Patients, society, and the increase in self medication

Impact of pension income on healthcare utilization of older adults in rural China

OBJECTIVE

In China, rural residents experience poorer health conditions and a higher disease burden compared to urban residents but have lower healthcare services utilization. Rather than an insurance focus on enhanced healthcare services utilization, we aim to examine that whether an income shock, in the form of China's New Rural Pension Scheme (NRPS), will affect outpatient, inpatient and discretionary over-the-counter drug utilization by over 60-year-old rural NRPS residents.

METHODS

Providing a monthly pension of around RMB88 (USD12.97), NRPS covered all rural residents over 60 years old. Fuzzy regression discontinuity design (FRDD) was employed to explore the NRPS causal effect on healthcare services utilization, measured by outpatient and inpatient visits and discretionary over-the-counter drug purchases. The nationwide China Health and Retirement Longitudinal Study (CHARLS) 2018 provided the data.

RESULTS

Without significant changes in health status and medication needs, 60-plus-year-old NRPS recipients significantly increased the probability of discretionary OTC drug purchases by 33 percentage points. NRPS had no significant effect on the utilization of outpatient and inpatient utilization. The increase in the probability of discretionary OTC drug purchases from the NRPS income shock was concentrated in healthier and low-income rural residents. Robustness tests confirmed that FRDD was a robust estimation method and our results are robust.

CONCLUSION

NRPS was an exogenous income shock that significantly increased the probability of discretionary over-the-counter drug purchases among over 60-year-old rural residents, but not the utilization of inpatient or outpatient healthcare services. Income remains an important constraint for rural residents to improve their health. We recommend policymakers consider including commonly used over-the-counter drugs in basic health insurance reimbursements for rural residents; provide health advice for rural residents to make discretionary over-the-counter drug purchases; and to mount an information campaign on over-the-counter drug purchasing in order to increase the health awareness of rural residents.

Barriers and facilitators for providing self-care advice in community pharmacies: a qualitative study

BACKGROUND

Community pharmacies are easily accessible for self-care advice. Guidelines for providing self-care advice were introduced in several countries, including the Netherlands in the 1990s. Previous studies have indicated room for improvement in self-care advice in daily pharmacy practice.

AIM

To identify barriers and facilitators for providing self-care advice.

METHOD

Semi-structured interviews were conducted face-to-face or online with pharmacists and pharmacy assistants using a topic guide based on the Theoretical Domains Framework. The interviews were audio-recorded and transcribed verbatim. The transcripts were deductively analysed to identify barriers and facilitators for self-care counselling. COREQ guidelines were followed.

RESULTS

In total, 13 pharmacists and 12 pharmacy assistants were interviewed to reach data saturation. In general, most themes addressed by pharmacists and pharmacy assistants belonged to similar domains. The following domains were frequently mentioned: environmental context and resources (e.g. priority for prescription drugs, privacy, collaboration with general practitioners, access to patients' records), intentions (providing reliable advice), skills (communication, decision-making), knowledge (ready guideline knowledge), beliefs about consequences (patient safety), social influences (patient awareness of pharmacist role), reinforcement (lack of reimbursement for relatively time-consuming advice).

CONCLUSION

This study identifies barriers and facilitators for evidence-based self-care advice. Pharmacists should first support pharmacy assistants by helping them keep their knowledge and skills up to date and creating suitable pharmacy preconditions to facilitate improvements in self-care counselling. Second, collaboration with general practitioners regarding minor ailments should be improved.

Coconut oil based self-nano emulsifying delivery systems mitigate ulcerogenic NSAIDs side effect and enhance drug dissolution: Formula optimization, in-vitro, and in-vivo assessments

