As temperatures cool, days shorten and store aisles fill with holiday displays, pharmacists in the Northern Hemisphere know cold and flu season is imminent.

Pharmacies are perhaps best known for their key role in preventing infections and reducing transmission of influenza by dispensing flu immunizations. (See CDC recommendations for the U.S. and NACI summary on influenza for Canada.)

Pharmacists can also make a positive impact in other methods of infection prevention, symptom management, patient self-care, and antimicrobial stewardship (AMS). Recent programs reported in the Pharmaceutical Journal are designed to help pharmacy teams become more effective in these critical areas.

Community pharmacies in the U.K. organize to provide consistent care

In the U.K., an average of six to 10 customers came to a community pharmacy daily during cold and flu season for advice and over-the-counter (OTC) relief for cold and flu symptoms. This was according to 1,169 pharmacy professionals who responded to a survey conducted by the Pharmaceutical Journal in April and May 2019.

Although the conversations with these customers are often of a transactional nature, if properly managed, they’re opportunities to provide vital education on self-care and related agendas.

Such interactions can allow pharmacists to recommend the most appropriate pharmaceutical and non-pharmaceutical options based on patient need and lifestyle; inform patients about symptom duration and actions to take if their symptoms worsen or don’t improve; and observe red flag indicators calling for a referral to a healthcare specialist.

Survey results were analyzed by a roundtable panel and informed new training materials for a program to help pharmacy teams working across multiple and independent community pharmacies provide consistent and reliable flu and cold management advice to the public.

“It is vital that consistent messaging around self-care is delivered by pharmacy teams in order to promote community pharmacy as an accessible point of care and the first port of call for minor conditions,” write authors of an article on re-visioning pharmacy’s role in flu and cold.

Antimicrobial stewardship (AMS)

One area of improvement that was called for based on the survey was promoting antimicrobial stewardship (AMS) principles when managing patients with cold or flu symptoms.

Findings from a 2017 survey of over 1,700 people found that only 11% said they’d approach the pharmacy for advice if they had a respira­tory tract infection. Almost 40% of those who said they’d visit a doctor or clinic said that they would expect to be given an antibiotic while only 34% would consider an OTC medicine.

To address the high number of people expecting antibiotics, pharmacists need to work on shifting patient expectations versus merely challenging inappropriate prescriptions.

“Pharmacists must encourage their teams to reinforce public health messaging around prevention of infection and self-care for cold and flu, and they must strongly discourage patients from automatically seeking antibiotics,” said Diane Ashiru-Oredope, lead pharmacist for Healthcare Associated Infections and Antimicrobial Resistance Division Public Health England. “To have a positive impact on antimicrobial resistance rates, this change needs to begin at the start of the patient journey — at first presentation.”

Ashiru-Oredope was one of 10 experts who attended a June roundtable event at the Royal Pharmaceutical Society’s London headquarters to discuss the management of cold and flu in community pharmacy.

Sore throat pilot in Wales greatly reduces antibiotic treatment

A community pharmacy-based sore throat “test and treat” pilot was launched in Wales last November. The service involves a swab test to determine whether a patient’s sore throat was caused by a viral or a bacterial infection. People with viral infections, not treatable with antibiotics, received advice on symptom relief and recovery.

The pilot, which started with 58 community pharmacies, won the innovation and technology category at the 2019 Antibiotic Guardian awards.

Of the 3,655 consultations recorded since the pilot began, antibiotics were prescribed in only 752 or 21% of the cases, reported Vaughan Gething, Welsh minister for health and social services. He added that by winter 2020, 50% of community pharmacies across Wales are expected to be able to provide this service.

These programs help illustrate how pharmacists play a critical role in maintaining public health in their respective communities.