Thrush - circumstances when an OTC supply is inappropriate?

[roper]

Having not looked into this recently and being just back from maternity leave, I found myself unsure if it was appropriate to sell a canesten product to a lady with diabetes. I came home and logged on to CPPE but could not find a suitable distance learning pack to download. It does not appear to be found on a search of the women's health PDF. Does anybody know of an online training resource I can refer to to document my CPD please. We referred the lady to her GP as it seemed appropriate - but looking at the spc (once I got home) I see no reference to diabetes.

[Nik]

CPPE have a minor ailments module which I have a copy of. It basically states, "Patients with diabetes who are poorly controlled are especially prone to candidal infections. It can also be one of the indicators of undiagnosed diabetes. Any patient with recurrent thrush should be referred to the GP." One of the otc texts also recommends referring all diabetics to their GP.

[roper]

Thanks - That is what I expected. Which otc text is it please? I chose to back up the assistant as I was sure she had read it somewhere - but I feel that we may have been better to sell a pessary as this consultation was at 9pm!

[culchie82]

Just had two cases of oral thrush in a row this morning, both medication related I suspect. One from use of broad spectrum Antibiotics and the other from inhaled corticosteroids. Not strictly relevant to this thread, but hey what the hell.

[Nik]

Thanks - That is what I expected. Which otc text is it please?

Community pharmacy; symptoms, diagnosis and treatment by Paul Rutter. Very informative.

Funnily enough, there was a question on thrush and antibiotics on the pre-reg exam yesterday. Not really relevant to the thread but what the hell !

[Pharmanaut]

CPPE have a minor ailments module which I have a copy of. It basically states, "Patients with diabetes who are poorly controlled are especially prone to candidal infections. It can also be one of the indicators of undiagnosed diabetes. Any patient with recurrent thrush should be referred to the GP." One of the otc texts also recommends referring all diabetics to their GP.

Which is good advice.
However, what happens on saturday afternoon at 15:00 when someone presents with oral thrush?
If there are no contraindications I would make sure they left with something to treat it; but with instructions to speak to their GP.
Wonder if the brave new world of IT will eventually enable us to pass a note on to their GP?

[hibernia]

Which is good advice.
However, what happens on saturday afternoon at 15:00 when someone presents with oral thrush?
If there are no contraindications I would make sure they left with something to treat it; but with instructions to speak to their GP.
Wonder if the brave new world of IT will eventually enable us to pass a note on to their GP?

I would agree with you. Because a woman has diabetes seems a very poor reason for her to have to suffer overnight (or possibly longer) before seeing a GP who will probably prescribe a canesten pessary anyway.

I don't think technology is the real barrier to us communicating with the GP. We could use a written note, a phone call or fax to make structured referrals or advise of OTC treatments supplied in this sort of case but we don't. Any ideas why?

[medical6969]

I don't think the GP's would appreciate a million referals clogging up their telephone lines, or fax machines (plus in this new age of pharmacy, I dont have time to sneeze, nevermind make a formal referal)

[Pharmanaut]

I don't think the GP's would appreciate a million referals clogging up their telephone lines, or fax machines (plus in this new age of pharmacy, I dont have time to sneeze, nevermind make a formal referal)

And we don't have time to sneeze because we are on the treadmill.
Doing more with less.

[hibernia]

I don't think the GP's would appreciate a million referals clogging up their telephone lines, or fax machines (plus in this new age of pharmacy, I dont have time to sneeze, nevermind make a formal referal)

I don't think it would be anything like a million referals, I'd say about one a day in an average pharmacy and possibly 2-3 notifications of actions we have taken that may be relevant to the GP, such as supplying thrush treatment to a diabetic or to a patient who is taking a course of antibiotics.
I'm not suggesting letting them know every time we sell a bottle of Calpol.

I do accept that time is a big issue for all of us but I'd say confidence is a bigger one. Are we willing to record our professional interventions and subject them to the scrutiny of another health professional?