Gastric ulcer is a common gastrointestinal ailment that affects many people worldwide. NSAIDs induced ulcers are the second most common etiology of gastric ulcers. Coconut oil has well-known potential anti-ulcerogenic characteristics. This work aimed to develop and optimize diclofenac potassium (a highly used model drug of NSAIDs) as self-nanoemulsifying delivery system containing coconut oil (DFP-COSNEDS) to overcome its ulcerogenic effect. A mixture design was applied for formula optimization and investigation of the effect of different formulation factors on the droplet size (DS) and polydispersity index (PDI) of the prepared DFP-COSNEDS. The optimized formulae showed good self-emulsification characters and better drug dissolution compared with the drug suspension. The ulcer protection was assessed in-vivo using 7 groups of adult male Wistar rats. Oxidative stress parameters (MDA, GSH, and SOD), inflammatory mediators (PGE-2, TNF-α, and IL-6) and peroxisome proliferator-activated receptor-γ (PPAR-γ) gene expression were measured. The results revealed that pure coconut oil and DFP-COSNEDS containing 25 % of coconut oil showed close figures to normal group and better values than famotidine (FAM) group. In conclusion, coconut oil showed high potential for gastric-protection activity against DFP induced ulcer. DFP-COSNEDS offers dual benefits of improving DFP dissolution and alleviating its ulcerogenic effect.

Self-Medication With Antibiotics: An Element Increasing Resistance

Self-medication refers to the consumption of drugs such as antibiotics by individuals based on their own experience and knowledge, without consulting a doctor either for diagnosis or prescription. The inappropriate use of antibiotics is the primary source of antibiotic resistance (AR) development in microorganisms. As a result, some specific types of microorganisms that are naturally resistant to antibiotics have become considerably more common. Self-medication poses a danger to the advantages of antibiotics since it results in financial burdens on low and middle-income countries (LMICs), management failures, the evolution of antibiotic-resistant bacterial serotypes, and a higher risk of contamination of the general population by such tensions. Antibiotic misuse puts patients at risk for adverse drug reactions, false symptom relief, and the rise of drug-resistant microorganisms. It carries many health risks, chiefly in LMICs. These risks are linked to various factors, including a shortage of medical experts, low-level healthcare facilities, unregulated medication delivery, and negative public perceptions of doctors. The primary issue with self-medication is that majority of the population is uninformed of the harmful consequences of antibiotic resistance and how they might donate to it by self-diagnosing and self-treating with antibiotics. Antibiotic self-medication remains a common practice in society, and educational attainment significantly affects the frequency of this behavior. The article aims to educate the people by showing the development and plausible future to decrease antibiotic misuse. It also tells about the various challenges and prevention of this preceding problem.

University Students' Self-Medication Practices and Pharmacists' Role: A Cross-Sectional Survey in Hail, Saudi Arabia

Background: Self-medication is an important issue for health authorities around the world. It is also a common practice among university students.

Objective: This study aimed to assess the prevalence of and reasons for self-medication among university students.

Methods: A descriptive, cross-sectional community based survey design was adopted for the current study. All the students enrolled in Hail University, Saudi Arabia were selected to include in the study. Data was collected from February to April 2020 using a validated questionnaire and were analyzed using IBM SPSS Statistics, Version 22.0. Using convenient sampling technique, the total sample size calculated was 370 participants. A descriptive analysis was performed. Chi-square test and binary logistic regression was used for analyzing the data where statistical significance was set at p ≤ 0.05.

Results: A total of 373 participants completed the questionnaire. The response rate was 84%. The overall prevalence of self-medication among the students was 98.2%. Of the 373 participants, 40.8% were men, and 59.2% were women. Furthermore, 56% were in fields other than health sciences, 23.1% were in preparatory foundation courses, and 20.9% were from the health and medical sciences. The most frequent medical condition that led to self-medication was headaches (92.85%), followed by coughs (37.5%), colic (31.9%) and influenza (30.3%). On univariate analysis, it is revealed that for both abdominal colic [OR 0.54 (0.34–0.86), p = 0.01] and constipation [OR 0.57 (0.32–1.02), p 0.05], female gender was observed significantly with low prevalence than male. However, for influenza, the self-medication prevalence [OR 1.86 (1.19–2.91), p = 0.006] observed was significantly higher in female participants than male. A significant association (p = 0.011) between the self-medication factors and gender was shown in the current study results.

Conclusion: An alarming prevalence of self-medication among the students was recorded. Health care providers can increase awareness of the issue by educating individuals about the harmful effects of irresponsible self-medication.

