A Good OTC Consultation Starts With a Question: 5 Checks for Pharmacists

The medicine a patient requests is not always the medicine they need.

In community pharmacy, patients often approach the counter with a specific product in mind. They may know the brand, strength or dosage form they want and expect a quick transaction.

But an over-the-counter (OTC) medicine being available without a prescription does not remove the pharmacist's responsibility to assess whether it is appropriate for the individual patient.

A good OTC consultation can be brief. What matters is asking the right questions.

The International Pharmaceutical Federation (FIP) identifies assessment, clinical decision-making, communication and recognition of situations requiring referral as important components of pharmacists' role in supporting self-care.

Start with one question

"Who is the medicine for, and what is it being used for?"

This simple question can open a meaningful consultation and prevent the pharmacist from treating the requested product as the starting point of the decision.

From there, five practical checks can help guide the consultation.

1. Who is the medicine for?

Age and other patient characteristics can affect the suitability, dose, precautions and safety of a medicine.

A medicine requested for an adult may not be appropriate for a child, while pregnancy, breastfeeding, allergies and certain underlying conditions may also influence the choice of treatment.

The pharmacist should establish enough relevant information to make a safe recommendation.

2. What are the symptoms?

Find out what the patient is experiencing, when the symptoms started and what they have already tried.

The patient's requested medicine may not address the underlying problem. A short consultation can also help distinguish a minor, self-limiting condition suitable for self-care from symptoms that require further assessment.

3. What other medicines are being used?

Ask about prescribed medicines, other OTC products and relevant supplements.

This can identify potential duplication, interactions, contraindications or other medication-related problems.

The World Health Organization recognises medication-related harm as an important patient-safety concern and emphasises safer medication practices across the medication-use process.

4. Are there reasons to refer?

An OTC consultation is not simply an exercise in selecting a product.

The pharmacist should recognise situations where self-care is inappropriate and referral to another healthcare professional is necessary. Persistent, severe or unusual symptoms, significant deterioration or other clinical warning signs may require further assessment.

Knowing when not to supply can be as important as knowing what to recommend.

5. What does the patient need to know?

Once an appropriate medicine has been identified, the consultation should not end with handing over the product.

The patient should understand how to use the medicine, relevant precautions, what to expect and when further medical attention may be required.

Clear, patient-centred communication is an important part of medicines use and adherence. NICE guidance also supports using appropriate questions and communication to understand patients' needs and support safe medicine use.

The takeaway

OTC does not mean "no professional judgement required."

It means that a prescription may not be required for the medicine to be supplied. The pharmacist's clinical judgement remains important in determining whether the medicine is appropriate for the person, the symptoms and the circumstances.

Before reaching for the requested product, start with a question.

Evidence

1. International Pharmaceutical Federation (FIP). Knowledge and Skills Reference Guide for Pharmacists Supporting Self-Care. 2024.

2. World Health Organization (WHO). Medication Without Harm: Policy Brief. 2024.

3. National Institute for Health and Care Excellence (NICE). Medicines adherence: involving patients in decisions about prescribed medicines and supporting adherence.