Safe medication

FROM THE CEO’S DESK Importance of partnerships for mental health care in a pandemic

By Carol Lambie

The alarming mental health and addiction statistics we are seeing with the COVID-19 pandemic heightens the importance of September as national Recovery Month, and Mental Illness Awareness Week from October 4 to 10. Unfortunately, one description of the stages of a pandemic indicates mental health challenges as the fourth wave unfortunately giving the impression it follows previous waves. In truth, we started to see alarming mental health needs months ago. Provincially, hospitals, community organizations, and associations are supportive of Ontario’s Roadmap to Wellness strategy and are ready to partner with government to meet the increased demand for access to treatment and care in the pandemic’s wake.

Waypoint Centre for Mental Health Care and our partners across the system have worked hard to maintain services while keeping patients and clients, and the staff we need to care for them, safe during the pandemic. Virtual services were rapidly implemented and adjustments with a focus on infection control were made to ensure patient and staff safety. Six months later we are now focused on how to increase supports not only for those already in hospital and receiving community services, but to meet emerging needs of all ages for mental health and addiction services.

As a specialty mental health hospital serving the Simcoe County, Muskoka and Parry Sound areas, and the entire province for high-secure forensic mental health programs, our patients’ recovery journeys can vary in length and require multiple services from in-hospital, to community and supportive housing. When the pandemic forced us to change the way we work, it not only put a strain on our patients, but also on staff.

With this new reality, partnerships at all levels have become more important than ever. Working with ENHANCEMENTS TO WELLNESS PROGRAMMING, DEVELOPING RESILIENCY WORKSHOPS AND AT-HOME WELLNESS ACTIVITIES, OFFERING MINDFULNESS SESSIONS, AND SHARING RESOURCES ON HOW TO STAY ACTIVE WHILE PRACTICING PHYSICAL DISTANCING ARE JUST SOME OF THE SUPPORTS AVAILABLE.

other hospitals and organizations allows us to advocate with one voice, enhance programs, and build on each of our strengths. Waypoint’s membership in the Central Ontario Regional Ontario Health Team for Specialized Populations is one of those partnerships.

The ten members are a network of agencies in Central Ontario providing person-centered care for vulnerable people and their families and caregivers with highly complex needs who require specialized intensive services throughout their lifespan with a focus on mental health and addictions. This specialized Ontario Health Team provides the opportunity to collaborate with hospitals, primary care physicians, community and acute care partners through other local Ontario Health Teams.

With so much shifting in the way healthcare workers are caring for patients, it’s also a priority to help them through this pandemic, ensuring supports are available through these unprecedented times.

Enhancements to wellness programming, developing resiliency workshops and at-home wellness activities, offering mindfulness sessions, and sharing resources on how to stay active while practicing physical distancing are just some of the supports available.

Rapid access to free mental health care support for healthcare and frontline workers became a focus for Waypoint in partnership with four other hospitals across Ontario and supported by the Mental Health and Addiction Centre of Excellence at Ontario Health. This service for healthcare and frontline workers provides free, confidential wellness and coping support during COVID-19. I urge you to make sure your staff know about this and other provincial services for healthcare workers by sharing the provincial website: COVID-19: Get support if you are a health care worker.

With an eye toward future supports for mental healthcare professionals, a research study is also underway in partnership with Georgian College to benefit today’s and future healthcare workers. ECHOES, or Effects of COVID-19 on Healthcare Providers: Opportunities for Education and Support, is a joint study with Waypoint designed to learn more about healthcare providers’ experiences with the pandemic and the impact on their professional practice.

As we move into the fall, we don’t know when this pandemic will end, but we do know that people have an increased need to access mental health and addiction treatment and care. We will continue to keep our focus on advocating for this with our partners, being innovative and finding new ways to support patients and clients to enhance their quality of life, and ensuring we are supporting our staff so they can continue to provide essential mental health care. Stay safe and be well. ■ H

Moving towards safer and better self-care

By Crystal Zhang, Yifan Zhou, and Certina Ho

“ M y headache is killing me. I’ll take whatever medication is available in that gas station to help with the pain.”

Self-medication is becoming increasingly common for management of minor illnesses due to the ease of access of non-prescription medications. However, patients may risk misdiagnosing their condition(s) and/or misusing self-selected medications, resulting in inappropriate or delayed healthcare management. As the most accessible healthcare professionals, pharmacists are uniquely positioned to bridge this gap and facilitate safe medication use.

