Over-the-Counter Over-the-Counter Medications (OTCs) and Medications (OTCs) and

Home RemediesHome Remedies

Washington Heights Washington Heights

Family Health CenterFamily Health Center

Aim StatementAim Statement

Our aim is to increase provider screening for, Our aim is to increase provider screening for, documentation of, and counseling about the use of over documentation of, and counseling about the use of over the counter medication and herbal supplements in our the counter medication and herbal supplements in our patient population. We will accomplish this by increasing patient population. We will accomplish this by increasing the communication between providers and patients the communication between providers and patients regarding over the counter medication and herbal regarding over the counter medication and herbal supplement usage and implementing both policy supplement usage and implementing both policy statements and evidence based studies to counsel statements and evidence based studies to counsel patients and families about the proper use and potential patients and families about the proper use and potential dangers of these products.dangers of these products.

Specific GoalsSpecific Goals 90% of patients will be screened 90% of patients will be screened

and documented for OTCs and and documented for OTCs and herbal supplement use, at any age, herbal supplement use, at any age, at both well and sick visits.at both well and sick visits.

Effective methods of screening for Effective methods of screening for OTC/home remedy use will be OTC/home remedy use will be identified and 100% of providers will identified and 100% of providers will receive education. receive education.

The 10 most common OTCs and The 10 most common OTCs and home remedies in our population home remedies in our population will be identified and 100% of will be identified and 100% of providers will receive education for providers will receive education for indications, dosages, formulations, indications, dosages, formulations, side effects, drug interactions, and side effects, drug interactions, and contraindications. contraindications.

Standard of CareStandard of Care

The AAP on Medication Reconciliation: The AAP on Medication Reconciliation: Optimal care for patients requires totally effective Optimal care for patients requires totally effective

communication regarding medication use.communication regarding medication use. The AAP on Cold Medicines: The AAP on Cold Medicines:

Over-the-counter cough and cold medicines do not Over-the-counter cough and cold medicines do not work for children younger than 6 years and in some work for children younger than 6 years and in some cases may pose a health risk.cases may pose a health risk.

The efficacy and risk of such medications needs to be The efficacy and risk of such medications needs to be studied in children. studied in children.

The labeling needs to reflect what we know.The labeling needs to reflect what we know.

RealityReality

OTCs, herbs and home OTCs, herbs and home remedies are often given to remedies are often given to children in an effort to treat children in an effort to treat or relieve a variety of or relieve a variety of common ailments.common ailments.

These medications and These medications and supplements are frequently supplements are frequently not discussed, nor not discussed, nor documented during our documented during our patient encounters. patient encounters.

Self-AssessmentSelf-Assessment

0%10%20%30%40%50%60%70%80%90%

100%

I ask

abo

utO

TC

I ask

how

spec

ific

OT

C

I doc

umen

tus

e of

OT

C

I cou

nsel

patie

nts

and

A g

iven

ailm

ent

I ask

abo

utob

serv

ed

strongly disagree (0%)

somew hat disagree(25%)

undecided (50%)

somew hat agree (75%)

strongly agree (100 ofthe time%)

Medication StickerMedication Sticker

Medications: mark or

Rx_____ OTC_____ Home Remedies_____

____________________________________

____________________________________

____________________________________

Visual prompt in the patient’s chartVisual prompt in the patient’s chartPoll of providers during later cycle: 100% reported Poll of providers during later cycle: 100% reported

that the sticker was usefulthat the sticker was usefulSticker was placed on H&P forms by PFAsSticker was placed on H&P forms by PFAsSticker “disappeared” often from formsSticker “disappeared” often from formsPermanent stickerPermanent sticker

How did we do?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%

CollaborationsCollaborations

Survey on herbal use in our ACNsSurvey on herbal use in our ACNs Commonly used herbs adapted for providersCommonly used herbs adapted for providers Questions in Spanish/English adapted for Questions in Spanish/English adapted for

providersproviders Pilot questions on 10 patientsPilot questions on 10 patients 8/10 providers correctly identified all OTCs/HRs 8/10 providers correctly identified all OTCs/HRs

being used being used that daythat day 19 other OTCs / remedies not revealed to the 19 other OTCs / remedies not revealed to the

providerprovider

Educating OurselvesEducating Ourselves

What exactly should we be What exactly should we be asking about?asking about? ““What types of medicines What types of medicines

or remedies have other or remedies have other people told you to use?” people told you to use?”

