A well-prepared and focused community pharmacy team will always provide the best possible experience and course of treatment for its patients, writes Emma Boyle

When it comes to digestive health issues and complaints the frequency of pharmacy visits is high, and a number of digestive health concerns can be attributed to constipation. So, how can pharmacy teams respond and spot patterns when patients come in regularly with the same complaints?

Looking beyond just the symptoms is key in understanding contributing factors; further questions can be asked around diet and lifestyle that may lead to constipation and digestive health issues. Constipation can often be misconstrued, particularly in older people, and exploring lifestyle and diet with a patient could be key to helping and spotting patterns when patients come in regularly to pharmacy with the same complaint.

Standard 20-tablet packs of constipation tablets may be appropriate for a patient displaying mild constipation, but pharmacies are seeing an increased amount of people coming into pharmacy more frequently, so could their digestive health issues be more complex than simply constipation?

Covid-19 has resulted in reduced footfall into pharmacy and, consequently, it has been more of a challenge to diagnose digestive health conditions as effectively, when talking to patients and asking questions is key and the lack of body language being able to be observed with the use of face masks could continue to be a factor pharmacy staff need to consider for all such consultations.

We have seen demand for GI category related products be consistent throughout, showing that issues are still prevalent. Covid-19 has interrupted both people’s diet and lifestyle, and this has undoubtedly played a part in the GI category.

From a diagnosis perspective, it has never been more important to ensure that the correct laxative product is given to someone who may need it and over the last six months there has been a seismic change in the industry with regards to the classification of constipation products to react to the issue around potential laxative misuse.

One of the most topical and recent changes within pharmacy occurred post-Q3 in 2020, as certain constipation Senna based laxatives tablet products (previously available in larger packs and available on shelf, including up to a 100-tablet pack) were reclassified.

This has impacted how pharmacists and pharmacy assistants need to manage engagements with their patients around these products. The MHRA, in partnership with The Royal Pharmaceutical Society, created new guidance post, a national safety review in 2020 after BEAT – the eating disorder charity – raised awareness that laxatives were playing a role in the lives of people with eating disorders and their findings have elicited the change.

With that in mind, and in order to protect vulnerable members of society, the recommended regulation change was that on-shelf products should carry a maximum of 20 tablets only, customers asking for access to more should be given dietary and lifestyle advice in the first instance, and that larger packs of 60 and 100 would be held behind the counter or provided as part of a medical prescription.

While there isn’t a specific task force visiting every pharmacy to ensure the guidelines are being followed, spot checks have taken place. Therefore, it’s important that pharmacies do review the regulatory advice and not only protect their business and colleagues, but importantly those community members that may not be taking laxatives for their intended purposes.

This reclassification of pack size, in addition to accompanying patient information leaflets clearly stating that, if a problem persists, to see a GP are now accompanied on pack with a clear warning that the product is only available to over 18s.

Still available but moved to a ‘P’ classification and away from shelf, 60s and 100s now involve a health check with an HCP who can dispense the product. This has taken some time for not only pharmacy staff to get used to, but also patients, who have been used to buying larger pack sizes without a consultation.

This is an opportunity to re-educate particularly older patients who may need a
clearer understanding of the reclassification and what it means to them. A duty of care to patients is tantamount, bearing in mind laxative products are now only available to over 18s and this will bring about a change of dynamic with regards to laxative products within the pharmacy.

Ultimately, constipation is a difficult conversation for many people to have and the move towards more of a consultation when dispensing the larger packs might prove uncomfortable for many, especially older patients.

This is where the pharmacy assistants and pharmacists can play a large role in how they also adapt to a more ‘consultation-led’ approach to constipation products.

Pharmacies are being asked to provide the community with a wider set of services than ever before and pharmacy assistants are having to advise more and more patients about self-treating minor health concerns. Stomach and bowel complaints are very common in today’s society and these can usually be fixed with lifestyle changes and/or appropriate pharmacy remedies.

To ensure customers have the best possible experience when visiting the pharmacy, it’s worth engaging in some internal training to help refocus the team and reinstate knowledge of some of the most commonly encountered stomach and bowel ailments, identifying the common complaints relating to the upper and lower gastro-intestinal tract, the variety of over-the-counter treatments that can remedy them, and when it’s time to refer to the GP.

Additionally, to help identify the symptoms and therefore triage the patient more efficiently, pharmacists and pharmacy assistants should consider any possible indicators around aspects such as age, location of complaint, nature of the pain, severity and radiation of the pain, any associated symptoms, aggravating factors and any personal factors that might help pinpoint the issue.

A prepared and focused pharmacy team will always be a more effective team and provide the best possible experience and course of treatment for its visitors.

It’s widely acknowledged that good merchandising is akin to having a silent salesman; how products are presented and located can make the difference in a customer having a positive pharmacy experience – visibility and accessibility are key.

In the majority, customers know what they need when they visit a pharmacy but decisions on the exact product are not finalised, so there is opportunity to influence that purchase decision.

Emma Boyle is brand manager for Care at Thornton & Ross.

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