Transcript OTCs and Home Remedies

Over-the-Counter
Medications (OTCs) and
Home Remedies
Washington Heights
Family Health Center
Aim Statement
Our aim is to increase provider screening for,
documentation of, and counseling about the use of over
the counter medication and herbal supplements in our
patient population. We will accomplish this by increasing
the communication between providers and patients
regarding over the counter medication and herbal
supplement usage and implementing both policy
statements and evidence based studies to counsel
patients and families about the proper use and potential
dangers of these products.
Specific Goals

90% of patients will be screened
and documented for OTCs and
herbal supplement use, at any age,
at both well and sick visits.

Effective methods of screening for
OTC/home remedy use will be
identified and 100% of providers will
receive education.

The 10 most common OTCs and
home remedies in our population
will be identified and 100% of
providers will receive education for
indications, dosages, formulations,
side effects, drug interactions, and
contraindications.
Standard of Care
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The AAP on Medication Reconciliation:
 Optimal care for patients requires totally effective
communication regarding medication use.
The AAP on Cold Medicines:
 Over-the-counter cough and cold medicines do not
work for children younger than 6 years and in some
cases may pose a health risk.
 The efficacy and risk of such medications needs to be
studied in children.
 The labeling needs to reflect what we know.
Reality

OTCs, herbs and home
remedies are often given to
children in an effort to treat
or relieve a variety of
common ailments.

These medications and
supplements are frequently
not discussed, nor
documented during our
patient encounters.
Self-Assessment
strongly disagree (0%)
somew hat disagree
(25%)
undecided (50%)
I ask about
observed
A given
ailment
I counsel
patients and
I document
use of OTC
I ask how
specific OTC
somew hat agree (75%)
I ask about
OTC
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
strongly agree (100 of
the time%)
Medication Sticker
Medications: mark f or p
Rx_____ OTC_____ Home Remedies_____
____________________________________
____________________________________
____________________________________
Visual prompt in the patient’s chart
Poll of providers during later cycle: 100% reported
that the sticker was useful
Sticker was placed on H&P forms by PFAs
Sticker “disappeared” often from forms
Permanent sticker
How did we do?
Documentation
No sticker %
+ sticker %
All %
Didn't doc at all
6.5%
9.1%
8.3%
Didn't doc OTC/HR
61.3%
29.9%
38.9%
Didn't doc HR
29.0%
14.3%
18.5%
Doc all three
3.2%
46.8%
34.3%
Collaborations

Survey on herbal use in our ACNs
 Commonly used herbs adapted for providers
 Questions in Spanish/English adapted for
providers
 Pilot questions on 10 patients
 8/10 providers correctly identified all OTCs/HRs
being used that day

19 other OTCs / remedies not revealed to the
provider
Educating Ourselves

What exactly should we be
asking about?
 “What types of medicines
or remedies have other
people told you to use?”
 Naming remedies
commonly used in a
certain age group /
medical condition
Chart Review
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
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40 charts reviewed for visits within 4 months
20 WCC, 20 walk-ins
24 attending visits, 16 resident visits
percentage of notes with medication sticker: 90%, used stickers:
70%
No
documentation
Partial
documentation
Full documentation
of all 3 types of
meds
Educational Tools
What can I give my child?

Creating health literate &
culturally competent
educational handouts for
our patient population



Home remedies
OTC medications
Treating of colds/cold
symptoms
Cycle 7: Educational Tools
Evaluating our Tools
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Piloted handout summarizing safe / unsafe cold
medicines
3 clinic sessions with handout, 3 without handout
Qualitatively elicited more responses with
handout
Revised cold handout and created patient
version of home remedy handout
Elicited feedback from providers to finalize
handout via email/in clinic
Next Steps
 The

Electronic Medical Record
How will we incorporate these changes into
Eclypsis?
 Solidify
placement of handouts in exam
rooms and to ACN
 Ensure that our projects are continued

Didactic sessions to remind and educate
providers
Recent Projects

Dental Health


EI to CPSE Transition


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69% of eligible patients (6 months or older) had
documentation of anticipatory guidance
2 patients (10%) were enrolled in EI
Both had documentation of transition but no sticker
Iron Deficiency

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100% of eligible patients had 1 and 2 year CBC and
lead levels
40% of patients 1-3 years of age were given a
multivitamin with iron
2 patients were anemic, 1 was given Rx for iron and
had hemoglobin rechecked at the appropriate time
Our Team
Ola Aganga
John Babineau
Maja Castillo
Caroline Chang
Robyn Greenfield
Neva Howard
Matt Laurich
Lauren Levine
Brenton Mar
Mahbod Mohazzebi
Kim Noble
Brenda Ritson
Carol Senkler
Sarah Shrager
Dawn Wetzel
Steve Caddle - Mentor
Marina Catallozzi
Anne Armstrong-Coben
Melanie Gissen
Melissa Glassman
Elyse Olshen Kharbanda
Adriana Matiz - Mentor
Mary McCord
Dodi Meyer
Maria Mosquera
Mary Zweighaft
Ivelisse Rodriguez
Iliana Torres
and the staff at WHFHC
Special thanks to Dan Hyman and
Mariellen Lane