Patients Are Knowledge Workers in the Clinical Information Space

BACKGROUND

Limited research exists on patient knowledge/cognition or "getting inside patients' heads." Because patients possess unique and privileged knowledge, clinicians need this information to make patient-centered and coordinated treatment planning decisions. To achieve patient-centered care, we characterize patient knowledge and contributions to the clinical information space.

METHODS AND OBJECTIVES

In a theoretical overview, we explore the relevance of patient knowledge to care provision, apply historical perspectives of knowledge acquisition to patient knowledge, propose a representation of patient knowledge types across the continuum of care, and include illustrative vignettes about Mr. Jones. We highlight how the field of human factors (a core competency of health informatics) provides a perspective and methods for eliciting and characterizing patient knowledge.

CONCLUSION

Patients play a vital role in the clinical information space by possessing and sharing unique knowledge relevant to the clinical picture. Without a patient's contributions, the clinical picture of the patient is incomplete. A human factors perspective informs patient-centered care and health information technology solutions to support clinical information sharing.

Treatment, Persistent Symptoms, and Depression in People Infected with COVID-19 in Bangladesh

Background: Coronavirus disease (COVID-19) has affected people's lives globally. While important research has been conducted, much remains to be known. In Bangladesh, initial treatment (self-administered, hospitalized), persistent COVID-19 symptoms ("long COVID-19"), and whether COVID-19 leads to changes in mental state, such as depressive symptoms, of people are not known. This study aimed to examine treatment, persistent symptoms, and depression in people who had been infected with COVID-19 in Bangladesh. Methods: A cross-sectional survey was conducted on 1002 individuals infected with COVID-19 (60% male; mean age = 34.7 ± 13.9; age range = 18-81 years), with data taken over a one-month period (11 September 2020 to 13 October 2020). A self-reported online questionnaire was used to collect data on socio-demographics, lifestyle, COVID-19 symptoms (during and beyond COVID-19), medication (over-the-counter or doctor-prescribed), and depression (assessed using the Patient Health Questionnaire (PHQ-9)). Results: Twenty-four percent of participants self-medicated with over-the-counter medicine when they were first diagnosed with COVID-19. Self-medication was higher among female vs. male respondents (29.6% vs. 20.2%, respectively, p = 0.002). A minority (20%) reported that they experienced persistent COVID-like symptoms after recovering from COVID-19. The most reported persistent symptoms were diarrhea (12.7%) and fatigue (11.5%). Forty-eight percent of participants were categorized as having moderate to severe depression. Based on multivariate regression analysis, depression during COVID-19 was positively associated with lower family income, poor health status, sleep disturbance, lack of physical activity, hypertension, asthma/respiratory problems, fear of COVID-19 re-infection, and persistent COVID-19 symptoms. Conclusions: The findings suggest a need for appropriate interventions for COVID-19 patients to promote physical and mental wellbeing.

Public's perspectives on guideline-recommended self-medication consultations in German community pharmacies

The aim of this study was to assess the public's opinions and expectations of self-medication consultations in German community pharmacies with special emphasis on the acceptance of guideline-recommended consultation. In a cross-sectional study in the city centre of Leipzig, Germany, we conducted a questionnaire-based survey administered via an interview with passers-by from June to September 2018. The structured questionnaire contained questions assessing (I) previous experience with self-medication consultations, (II) possible reasons for declining self-medication consultations, (III) the attitude towards information gathering and (IV) expectations of self-medication consultations. (I) 92% of the 963 respondents stated they were generally satisfied with self-medication consultations in community pharmacies. Around one-fifth of all respondents claimed that they would like to be asked more health-related questions (22%) and receive more information on non-prescription drugs (20%). (II) Privacy issues (39%) and reluctance to talk about some medical conditions (43%) were the most frequent reasons for declining self-medication consultation. (III) Respondents understood the need for answering guideline-recommended questions (85-96%) and did not mind being asked these questions (70-96%). (IV) Most of the respondents expected to be counselled even if they did not ask for it directly (69%). Pharmacies were further expected to recommend the best drug, even if it was not what the customer initially intended to buy (87%). However, more than half of the respondents would consider counselling as unimportant if they knew exactly which medication they wanted to buy (56%) or if they had used the non-prescription drug before (70%). The majority also expected to receive guideline-recommended drug information (each item at least 52%). Thus, our study shows that respondents were mostly in line with the required standards of self-medication counselling guidelines. Customers expect high-quality counselling on self-medication. These findings support pharmaceutical staff's understanding of customers' barriers and expectations during self-medication consultations.

