6. Identifying your customers' needs- symptom assessment

45% of module complete

	Medicines Use Reviews (MURs), can provide an ideal opportunity to review prescription and OTC medication being used and establish whether the number of medicines being taken can be reviewed and even reduced, which can be discussed further with the patient’s GP.

Although many people will self-diagnose their symptoms, it is important to check what they mean by the terms they use to describe their symptoms to ensure their diagnosis is correct.

Who is the treatment for?

If a customer is requesting an OTC treatment, it is important to check whether the treatment is for themselves, or if they are purchasing the product on behalf of another person. There are certain groups who will require additional considerations so first establish whether the person requiring treatment falls into the following categories:

Pregnant women

Bowel conditions commonly occur during pregnancy. There are certain products that should not be used during pregnancy and others should only be used if advised by a GP, nurse prescriber or pharmacist prescriber. In the case of medication not being a viable option, pharmacists should give advice on lifestyle measures that may help relieve the symptoms. This would include ensuring that a healthy, balanced diet is being followed and that safe exercise including walking, swimming and other low impact activity is being undertaken.

Children

Bowel conditions, particularly constipation, are extremely common in children. This can occur for a number of reasons, but most often it is due to problems with diet, or because the child is holding stools in and resisting the urge to go to the toilet. Some OTC medications can be used in children, but it is important to check the product is appropriate before making a recommendation. It is generally recommended that medical advice is sought for children with constipation, but fruit juices containing fructose and sorbitol (e.g. prune, pear, apple) may help.

If a child is experiencing stomach pain, with no known cause, it would be advisable that they are referred to their GP.

Concurrent medication

Bowel symptoms are often an unwanted side-effect of taking some medications. The medication may be the cause of the bowel symptoms, or they can make an existing bowel condition worse.

This issue is particularly problematic for elderly people. As people get older, the number of medications they take tends to increase. More than half of all prescriptions are written for people over the age of 609. For people over the age of 75, 80% take at least one prescribed medication, and 36% take four or more medicines.10

Medicines Use Reviews (MURs), can provide an ideal opportunity to review prescription and OTC medication being used and establish whether the number of medicines being taken can be re-assessed and even reduced, which can be discussed further with the patient’s GP.

MURs are an ideal opportunity to find out if a customer is experiencing bowel symptoms as a side-effect of the medication they are taking. They may not be aware that the medication is the cause of their symptoms, and in some cases, may not ask for advice without the issue being raised first by the pharmacist. After establishing that a customer is experiencing bowel symptoms during an MUR, recommendation of an OTC treatment, if appropriate, could be made.

The table below outlines the drugs that are most likely to cause bowel symptoms as a side-effect:

How long have they been experiencing symptoms?

It is essential to establish how long the person has been experiencing the symptoms they describe in order to help decide whether an OTC treatment should be recommended (and which one is most appropriate), or whether a referral to a GP is required for further investigation.

Ask the customer about previous medical history to establish whether it is a new problem. A preexisting condition does not necessarily require referral; the customer may have suffered from a mild condition their whole life, but only recently chosen to seek advice. On the other hand, a new persistent problem that started suddenly would need to be investigated.

The severity of symptoms and requirement in terms of how quickly relief is needed should also be considered when deciding on appropriate treatments. A treatment that suits the requirements of that person’s needs must be taken into account (e.g. for constipation, consider an oral laxative with a flexible dosing option for overnight relief, or a suppository for rapid relief).

What has the customer previously tried?

Speak to the customer about any treatments they have tried previously to relieve their symptoms and how long they used the product for. Also discuss lifestyle measures to establish whether they can make improvements that may help to relieve symptoms(click here for lifestyle advice).