SELF-SELECTED MEDICATIONS

According to the National Association of Pharmacy Regulatory Authorities (NAPRA) National Drug Schedules, there are medications that can be purchased without a prescription or without professional intervention from the pharmacist at the point of sale in Canada:

Schedule III medications are generally known as over-the-counter (OTC) medications. They must be sold in an accredited pharmacy but can be displayed in the self-selection area. Some examples include fluconazole (when sold in a particular dosage form and pack size for vaginal yeast infection) and lactulose (for constipation).

Schedule U or unscheduled medications can be sold from any retail outlets without professional supervision. Some examples include acetaminophen (when sold in particular dosage forms and pack sizes for fever, headache, or pain) and loperamide (for diarrhea when marketed for adult use (i.e. 12 years and older)).

Despite the relatively lower risk associated with OTC and unscheduled medications, their indication, efficacy, safety as well as cost and convenience should be thoroughly assessed prior to self-medication.

The self-selection process and considerations when choosing OTC and unscheduled medications may seem What to consider? Indication Can this medication be used to treat the condition or its symptoms? What does this mean?

Assessing the signs and symptoms of a presenting illness is essential prior to selecting proper therapies. Since many conditions may have similar clinical presentations, appropriate screening can help identify differentiating symptoms and narrowing down the possible conditions. Additionally, red-flag symptoms may surface during the screening process. They are indicative of a more serious underlying condition, requiring referrals for further investigation. Screening questions may include, but not limited to, precipitating/palliating factors, characteristics/description of the symptoms, affected areas, severity of the symptoms, duration of the symptoms, and frequency of symptoms occurrence, etc. A Case Scenario

A patient with a runny nose and sneezing says that spring and outdoors make the symptoms worse. Patient does not have a fever nor sore throat; the symptoms can last for hours and days. It is highly likely that patient may have seasonal allergies.

Efficacy Is this medication effective in treating the condition or alleviating its symptoms? Oftentimes, there may be more than one treatment option available for a condition or symptom. In this case, efficacy is likely the first differentiating factor. Things to consider include the patient's relevant medical and medication history, as well as the selected medication's mechanism of action and route of administration, etc.

Safety Is this medication safe for the patient? The safety consideration should include not only the potential adverse effects of a medication, but also patient-specific factors that may preclude certain treatment options, such as patient’s drug allergies, age, pregnancy/breastfeeding status, etc. A thorough medical and medication history of a patient can help identify and prevent potentially harmful contraindications as well as drug-disease and/or drug-drug interactions.

Cost/ Convenience Is this medication a good fit to the patient’s budget and personal preferences? The affordability and dosing schedule of the selected medication will also play a role, as they may contribute to patient’s medication adherence.

to be complicated. However, for safe and effective management of self-care medical conditions, patients are encouraged to reach out to their pharmacists and/or healthcare providers. It is also important for healthcare professionals to recognize the potential risks associated with self-medication and actively engage patients in their self-selection process. MOVING TOWARDS SAFER AND EFFECTIVE SELF-CARE

There are many medications that can be sold in the market without health professional supervision. Patients considering or have been self-medicating are encouraged to talk to their pharmacists and healthcare professionals in order to minimize the An antihistamine ophthalmic drop would be ineffective and inappropriate in this case, as the patient does not have any eye related symptoms.

If the patient is an older adult, then first-generation antihistamines (e.g. diphenhydramine) should be avoided. A second-generation antihistamine (e.g. cetirizine oral tablets) may be considered for alleviating the symptoms of runny nose and sneezing instead.

If the patient needs to drive to work every day, a second-generation (nondrowsy) antihistamine with oncedaily dosing may be more practical, as compared to a first-generation antihistamine that would require more frequent dosing and may cause more drowsiness.

potential risk of harm from misdiagnosis and/or medication misuse. Pharmacists are well-positioned to utilize their clinical expertise to promote safe and effective medication use. Partnering with patients, improving patient education, and understanding the benefits and risks of self-medication are crucial to moving towards safer and better self-care. ■ H

Crystal Zhang and Yifan Zhou are PharmD Students at the Leslie Dan Faculty of Pharmacy, University of Toronto; and Certina Ho is an Assistant Professor at the Department of Psychiatry and Leslie Dan Faculty of Pharmacy, University of Toronto.