Prescription, over-the-counter (OTC), herbal, and other treatments and preventive uses for COVID-19

The current COVID-19 pandemic has spread rapidly worldwide and has challenged fragile health care systems, vulnerable socioeconomic conditions, and population risk factors, and has led to an overwhelming tendency to misuse prescription drugs and self-medication with prescription drugs, over-the-counter (OTC) drugs, herbals products, and unproven chemicals as a desperate preventive or curative measure for COVID-19. In this chapter, we present the legislative differences between prescription drugs, OTC drugs, and herbals. Various approved and nonapproved prescription and OTC drugs as symptomatic treatment for COVID-19 are listed and evaluated based on their reported efficacy, safety, and toxicological profile. We also present the various herbal products that are currently studied and used as treatment and preventive for COVID-19. The efficacy, toxicology profile, safety, and legal issues of some speculative preventive and treatment options against COVID-19, such as Miracle Mineral Solution (MMS), chlorine dioxide solution (CDS), colloidal silver, and hydrogen peroxide is presented. The chapter also emphasizes the specific strategies that need to be implemented to guide the population in the effective and safe use of prescribed medications, such as the Medication Therapy Management or Pharmaceutical Care process. Finally, this chapter aims to provide a deeper insight into the lack of health literacy in the population and the effect that drug utilization research (DUR) has in the decision making of health authorities and general public. We aim to provide the current information about the various treatment and preventive options used for COVID-19.

Over-the-counter medicines, economic conditions, and citizens most in need in Greece: Is it a challenge for primary care research?

INTRODUCTION

Recent austerity experiences in Greece suggest a plausible link between extensive use of over-the-counter (OTC) medicines and socio-economic peculiarities of life.

COMMENTARY

During the economic crisis in Greece, accessibility to healthcare services has been impacted, particularly for people with low income. However, this fact has not been systematically analyzed in conjunction with an observed increase in use of OTC medicines. Gaining a better understanding of the reasons leading to self-care may help to answer additional questions. Further research is needed to assess the gap between self-care and medically assisted care/treatment by designing pilot monitoring actions and focusing on behaviours related to OTC medicine use. Primary care can offer more collaboration between primary care physicians, community pharmacists, patients, and their families.

IMPLICATIONS

It is crucial to create a multimodal research plan to gain a better understanding of motivational reasons that eventually lead to increasing use of OTC medicines. Efforts should be made to develop data collection techniques that will elicit information from various social groups that focus on changeable behaviours and perceived needs in relation to medicine consumption.

Contemporary Role and Regulation of Over-the-Counter Sinonasal Medications

OBJECTIVE

Numerous pharmaceutical options are available over-the-counter (OTC) for the relief of sinonasal symptoms. Patients typically utilize these drugs in an unsupervised manner, without appreciation of their relative efficacy or potential for adverse effects. This review covers the scope and regulation of the OTC drug market, the pros and cons of OTC availability, and specific concerns that surround the most common classes of OTC sinonasal drugs. Suggestions are provided for the improvement of patient care and public health.

DATA SOURCES

MEDLINE publications and market reports.

REVIEW METHODS

Literature review.

CONCLUSIONS

Some of the most commonly used OTC sinonasal remedies, including decongestants and first-generation antihistamines, are less effective than alternative drugs and pose potential safety concerns.

IMPLICATIONS FOR PRACTICE

Clinicians should advocate to their patients for the appropriate use of alternative agents, such as intranasal corticosteroids and newer-generation antihistamines, and discourage the unsupervised use of oral and topical decongestants. Furthermore, health care practitioners should encourage dialogue with their patients about the use of OTC sinonasal remedies, with the goals of optimizing individual health and health care delivery.

Prevalence, expenditures, and associated factors of purchasing non-prescribed Chinese herbal medicine in Taiwan

BACKGROUND AND AIMS

Purchasing Chinese herbal medicine (CHM) without a physician's prescription may have adverse effects on health. However, the recent status of purchasing non-prescribed CHM and the associated factors are not completely understood. We aimed to report the prevalence of purchasing CHM and associated factors.

