Introduction to

Self-Care
Brittany Stewart, PharmD, RD
PHA 4010
August 25, 2014

Objectives
Define self-care
Identify regulatory requirements for nonprescription

medications and dietary supplements

Understand influences on self-medication and effect

of new healthcare reform initiatives

Discuss key concepts in evaluating and assessing self-

care patients to make appropriate recommendations

Self-Care
Independent act of preventing, diagnosing,

and treating ones illness WITHOUT seeking

professional advice
Includes:
Dietary Interventions
Dietary supplements
Nonprescription or OTC products
Home diagnostics
Lifestyle modifications

Dr. Oz Phenomenon
Vitamin D

Garcinia
Cambogia

Self-empowered Patients
There is no shortage of information available to

patients
Internet, TV programs, self-help books, radio-TV

advertising provide information that influence

decisions patient make in regards to self-care
Patients are more self-empowered to address

their health care issues- is this best for patients?

Do patients make appropriate and informed
decisions?

Self-Medication
The practice of self-medication has increased

(utilization of vitamins, minerals, herbal

supplements and nonprescription
medications)
-Growth of aging population
-Restricted access to prescribers
-Increasing cost of health care
-High proportion of uninsured or underinsured
people in the US

Whats in a number?

$102,000,000,
000
300,0
00
8
0

Conditions commonly self-treated

Pain 78%
Cough/cold/flu/allergy 52%
Allergy/ sinus problems 45%
Heartburn, indigestion 37%
Constipation/diarrhea/gas 21%
Minor infections 12%
Skin problems 10%

OTC use for chronic disease

management
Aspirin for cardiovascular disease
Fish oil for dyslipidemia
Glucosamine with chondroitin for osteoporosis
Melatonin for insomnia
NSAIDs for osteoarthritis

Self-care/OTC medications and MTM

Review all medications
Lifestyle modifications
Wellness support
Ex) You are performing MTM with a 65 year

old female patient with HTN, DM, and COPD

who is a smoker
What self-care or OTC recommendations can be

made?

Nonprescription
Medications
Evaluated by the FDA- Center for Drug

Evaluation and Research

Held to the same standards of drug product

formulation, labeling, and safety as

prescription medications
Deemed safe and effective without a

prescribers oversight

FDA Label Requirements

How do patients figure out what

is right for them?
OTC use and label information

Nonprescription
Medications
How can they get this status?

1. They have a low potential for misuse and

abuse
2.Patients can use them for self-diagnosed
conditions
3.They are adequately labeled
4.They do not require access to a healthcare
provider for safe and effective use
Sales of these products in 2010 were
estimated at $17 billion dollars

What is a Dietary
Supplement?
Intended to supplement the diet
Contains one or more dietary ingredients
Vitamins
Minerals
Herbs
Botanicals
Amino acids

Intended to be taken by mouth as a pill,

capsule, tablet, or liquid

Labeled as being a dietary supplement

Nutritional Dietary Supplements

& Herbal Medications
Regulated by Dietary Supplements Health and

Education Act of 1994 (DSHEA)- bring some

standards to dietary supplements.
No provisions for FDA to approve for safety
or efficacy before reaching consumer
FDA must prove harmful before restricting or
removing from the market
Examples of potentially adverse effects with
common dietary supplements?

http://www.reuters.com/article/2010/08/03/us-usa-supplements-idUSTRE6721F520100803

Natural Products and

Homeopathic Remedies
Complementary and Alternative Medication (CAM)
Most common forms include:

-natural products
-deep breathing
-meditation
-chiropractic and osteopathic care, massage
Self-medication with herbals is a big component of
CAM
In 2009, herbal sales were 5.03 billion annually,
top sellers are cranberry, soy, saw palmetto, garlic,
and echinacea

Influence on SelfMedication
Patients often seek self-care to avoid

doctor/hospital visit
What does new health-care reform mean for

self-care?
Flexible spending accounts and OTC

medications

Availability of new products

Rx to OTC

Influence on SelfMedication
Aging population: 10,000 Americans turn 65 daily!
Life expectancy has increased, individuals reaching

65 years expected to live an additional 18.6 years

By 2030, expected 72 million US citizens to be

>65; it was 35 million in 2000

Increased use of nonRx medications with this

group-due to conditions, accessibility and low cost

New healthcare models

Primary care
provider

Pharmacy

$$ Hospital
$$
Health-Information
Technology

Care coordination

Improving Patient Care

http://www.chaindrugreview.com/newsbreaks-archives/2011-09-26/walgreens-pilots-ne
w-health-daily-living-formats

Well Experience at
UCSF

http://www.chaindrugreview.com/newsbreaks-archives/2011-09-26/walgreens-pilots-ne

Questions people may

ask you
Is this appropriate for self-care?

Questions people may

ask you
Should I take this with my cardiac meds?

Questions people may

ask you
What is this on me?

How to assess patients?

Develop a process for making assessments

and recommendations

QuEST Process
QUickly and accurately assess the patient
Patient complaint (SCHOLAR-MAC)
Medications and other products
Coexisting conditions and allergies
Establish whether the patient is an appropriate

self-care candidate
Suggest appropriate self-care strategies
Nonprescription medication(s)
General care measures

Talk with the patient

SCHOLAR = SUBJECTIVE
Symptoms
What are the main and

associated symptoms?

Characteristics
What are the symptoms

like?

History
What has been done so far?

Has this happened in the

past?

Onset
When did the symptoms

start?

Location
Where is the problem?
Aggravating factors
What makes it worse?
Remitting factors
What makes it better?

Appropriate Candidate for

Self-Care?
No severe symptoms
No symptoms that persist or return repeatedly
No self-treating to avoid medical care

3 Options for Recommendations

1) No product recommendation and non-

pharmacological options are discussed (e.g.,

proper sleep hygiene vs. antihistamine)
2) Self-care product
3) Refer to a physician or other healthcare

provider

Talk With the Patient

Advise and counsel on the proper course of action
About the medication, administration, and

adverse effects (how to manage)

About what to expect from the treatment
About reading the label correctly and carefully
About appropriate follow-up

The Pharmacists Role in Self-Care

Most accessible healthcare provider
Effective patient assessment techniques
Good communication skills
Avoid potential pitfalls
Multi-ingredient products
Special patient populations
Document interaction
Communicate with other HCP

SELF-CARE
Self-Care is really all

about taking care of

yourself by staying
abreast of new
therapies, lifestyle
modification and
appropriately using
products to keep
yourself healthy

RPH
EveryOne
else

DR

YOU
ADS

MEDIA
WWW.

Questions