Self-care Counseling by Pharmacists — QuEST/SCHOLAR
- QuEST/SCHOLAR process is a comprehensive self-care counseling process
- Guides the clinician to ask a series of questions with subsequent analysis in order to:
- Assess the patient's problems
- Establish that patient is a self-care candidate
- Select the most appropriate nonprescription product along with general care measures
- Counsel the patient on 5 aspects of their nonprescription medication
Reference
Buring SM et al. AJPE 2007; 71(1) Article 08.
Self-care Counseling by Pharmacists — QuEST/SCHOLAR
| Quickly and accurately assess the patient: Ask about the current problem (SCHOLAR) | Symptoms What are the main and associated symptoms? |
| The "E.S.T" Portion of QuEST: Establish, Select, and Talk | Characteristics What is the situation like? Is it changing? |
Establish that the patient is an appropriate self-care candidate:
|
History What has been done so far? |
| Suggest appropriate self-care strategies | Onset When did it start? |
Talk with patient about:
|
Location Where is the problem? |
| Aggravating factors? What makes it worse? |
|
| Remitting Factors What makes it better? |
*American Pharmaceutical Association
Exclusions to self-treatment of headache
- Severe head pain
- Headaches that persist for 10 days with or without treatment
- Last trimester of pregnancy
- Less than 8 years of age
- High fever or signs of serious infection
- History of liver disease or consumption of ≥ 3 alcoholic drinks per day
- Headache associated with underlying pathology (secondary headache)
- Symptoms consistent with migraine, but no formal diagnosis of migraine headache
Reference
Krinsky DL, Ferreri SP, Hemstreet B, et al, editors. Handbook of Non-Prescription Drugs, 18th edition. Washington DC: American Pharmaceutical Association; 2015. Chapter 5, Headache; p.63-81.
Morgan's Case: Initial Pharmacist Interaction
| Information to Obtain From Mrs. Smith About Morgan | What Mrs. Smith Tells You About Morgan |
|---|---|
| Quickly and accurately assess the patient: Ask about the current problem (SCHOLAR) | |
| Symptoms | Experiencing painful, sharp, throbbing headaches |
| Characteristics | Increased intensity in the last 3 months |
| History | Excedrin Migraine 1-2 tablets daily |
| Onset | 6 months ago |
| Location | Unilateral (right-side); behind eye |
| Aggravating Factors | Stress |
| Remitting Factors | Excedrin Migraine tablets; May be contributing to medication overuse headache |
| Establish that the patient is an appropriate self-care candidate: | Your assessment, recommendation, and counseling |
| Suggest appropriate self-care strategies | Patient is not a candidate for self-care given symptoms consistent with migraines and high suspicion of medication overuse headache |
| Talk with the patient |
Question: Which of the following are associated with migraine headache? (Select all that apply.)
Migraine pain is often describe as moderate to severe, frequently occurring on one side of the head
Patients with migraine may experience light or sound sensitivity, nausea, vomiting
Question: Medication overuse headache occurs with acute therapies used to treat migraine such as:
Overuse of triptans and simple analgesics can cause MOH in a patient experiencing frequent migraines per month
Anti-depressants and beta-blockers are preventive/prophylactic therapies which help prevent the onset of migraine and are not associated with MOH
