level of satisfaction among graduates from a web-based pharmacy program and to describe what subjects and skills students would have liked more or less of in their education. A secondary objective was to compare the level of satisfaction before and after the Swedish pharmacy market was re-regulated. A cross-sectional survey was conducted in 2015 with all alumni who had graduated from the pharmacy program between 2006 and 2014 (n = 511), and responses to questions about graduates’ satisfaction with the program were analyzed (n = 200). Most graduates (88%) agreed or strongly agreed that the knowledge and skills acquired during their education were useful in their current job. The graduates stated that they would have wanted more applied pharmacy practice and self-care counselling, and fewer social pharmacy and histology courses. Further, 82% stated that they would start the same degree program if they were to choose again today, and 92% agreed or strongly agreed that they would recommend the program to a prospective student. Graduates were more likely to recommend the program after the re-regulation (p = 0.007). In conclusion, pharmacy graduates were very satisfied with their education, and no negative effects of the re-regulation could be observed on program satisfaction.

MAHILA: a protocol for evaluating a nurse-delivered mHealth intervention for women with HIV and psychosocial risk factors in India.

BackgroundWomen living with HIV are vulnerable to a variety of psychosocial barriers that limit access and adherence to treatment. There is little evidence supporting interventions for improving access and treatment adherence among vulnerable groups of women in low- and middle-income countries. The Mobile Phone-BasedApproach forHealthImprovement,Literacy andAdherence (MAHILA) trial is assessing the feasibility, acceptability and preliminary efficacy of a novel, theory-guided mobile health intervention delivered by nurses for enhancing self-care and treatment adherence among HIV-infected women in India.Methods/DesignWomen (n = 120) with HIV infection who screen positive for depressive symptoms and/or other psychosocial vulnerabilities are randomly assigned in equal numbers to one of two treatment arms: treatment as usual plus the mobile phone intervention (experimental group) or treatment as usual (control group). In addition to treatment as usual, the experimental group receives nurse-delivered self-care counselling via mobile phone at fixed intervals over 16 weeks. Outcome measures are collected at baseline and at 4, 12, 24 and 36 weeks post-baseline. Outcomes include antiretroviral treatment adherence, HIV-1 RNA, depressive symptoms, illness perceptions, internalized stigma and quality of life.DiscussionThe MAHILA trial will provide information about how a mobile health counselling intervention delivered by non specialist nurses may improve access to care and support the adherence and clinical outcomes of women with HIV infection living in low- and middle-income countries such as India.Trial registrationNCT02319330 (First received: July 30, 2014; Last verified: January 2016)

Abstract 12543: Smartphone Delivered Cardiac Rehab for Heart Failure Management: A Feasibility Study

Background: Congestive heart failure (CHF) is the leading cause of hospitalization. Exercise training and self-care counseling through cardiac rehab (CR) benefits CHF patients by increasing exercise tolerance, improving clinical symptoms and reducing risk of future clinical events. However, CR programs are severely underutilized due to high insurance co-pays and issues with access. Remote CR programs delivered through patients’ smartphones show promise in addressing this gap. We studied the feasibility of utilizing a mobile application to implement a home-based cardiac rehab program for CHF patients. Methods: Ten consecutive ambulatory patients with a prior history of CHF and an Android smartphone downloaded and received training for the cardiac rehab smartphone application. The application engaged the patient to complete daily tasks at home. Data were wirelessly collected for 14 days. Metrics evaluated included passively collected activity (minutes), compliance to weight &amp; blood pressure tracking and viewing of educational tasks. Patient on-boarding time was also tracked. Results: A broad range of patients were included in the study (Table 1); 20% were inotrope dependent. On-boarding took an average of 15 minutes. Table 1 summarizes results. Participants met minimum recommended daily activity (30 minutes) an average of 8±5 days in the 14 day period. Four participants entered vital sign values only in the office, possibility indicating lack of equipment at home. Conclusion: A smartphone-based remote cardiac rehab is feasible and useful in a fairly ill population. Minimum daily activity can be achieved and education content can be effectively delivered. However, results indicate the need to engage participants more to complete educational tasks. Participants need to be provided scales and blood pressure cuffs to track vital signs at home. Further study is warranted to assess the effect of this application on functional capacity and symptoms.

Incorporating patients with chronic heart failure into outpatient cardiac rehabilitation: practical recommendations for exercise and self-care counseling-a clinical review.

