This article is a supplement from the October 2014 feature, “Q&A: OTC medicine use during flu season” from The Clinical Advisor.
Most clinicians are used to sending patients to the pharmacy after a flu diagnosis is made, but that route might be reversed with the advent of collaborative practice agreements, explains Michael E. Klepser, PharmD.
“When patients get ill, they usually try to make it through the illness themselves and try to treat their own symptoms,” Klepser tells The Clinical Advisor. “During flu season, then, many individuals will go to drugstores for over-the-counter [OTC]products, not knowing that they might have the flu.”
To help determine whether or not the person should see a provider, Klepser has been taking part in a study on developing collaborative practice agreements between retail pharmacists and clinicians, sponsored by the National Association of Chain Drug Stores Foundation.
The initiative allows persons who come to the pharmacy without first seeing a provider to discuss their disease state with the pharmacist and undergo a physical assessment during which the pharmacist measures blood pressure, pulse, respiratory rate, pulse oximetry, and temperature.
“The primary purpose is to screen those patients who have symptoms consistent with influenza-like illness,” states Klepser. “Based on the collaborative practice screen, the provider works with the pharmacist to establish criteria for clinical stability. If the person’s blood pressure is too low, for example, the pharmacist then would instruct the person to make an appointment with a provider, or the pharmacist can call and ask whether the provider wants to see the person or if the provider would prefer to call in a prescription right then.”
If specific criteria are met when influenza is present in the community, says Klepser, the pharmacist is permitted to perform a rapid diagnostic test for influenza using a nasal swab.
“The pharmacist would then call the prescriber again with the results, or in some states the collaborating provider is allowed to write right into the collaborative practice agreement that if all the criteria are met and the flu test is positive, the pharmacist can then dispense the medication.”
According to Klepser, a key element of the collaborative practice agreement is communication. “Anybody who has been seen in the pharmacy gets follow-up calls 24 to 48 hours later from the pharmacy,” he affirms. “Also, all pharmacists send a summary of all screened patients to the provider.”
This practice model has indicated that persons at lowest risk for complications can probably be managed outside of traditional health-care settings. And, adds Klepser, high-risk and clinically unstable patients often see their provider sooner than they might on their own, “because we’re encouraging them to take that route.”