Pharmacists in Smoking Cessation

don’t look inflamed and there
are no white spots, I tell them
I think it’s just viral. So you
aren’t just simply saying no
to your customers that are
coming in, not feeling well.
Maybe they didn’t want to pay
the doctor €50, maybe it was
pre-KDOC [an out-of-hours
GP service in Kildare and
West Wicklow] times, maybe
they didn’t have a car to go
to KDOC etc. So we ended up
performing clinical services
to rationalise to people to
say, “You have to go because
you have this infection, I can
see it”, as opposed to just
saying, “I’m not giving you an
antibiotic because you need a
prescription for it; you have to
go to the doctor”.
I’ve been doing this for
years. When the free GP under
6 scheme (as well as the free
GP over 70 scheme) came out,
it was in the media that GPs
were saying their surgeries
were full. A lot of people did
go to the doctor because
they didn’t have to pay for it.
Payment can be a barrier to
attendance so they were able
to go fairly easily, which meant
the doctors who are totally
under resourced became
overwhelmed. That meant that
everyone (paying customers
and people who get in for free)
wouldn’t get an appointment
for possibly up to three or four
days around here.
I had an example with one
of my patients, who has been
a patient since we opened,
which is 60 years this year.
Her daughter rang me because
she thought her mum had a
UTI. I asked if she rang the
surgery and she had – this
was a Thursday and they
had an appointment for
her on Tuesday. Her mother
is 92! She asked if there was
anything I could do and I said,
“Of course there is – bring me
down a sample”. She did that
and I put a urine dipstick in,
which confirmed an infection.
So I told her she was now
justified to put her 92-yearold
mother in a car and go to
KDOC because there was an
infection there that could not
wait until the Tuesday. So that
was the triage working.
The same model applies to
kids. I had parents talking to
me on a Monday saying their
child wasn’t well with a sore
throat and sore ear. They’d
called the surgery but they
didn’t have an appointment
until Friday, and asked if there
was anything I could do. So
I’d have a look at their throat
and use an otoscope, very
cautiously, for their ear. If it
looked healthy (no bulging,
no hole etc.), I’d recommend
to manage it with some
painkillers while they waited
for their appointment with
the GP. If they felt better in the
meantime, they could then
cancel their appointment. Or
what could have happened
is you looked into the child’s
throat, you saw those white
spots on the tonsils and
you know that’s
definitely a
bacterial
infection and they need to go
to KDOC.
So the triage was a way of
reaffirming or telling someone
that their interpretation may
not be correct – so you’re
confirming they may need
an antibiotic or you’re saying
it’s viral, and you give your
rationale.
But as I always say to
parents, if I don’t know what’s
wrong, I’m still going to refer
you. You always give the
caveat – if this changes or this
happens, you need to go to
your prescriber.
How did you decide on what
common ailments to include in
the service?
Urine analysis is part of it
because it’s easily done but
clinically relevant. The throat
is a highly common one as
well. So many viral infections
start off with a sore throat but
can progress to tonsillitis or
strep throat. But again, it’s a
non-invasive easily accessed
part of the body that you can
have a look at and give an
opinion on it. And the ear is
the same –you’re not going
to use any instrument that
breaks the skin; it allows you
to visualise properly because
you’re
magnifying under
illumination the site that you
want to have a look at. And
again, taking a temperature
is non-invasive and easy to
do. So you encompass those
conditions where looking in a
throat or an ear is warranted
versus, say, when someone
thinks they have a chest
infection, you’re getting into
stethoscope space, which
you’re not practised at and
have never done. For me,
that’s the wrong way to go.
It was the simplicity of the
conditions that enabled me
to have a look at them which
made me pick them.
Do you envisage any objections
to providing this service to
patients?
I have never had anyone pick
up the phone and say, “You
shouldn’t be doing that”, and
any pharmacists I’ve said it
to have said, “I think it’s the
best thing I’ve ever heard
but I wouldn’t know how to
go about it”. So if I get the
training and I can train them,
then they know how to go
about it. It would be trying
to learn and package up a
framework for my colleagues
so that they could try it.
Go back 20 years,
pharmacists wouldn’t
carry out blood pressure
measurements. . . and look
how we’ve evolved. This
is the next level. Before
Dermot Twomey,
pharmacists would
never have thought
about doing an
INR and working
with their local
hospitals for the
convenience of
their patients.
” I think the biggest challenge for pharmacy
at the moment is proving our value in the
public space. Pharmacists are great; I love
our profession. We do a lot of unsung hero
work that doesn’t get recognised.”
IPUREVIEW FEBRUARY 2017 25