Naming remedies Naming remedies commonly used in a commonly used in a certain age group / certain age group / medical conditionmedical condition

Chart ReviewChart Review 40 charts reviewed for visits within 4 months40 charts reviewed for visits within 4 months 20 WCC, 20 walk-ins20 WCC, 20 walk-ins 24 attending visits, 16 resident visits24 attending visits, 16 resident visits percentage of notes with medication sticker: 90%, used stickers: percentage of notes with medication sticker: 90%, used stickers:

70%70%

Full documentation of all 3 types of meds

No documentation

Partial documentation

Educational ToolsEducational Tools

What can I give my child?What can I give my child?

Creating health literate & Creating health literate & culturally competent culturally competent educational handouts for educational handouts for our patient populationour patient population Home remediesHome remedies OTC medicationsOTC medications Treating of colds/cold Treating of colds/cold

symptomssymptoms

Cycle 7: Educational ToolsCycle 7: Educational Tools

Evaluating our ToolsEvaluating our Tools

Piloted handout summarizing safe / unsafe cold Piloted handout summarizing safe / unsafe cold medicinesmedicines

3 clinic sessions with handout, 3 without 3 clinic sessions with handout, 3 without handouthandout

Qualitatively elicited more responses with Qualitatively elicited more responses with handouthandout

Revised cold handout and created patient Revised cold handout and created patient version of home remedy handoutversion of home remedy handout

Elicited feedback from providers to finalize Elicited feedback from providers to finalize handout via email/in clinichandout via email/in clinic

Next StepsNext Steps

The Electronic Medical RecordThe Electronic Medical Record How will we incorporate these changes into How will we incorporate these changes into

Eclypsis?Eclypsis? Solidify placement of handouts in exam Solidify placement of handouts in exam

rooms and to ACNrooms and to ACN Ensure that our projects are continuedEnsure that our projects are continued

Didactic sessions to remind and educate Didactic sessions to remind and educate providersproviders

Recent Projects Recent Projects Dental HealthDental Health

69% of eligible patients (6 months or older) had 69% of eligible patients (6 months or older) had documentation of anticipatory guidancedocumentation of anticipatory guidance

EI to CPSE TransitionEI to CPSE Transition 2 patients (10%) were enrolled in EI2 patients (10%) were enrolled in EI Both had documentation of transition but no stickerBoth had documentation of transition but no sticker

Iron DeficiencyIron Deficiency 100% of eligible patients had 1 and 2 year CBC and 100% of eligible patients had 1 and 2 year CBC and

lead levelslead levels 40% of patients 1-3 years of age were given a 40% of patients 1-3 years of age were given a

multivitamin with ironmultivitamin with iron 2 patients were anemic, 1 was given Rx for iron and 2 patients were anemic, 1 was given Rx for iron and

had hemoglobin rechecked at the appropriate timehad hemoglobin rechecked at the appropriate time

Our TeamOur TeamOla AgangaOla Aganga Brenton MarBrenton MarJohn BabineauJohn Babineau Mahbod MohazzebiMahbod MohazzebiMaja CastilloMaja Castillo Kim NobleKim NobleCaroline ChangCaroline Chang Brenda RitsonBrenda RitsonRobyn GreenfieldRobyn Greenfield Carol SenklerCarol SenklerNeva HowardNeva Howard Sarah ShragerSarah ShragerMatt LaurichMatt Laurich Dawn WetzelDawn WetzelLauren LevineLauren Levine

Steve Caddle - MentorSteve Caddle - MentorMarina CatallozziMarina CatallozziAnne Armstrong-CobenAnne Armstrong-CobenMelanie GissenMelanie GissenMelissa GlassmanMelissa GlassmanElyse Olshen KharbandaElyse Olshen KharbandaAdriana Matiz - MentorAdriana Matiz - MentorMary McCordMary McCordDodi MeyerDodi MeyerMaria MosqueraMaria MosqueraMary ZweighaftMary Zweighaft

Ivelisse RodriguezIvelisse RodriguezIliana TorresIliana Torresand the staff at WHFHCand the staff at WHFHC

Special thanks to Dan Hyman and Special thanks to Dan Hyman and Mariellen LaneMariellen Lane