Pain management: best practice in S3 referrals

Pain management and community pharmacy

Pain management best practice can be improved with the help of pharmacy staff in S3 referrals as they are often the first point of contact with customers who present with strong pain, says Michelle Bou-Samra, pharmacy business consultant.

Often the S3 category is seen as ‘too hard’ or ‘high maintenance’ as regulations require the intervention of the pharmacist who may be busy; and it also requires that pharmacy assistants have to make a judgement whether referral is necessary. This can be challenging for both pharmacy staff and the customer, says Bou-Samra.

She was speaking at PA 2015 last Saturday on best practice in pain management and the S3 category.

Bou-Samra stresses that the role of pharmacy assistant “cannot be under-estimated” in screening customers, especially when they need help and are in pain.

“Pharmacy assistants often have that key relationship with customers.”

Overcoming barriers

But she concedes there are barriers to customer engagement, both physical—for example, the physical barrier of the counter—and the need for customer interaction, and assessment.

“However, utilising the medications in the pharmacist-only category is vital as if acute pain is untreated it can lead to chronic pain.”

Chronic pain can lead to lost productivity, says Bou-Samra, which has been estimated to cost $34bn to the Australian economy. She says chronic pain also has a huge impact on the individual.

Therefore, she says it is imperative when dealing with customers in pain not to be judgemental as everyone’s experience of pain is different. “Pain is very subjective and no two people experience it in the same way.”

Pain is subjective

She says pain is also affected by societal and cultural perceptions, is multidimensional, and a highly emotive health condition.

Bou-Samra points out when using your pharmacy protocols it is important not to appear that it is an interrogation with the customer. Rather, you should engage with them and find out what they are experiencing and how you can help. So show empathy and sympathise and act “like a friend”.

Gate-keepers vs health professional

“It is important that you gather as much information as possible in your ‘gate-keeper’ role. But remember, people in pain may need special attention as their pain may make them angry or impatient; and your attitude towards the customer in pain can have a significant influence on treatment outcomes,” says Bou-Samra.

She adds it is really important that you listen to your customers, ask open-ended questions and also observe their body language.

It is also crucial pharmacy staff have a solid understanding of treatment options—as advice, and knowledge is what your customers value and seek you out for.

Common S3 analgesic options include: paracetamol and codeine, paracetamol, codeine and doxylamine succinate, aspirin and codeine, ibuprofen and codeine, ibuprofen and paracetamol, and diclofenac.

Don’t forget that lifestyle measures such as exercise, nutrition, physiotherapy and massage can also assist with someone’s experience of pain, she adds.

Pharmacy assistants should also build their pain category knowledge with regular training and online training such as the ‘Hard-to-Treat PainPod’ module.

Pharmacies are accessible and pharmacy assistants are dealing with people in pain every day so it shouldn’t be a difficult category to sell, she says.

And if you can help your customers manage their pain before it becomes chronic they will really value you for it and become loyal, valuable customers.

“Generally, pharmacy should embrace the pharmacist-only category more as it is a highly profitable; and profit is not a dirty word as it keeps us all in work; allows us to invest in more health services and takes pressure of the health system so that customers don’t have to see their GP.”

The S3 category also positions pharmacy as a health destination and so that pharmacy can offer patients a true health solution, but it is often a missed opportunity in many pharmacies because it feels like “high maintenance”, says Bou-Samra.


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