Self-prescription practices by Nigerian medical doctors

Are doctors using more preventive medication for cardiovascular disease? A Swedish cross-sectional study

BACKGROUND

Despite decreasing mortality from cardiovascular disease (CVD), there are persistent inequities in mortality between socioeconomic groups. Primary preventative medications reduce mortality in CVD; thus, inequitable treatments will contribute to unequal outcomes. Physicians might contribute to inequality by prescribing preventative medication for CVD to themselves in a biased manner.

AIM

To determine whether primary medications for preventing CVD were prescribed inequitably between physicians and non-physicians.

DESIGN AND SETTING

This retrospective study retrieved registry data on prescribed medications for all physicians in Sweden aged 45-74 years, during 2013, and for reference non-physician individuals, matched by sex, age, residence, and level of education. The outcome was any medication for preventing CVD, received at least once during 2013.

METHOD

Age and the sex-specific prevalence of myocardial infarction (MI) among physicians and non-physicians were used as a proxy for the need for medication. Thereafter, to limit the analysis to preventative medication, we excluded individuals that were diagnosed with CVD or diabetes. To analyse differences in medication usage between physicians and matched non-physicians, we estimated odds ratios (ORs) with conditional logistic regression and adjusted for need and household income.

RESULTS

MI prevalences were 5.7% for men and 2.3% for women, among physicians, and 5.4% for men and 1.8% for women, among non-physicians. We included 25,105 physicians and 44,366 non-physicians. The OR for physicians receiving any CVD preventative medication, compared to non-physicians, was 1.65 (95% confidence interval 1.59-1.72).

CONCLUSION

We found an inequity in prescribed preventative CVD medications, which favoured physicians over non-physicians.

Retrospective study of COVID-19 outcomes among healthcare workers in Rivers State, Nigeria

OBJECTIVE

To determine the illness severity and mortality among COVID-19-infected healthcare workers (HCWs).

DESIGN

A retrospective cohort study using population-level data. Secondary analysis was conducted on collated data from the Public Health Emergency Operations Centre (PHEOC) at the State Ministry of Health, Rivers State, Nigeria. Data were gathered from the COVID-19 patient database of the PHEOC on demographics, place of work, illness severity and outcome.

PARTICIPANTS

The cohort included all documented HCWs with confirmed COVID-19 infection (diagnosed by PCR).

PRIMARY AND SECONDARY OUTCOME MEASURES

Illness severity defined as 'hospitalisation required' and treatment outcome labelled as 'alive' or 'dead' were the outcomes of interest.

RESULTS

The mean age was 43 years and 50.5% of the cohort were female. Of the 301 HCWs infected, 187 patients were symptomatic with 32 requiring hospitalisation. Seven infected HCWs died of their COVID-19 infection, resulting in a case fatality ratio (CFR) of 2.3%. Population proportions for age groups, case presentation and mortality, would be significantly greater than those seen in the study population. Health professionals made up 79.7% (240) of the study cohort, with 68.8% (165) of them working at the teaching hospitals; the association between HCWs and health facilities they worked in, was significant. Symptomatic cases were more inclined to progress to severe illness ([Formula: see text] adjusted OR (aOR) 10.658, 95% CI 2.494 to 45.552); patients also had greater odds of dying from COVID-19 ([Formula: see text] aOR 1.079, 95% CI 1.02 to 1.141) per year increase in age adjusted for sex, case class and illness severity.

CONCLUSIONS

Frontl-ine HCWs are at an increased risk of exposure to COVID-19 infections. In Nigeria, there is a higher risk of experiencing severe illness if symptomatic while infected with COVID-19. Preventive strategies, proper education and awareness must be put in place to protect HCWs.

OBJECTIVE

To determine the illness severity and mortality among COVID-19-infected HCWs.