A recent policy change from the Centers for Medicare and Medicaid Services includes coverage of cardiac rehabilitation (CR) for patients with chronic heart failure (CHF) with reduced ejection fraction. This article provides a framework by which CR programs can incorporate disease-specific services for patients with CHF who participate in CR. Cardiac rehabilitation should include self-care counseling that targets improved education and skill development (eg, medication compliance, monitoring/management of body weight). Various tools are available for assessing exercise tolerance (eg, stress test with gas exchange and 6-minute walk), health-related quality of life, and other outcome-related parameters. Exercise should be prescribed in a manner that progressively increases intensity, duration, and frequency, to a volume of exercise equivalent to 3 to 7 metabolic equivalent task (MET)-hr per week. The benefits of exercise training are limited by patient adherence; therefore, CR providers need to identify the adherence challenges unique to each patient and address each accordingly. To optimize the referral of patients with CHF to CR, program staff should develop strategies to raise both health care provider and patient awareness about the benefits of CR, as well as work collaboratively to set up system-based approaches to CR referral. The referral of patients with CHF to CR will increase in 2014 and beyond, due partly to a policy change from the Centers for Medicare and Medicaid Services that allows coverage for CR. These patients should be integrated into existing programs, with the intent of providing both standard CR services and CHF-specific education and disease management activities that target improved outcomes.

Women with heart failure: do they require a special approach for improving adherence to self-care?

The purpose of this review is to evaluate research regarding whether women with heart failure (HF) need a special approach for improving their adherence to self-care. Prior research has sampled mostly white, male populations and these results have been generalized to the population of all HF patients. After age 65, women are at a higher risk than men for developing HF. Once women develop HF they are more likely than men with HF to experience greater symptom burden, re-hospitalizations, social isolation, and higher mortality rates. In this review we will explore barriers and facilitators that women experience when performing self-care, and whether they need individualized interventions or approaches to care that are different from those for male patients with HF. Special approaches such as assessment of social support and self-care counseling when treating women with HF will be discussed, as this may improve women's adherence, thereby slowing the symptom burden and disease progression.

Self-care counseling for patients with psychiatric disorders

According to the National Institute of Mental Health, 1 in 17 adults has a serious mental illness and, of those, almost one-half have two or more disorders.1.Kessler R.C. Chiu W.T. Demler O. Walters E.E. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication.Arch Gen Psychiatry. 2005; 62: 617-627Crossref PubMed Scopus (7709) Google Scholar About 18% of adults have anxiety,2.National Institute of Mental Health. The numbers count: mental disorders in Americawww.nimh.nih.gov/health/publications/thenumbers-count-mental-disorders-in-america/index.shtmlDate: 2013Google Scholar 3% have bipolar disorder,2.National Institute of Mental Health. The numbers count: mental disorders in Americawww.nimh.nih.gov/health/publications/thenumbers-count-mental-disorders-in-america/index.shtmlDate: 2013Google Scholar and between 5% and 10% are depressed.3.Centers for Disease Control and PreventionAn estimated 1 in 10 U.S. adults report depression.www.cdc.gov/features/dsdepressionDate: 2013Google Scholar In addition to psychiatric illnesses, many patients have a range of chronic medical conditions (e.g., hypertension). Pharmacists can provide valuable self-care counseling to these individuals. Pharmacists should ask patients with psychiatric disorders about their smoking status and, if needed, encourage smoking cessation. Patients with depression are more likely to smoke than those who are not depressed (29% vs. 19%).4.Sanderson Cox L. Feng S. Cañar J. et al.Social and behavioral correlates of cigarette smoking among mid-Atlantic Latino primary care patients.Cancer Epidemiol Biomarkers Prev. 2005; 14: 1976-1980Crossref PubMed Scopus (20) Google Scholar This finding also has been identified with bipolar disorder and schizophrenia. Multiple approaches (e.g., nicotine replacement therapies) are available OTC and should be discussed.■Pharmacists have important roles in promoting safe self-care practices among individuals with psychiatric illnesses.■Supplements are not well regulated, may not be safer than prescribed psychotropic drugs, and should never replace a prescription. ■Pharmacists have important roles in promoting safe self-care practices among individuals with psychiatric illnesses.■Supplements are not well regulated, may not be safer than prescribed psychotropic drugs, and should never replace a prescription. In a survey of more than 2,000 adults, 53% of those with depressive symptoms used complementary and alternative medicine (CAM), especially St. John's wort and 5-hydroxytryptophan.5.Kessler R.C. McGonagle K.A. Zhao S. et al.Lifetime and 12-month prevalence of DSM-IIIR psychiatric disorders in the United States: results from the National Comorbidity Survey.Arch Gen Psychiatry. 1994; 51: 8-19Crossref PubMed Scopus (10450) Google Scholar Other supplements such as valerian, kava, melatonin, and omega-3 fatty acids often are used by individuals with mental health issues. Counsel patients that supplements are not well regulated, may not be safer than prescribed drugs, and should never replace prescription therapy. Selective serotonin reuptake inhibitors (SSRIs) are a commonly prescribed class of antidepressants. Although safe, the development of serotonin syndrome is a serious concern when used with other serotonergic agents. Dextromethorphan possesses serotonergic activity and is present in many cough preparations. Natural products (e.g., St. John's wort, 5-hydroxytryptophan, S-adenosyl-Lmethionine) also are serotonergic and should be avoided in individuals using an SSRI or antidepressants, including duloxetine and venlafaxine. SSRIs (and serotonin-norepinephrine reuptake inhibitors) may increase the risk of bleeding, especially if taken with prescription antithrombotic agents. Patients should avoid OTC ibuprofen, naproxen, and analgesic dosages of aspirin to reduce the risk of bleeding and instead use acetaminophen. Anticholinergic effects may occur with bupropion use, so patients should be counseled to avoid OTC drugs with anticholinergic effects (e.g., diphenhydramine, dimenhydrinate, meclizine). When a patient presents with cough and cold symptoms, products to recommend include second-generation antihistamines, decongestants, and throat lozenges. Patients should avoid combination OTC cold products, as they most likely contain anticholinergic agents. Lithium remains a primary treatment for many patients with bipolar disorder. Self-care counseling should focus on any activity that would change lithium concentrations. Most importantly, changes in sodium ingestion, specifically sodium restriction, will increase the renal tubular reabsorption of lithium and result in lithium toxicity. Advise patients with concomitant bipolar disorder and hypertension to maintain adequate sodium and fluid intake. Patients taking lithium also should avoid the use of ibuprofen and naproxen, both of which can increase the renal reabsorption of lithium, resulting in increased concentrations. Tell patients to use acetaminophen for pain instead of NSAIDs. Daniel L. Krinsky, BSPharm, MS Column coordinator [email protected] Editor-in-Chief, APhA’s Handbook of Nonprescription Drugs: An Interactive Approach to Self-Care, 17th ed. (online at PharmacyLibrary.com)

