Self medication and health habits in the management of upper gastrointestinal symptoms

Health Decline Is Associated with Reports of No Coffee Consumption Years After Reporting Coffee Consumption Among Older Adults in Spain

BACKGROUND

Part of the health benefits of coffee reported in observational studies might be due to health status influencing coffee intake rather than the opposite.

OBJECTIVE

We examined whether changes in health influenced subsequent reports of no coffee consumption in older adults.

METHODS

Data came from 718 coffee drinkers aged ≥60 y recruited in the Seniors-Estudio de Nutrición y Salud Cardiovascular en España (ENRICA) cohort in 2008-2010 (wave 0) and followed-up in 2012 (wave 1), 2015 (wave 2), and 2017 (wave 3). Health status was measured with a 52-item deficit accumulation index (DAI) with 4 domains: functionality, self-rated health/vitality, mental health, and morbidity/health services use. Coffee intake was estimated with a validated diet history. We examined how changes in health status over a 3-y period (wave 0 to wave 1) influenced reports of no coffee consumption during the subsequent 5 y (wave 1 to wave 3) by using logistic regression models.

RESULTS

Health deterioration over 3 y was associated with a higher frequency of reports of no regular coffee consumption during the subsequent 5 y (fully adjusted OR: 1.48 per 1-SD increment in DAI; 95% CI: 1.17-1.87). Deteriorating function (OR: 1.38 per 1-SD increment; 95% CI: 1.06-1.81) and mental health (OR: 1.34 per 1-SD increment; 95% CI: 1.04-1.73) were the DAI domains associated with increased reports of no regular coffee consumption. Also, individuals with worsened perceived health or hypertension onset were more likely to report no regular coffee consumption. No associations were found for decaffeinated coffee.

CONCLUSIONS

Health deterioration was associated with reports of no regular coffee consumption years after reporting regular coffee consumption among older adults in Spain. A potential implication of this finding is that part of the beneficial effect of coffee consumption on health in observational studies might be due to reverse causation, which should be confirmed in future research.

Factors influencing dyspepsia-related consultation: differences between a rural and an urban population

BACKGROUND

Dyspepsia is a common, chronic condition but medical consultation rates for symptoms remain variable. We aimed to examine two populations with varied health-care provision to determine predictive factors for dyspepsia-related consultation.

METHODS

A cross-sectional, population-based study in both an urban and a rural community within a single Asian country was conducted. Details on dyspepsia-related consultation rates over a fixed period and independent factors influencing them were identified.

KEY RESULTS

A total of 4039/5370 (75.2%) adults from representative rural and urban areas in this country agreed to participate in the study. Although mean ages of respondents were similar (40.4years), the demographics of both populations varied in terms of gender (62.7% female, rural vs 55.7% female, urban, P<0.0001), marital status (75.4% rural vs 70.5% urban, P=0.002), ethnicity, (79% Malay rural vs 45.3% Malays urban, P<0.0001) and socio-economic status (professional occupation 7.1% rural vs 47.3% urban, P<0.0001). Dyspepsia-related consultation rates were found to be higher among rural compared to urban adults (41.4%vs 28.7%, P<0.0001). Over-the-counter medication consumption was higher among urban compared to rural dyspepsia sufferers (n=157 vs n=35, P<0.0001). Following logistic regression, rural population (OR 3.14, 95% CI=1.65-6.0), low quality of life (OR 1.90, 95% CI=1.17-3.10), and self-medication (OR 0.40, 95% CI=0.25-0.62) were found to independently predict dyspepsia-related consultation.

CONCLUSIONS & INFERENCES

Dyspepsia-related consultation varied significantly between urban and rural communities. Factors within the rural population, self-medication practices, and a low quality of life independently influenced dyspepsia-related consultation.

Are customers requesting medicines by name less likely to be advised or referred? Provision of over-the-counter H2-receptor antagonists and alginate products from pharmacies

Objectives

To identify selected factors which may influence the provision of over-the-counter alginate and H2-receptor antagonist (H2RA) products, advice and referral from community pharmacies, and to establish if referrals of customers with dyspepsia made by pharmacy staff were in line with published referral guidelines.

Setting

Customers supplied with over-the-counter alginates or H2RAs by 39 community pharmacies in Scotland and Wales in a six-month period.

Method

A structured questionnaire was issued to customers provided with an alginate or H2RA from community pharmacies, with one reminder sent to non-responders.

Key findings

A total of 608 completed questionnaires were returned (79 per cent response): 523 customers (86 per cent) stated they requested the product they were supplied with by name, with previous use being the most frequently cited reason. Customers who requested a product by name were less likely to receive advice about the supplied medicine, less likely to be referred to a medical practitioner (GP) and also less likely to receive lifestyle advice than customers who did not request a named product. Overall, only 30 per cent of patients who met criteria for referral to a GP were referred.

Conclusion

The findings of this study suggest that more emphasis should be placed on referrals by pharmacy staff and on the provision of lifestyle and product-specific advice, particularly when products are requested by name. The acceptability of these actions to pharmacy customers is not known.

Usage patterns of over-the-counter phenazopyridine (pyridium)

OBJECTIVES

Little is known about how the public uses formerly prescription medications that are available over-the-counter (OTC). This study examines whether consumers inappropriately use and substitute a recently widely distributed OTC urinary analgesic, phenazopyridine, for provider care.

DESIGN/SETTING

We conducted a cross-sectional survey of a stratified cluster random sample of OTC phenazopyridine purchasers (N = 434) in 31 Los Angeles retail pharmacies over 5 months. Recruited by shelf advertisements, participants were 18 years or older who purchased a phenazopyridine product. Each completed a 25-item self-administered anonymous questionnaire. Inappropriate use was defined as 1) having medical contraindications to phenazopyridine, or 2) not having concurrent antibiotic and/or provider evaluation for the urinary symptoms.

RESULTS

The survey response rate was 58%. Fifty-one percent of the respondents used OTC phenazopyridine inappropriately, and 38% substituted it for medical care. Multiple logistic regression analyses revealed that inappropriate use was correlated with having little time to see a provider (odds ratio [OR], 1.57; 95% confidence interval [95% CI], 1.26 to 1.96), receiving friend's or family's advice (OR, 1.25; 95% CI, 1.05 to 1.47), having prior urinary tract infections (OR, 0.49; 95% CI, 0.30 to 0.80), having used prescription phenazopyridine, (OR, 0.40; 95% CI, 0.25 to 0.63), and having back pain (OR, 0.34; 95% CI, 0.16 to 0.74). Similar correlates were found in those who substituted OTC phenazopyridine for provider care. Respondents with incorrect knowledge about phenazopyridine's mode of action had 1.9 times greater odds of inappropriate use and 2.2 times greater odds of substitution than those who had correct knowledge about this drug.

CONCLUSION

Inappropriate use of OTC phenazopyridine appears common. Increasing the public's knowledge about reclassified drugs may help to mitigate this problem.

Benefits and risks of self medication

Self medication is becoming an increasingly important area within healthcare. It moves patients towards greater independence in making decisions about management of minor illnesses, thereby promoting empowerment. Self medication also has advantages for healthcare systems as it facilitates better use of clinical skills, increases access to medication and may contribute to reducing prescribed drug costs associated with publicly funded health programmes. However, self medication is associated with risks such as misdiagnosis, use of excessive drug dosage, prolonged duration of use, drug interactions and polypharmacy. The latter may be particularly problematic in the elderly. Monitoring systems, a partnership between patients, physicians and pharmacists and the provision of education and information to all concerned on safe self medication, are proposed strategies for maximising benefit and minimising risk.