Self-medication among health care workers in a tertiary hospital in Southern Nigeria: knowledge, attitude, and practices

BACKGROUND Self-medication is linked to the inappropriate and irrational use of medicines. This study aimed to determine the knowledge, attitude, and practice of self-medication among health care workers (HCWs) in a tertiary hospital in Southern Nigeria. METHODS In a cross-sectional study carried out between June 2018 and December 2018 at Irrua Specialist Teaching Hospital, Edo State, 206 consenting HCWs were interviewed using validated questionnaires on their knowledge (assessed as good, fair, and poor), attitude (positive and negative), and practice of self-medication. Data analysis was performed using SPSS version 21 (IBM Corp., USA). Bivariate analysis was carried out using chi-square. Statistical significance was set as p<0.05. RESULTS Prevalence of self-medication in the last 4 months was 89.3%, and significantly decreased with increasing age (p = 0.04) and holding a positive attitude toward self-medication (p<0.01). Knowledge of self-medication was fair for the majority 111 (53.9%). Most of the medications were used for headache (92.4%), fever (81.5%), diarrhea (75.0%), and respiratory infections (61.4%). Common drugs self-medicated included antimalarials (91.3%), analgesics (81.0%), and antibiotics (71.2%). 39 subjects (21.2%) self-medicated with tranquilizers. Familiarity with the treatment options was the main reason for self-medication for 60.9% of the respondents. CONCLUSIONS Self-medication was prevalent among HCWs in the study area. Concerted efforts are needed to educate HCWs on responsible self-medication. On a broader scale, restrictions should be enforced on the sale of prescription drugs, such as antibiotics and sleeping pills, and drug dispensers should provide effective counseling before dispensing.

Doctors' experience of becoming patients and its influence on their medical practice: A literature review

PURPOSE

Doctors' illness experiences can deeply influence not only their perceptions of illness and roles but also their medical practice. Researchers and doctors have sought to understand what happens when doctors become patients. However, currently, literature reviews focused exclusively on their illness experiences are lacking. This review examines academic literature and combines it with illness narratives (i.e., pathographies) written by doctors to elucidate the unknown about doctors' experiences and its subsequent influence on medical practice.

METHODS

An electronic search of the databases Academic Search Complete, Google Scholar, PubMed, ProQuest, and Ichushi-Web was conducted using relevant keywords. The literature reviewed included studies that described doctors' illness experiences or doctors' perspectives on their experiences of being patients.

RESULTS

Previous studies showed that doctors' disease prognoses are generally better than or similar to those of patients belonging to the general population. However, doctors' documented illness experiences are multi-dimensional and have several common themes. These include the concept of the 'medical self' (behaving as a doctor despite being a patient) and 'role reversal' (the doctor adjusting to the patient role). The other elements of their experiences include barriers to health care, self-treatment and self-doctoring, presenteeism, and 'wounded healers' (those who can heal others using the wisdom from their illness experiences). Most previous literature has omitted the sociocultural and historical dispositions of doctors and their biomedical perspectives of their own afflictions, even though these strongly impact their illness experiences.

CONCLUSION

Further research that re-contextualises the meaning of illness for doctors is necessary.

Prevalence, sources and purpose of self-prescribed non-opioid analgesic among health professionals in Sokoto metropolis, Nigeria: a cause for concern

Background. Self-medication is defined as the use of medicines without a doctor’s prescription. The non-opioid analgesics (NOAs) constitute one of the most commonly self-prescribed drugs globally. This study aims to determine the prevalence of NOAs self-medication, and also explore the purpose and sources of the self-prescribed NOAs among health professionals in Sokoto metropolis, Nigeria.

Methods. Data obtained from a cross-section of 205 health professionals in Sokoto metropolis, Nigeria, were used for this study. The study tool used was a well-structured questionnaire. Data analysis was done using the SPSS version 20 software.

Results. Only 36.6% of the 205 subjects were within the age range of 26 to 30 years, 38.0% were nurses. The majority (85.9%) of the subjects had self-prescribed NOAs, of which 6.8% of them had a positive history treatment for NOA overdose. Patent medicine stores (43.0%) were reported to be the most common source of acquisition of self-prescribed NOAs. The majority (63.9%) of the subjects used NOAs to get relieved from headaches. Paracetamol (79.0%) and Diclofenac (65.9%) were the top two self-prescribed NOAs among the subjects.

Conclusion. Non-opioid analgesic self-prescription is a popular practice among health professionals in Sokoto metropolis, Nigeria. All the various routes of access (e.g. hospital pharmacy) to NOAs need to be revisited in order to curb the irrational use of NOAs in Nigerian society.