Phytotherapic Compounds

Pharmacists play an important role in providing information about natural products and in preventing risks related to these substances, particularly with respect to interactions with conventional drugs. For these reasons, a survey was specifically designed to investigate the quality of self-care counselling by pharmacists on phytotherapy. Twenty-three pharmacy stores took part in the project. Face-to-face interviews, using a pre-structured questionnaire, were undertaken by trained pharmacists to consumers buying a herbal product. The questionnaire included socio-demographic data and 17 items designed to elicit information regarding the reason of consumption, product knowledge, relationship/communication with healthcare providers, level of satisfaction, concurrent drug use and adverse reactions. The collection of interviews started in November 2006 until April 2007. From the analysis of 1420 questionnaires, it is evident that herbal use is increasing in Italy: 12% of our interviewees were buying a herbal product for the first time. The present survey highlights the favourable perception of efficacy of phytotherapic compounds by the pharmacy's consumers, who consider this healthcare modality to be an important and effective way to promote health/wellness and disease management as well as being safer overall than conventional drugs. Moreover, findings from this study demonstrate that pharmacists are more likely to answer correctly about the uses of herbal medicines than about drug interactions, adverse drug effects and cautions about these products.

The quality of self-care counselling by pharmacy practitioners, supported by IT-based clinical guidelines

The primary objective of the study was to assess the quality of self-care counselling from pharmacy practitioners, supported by national clinical guidelines. The research questions addressed (1) the distribution of symptoms among customers in need of self-care counselling, (2) the quality of the self-care advice provided by pharmacy practitioners, (3) the degree of customer compliance with appropriate pharmacy advice versus the extent of symptom relief, (4) and versus a subsequent medical care visit, and (5) which resource the customers would have turned to in the first place for their ailments, had the pharmacy practitioner not been available. Three large community pharmacies with non-prescription self-selection departments in central Sweden. Ten pharmacy practitioners counselled all customers > or = 18 years old, with whom a dialogue was initiated on advice or products for self-care. The counselling was based on national clinical guidelines for self-care advice in the form of a software decision support program. The data collection consisted of documentation of background customer information, independent assessments of the quality of the advice provided and of telephone follow-ups. Of all documented symptoms (n = 250), the most common were allergy (26.4%), musculoskeletal symptoms (8.4%) and dyspepsia (7.2%). Independent assessments of the documentation by a physician and a pharmacist found that self-care advice was appropriate to give 97.6% of the customers and that the advice provided was correct in 88.4% of the cases. In total, 217 cases (86.8%) were fully approved by both the physician and the pharmacist. Among the 182 customers who claimed that they complied completely with appropriate advice provided, 135 (74.2%) experienced a great improvement in symptoms. Among the 21 who had only partly followed the advice, six (28.6%) reported the same level of improvement (p < 0.001). If the pharmacy practitioner had not been available, 56.8% of the customers would have turned to medical care in the first instance. The study demonstrates the high quality of pharmacy practitioners' self-care counselling supported by IT-based national clinical guidelines, including a favourable impact on customers' ailments. Furthermore, it reveals that pharmacy practitioners greatly relieve the pressure on the health-care system, resulting in reduced costs to society.