METHODS

Using data from the 2017 Taiwan Survey of Family Income and Expenditure, we identified 16,528 individuals (householders) aged 18 years and older. Sociodemographic factors, expenditures on medical services and health behaviours were compared between people with and without a history of purchasing non-prescribed CHM by calculating adjusted odds ratios (ORs) and 95% confidence intervals (CIs) in a multiple logistic regression analysis.

RESULTS

The one-year prevalence of purchasing non-prescribed CHM was 74.8% in Taiwan. In addition to sociodemographics, marital status (OR 2.14, 95% CI 1.88-2.44), the use of traditional Chinese medicine (OR 3.62, 95% CI 3.30-3.97), the purchasing of non-prescribed biochemical medications (OR 3.09, 95% CI 2.75-3.48), the purchasing of health foods (OR 2.59, 95% CI 2.33-2.86), the use of folk therapy (OR 2.27, 95% CI 1.95-2.64), and a high level of expenditure on alcohol (OR 3.79, 95% CI 3.29-4.36) were strongly correlated with purchasing non-prescribed CHM.

CONCLUSION

The one-year prevalence of purchasing non-prescribed CHM is very high in Taiwan and is correlated with sociodemographics, health behaviours, and the utilization of medical care. The interaction of non-prescribed CHM with physician-prescribed herbal medicine and biomedical medications requires more attention.

What is the attitude towards and the current practice of information exchange during self-medication counselling in German community pharmacies? An assessment through self-report and non-participant observation

Background

Guidelines encourage relevant information exchange between pharmaceutical staff and patients during self-medication consultation. Thereby, assessing the patient’s situation and providing information is crucial for patient safety. So far, limited studies have investigated this information exchange, particularly in Germany. We aimed to assess the attitude towards and the current practice of guideline-recommended information exchange in German community pharmacies.

Methods

In total, twelve guideline-recommended parameters were predefined for gathering patient-related information and for the provision of information. These information exchange parameters were evaluated in two parts: Firstly, in a self-report of pharmaceutical staff via an online questionnaire to assess the reported importance, difficulty and frequency of the parameters as well as barriers to their implementation; secondly, in a non-participant observation in five pharmacies to evaluate the actual consultation practice.

Results

In the self-report, all parameters were rated by more than 76% of 1068 participants as important. ‘Concurrent medication’ was determined to be the most difficult parameter to address (54%). All parameters of information gathering were rated to be addressed during routine counselling by at least 70% of the respondents. Parameters of information provision were all rated to be addressed by at least 45%. ‘Lack of patient’s interest’ was identified as the most frequent barrier to appropriate counselling (84%). During the observation, the information gathering parameters were each addressed between 8 to 63% in the consultations, parameters of information provision between 3 to 34%.

Conclusion

Despite broad acceptance, the guideline parameters of information exchange were comparatively little addressed during the actual routine care. This might be due to a perceived ‘lack of patient’s interest’ in counselling. Our results suggest to scrutinize whether patients are in fact not interested in counselling and to further explore how the positive intention of pharmaceutical staff towards information exchange can be further translated into everyday practice.

Self-medication among pregnant women in two municipalities in the Central Region of Ghana

Self-medication in pregnancy is a concern in Ghana. We assessed the practice among 136 pregnant women in Effutu and Agona West Municipalities using facility-based, cross-sectional design and mixed method approach of data collection. Our findings show that pregnant women of varying backgrounds self-medicate for sociocultural and economic reasons, with 69% prevalence, motivated by cheaper treatment cost (17%), minor ailments (29%) and positive outcomes (33%). Commonly used medications include antibiotics (23%), pain killers (20%) and herbal preparations (19%). We recommend further studies on pharmacological compositions of the medications used and effects on pregnancy outcomes to inform policy and programs decisions.

Direct-To-Consumer Advertising of Over-the-Counter Sinonasal Remedies: A History of Mixed Messages

Sinus, cold, and allergy remedies comprise the most widely used sector of the over-the-counter (OTC) drug market. Direct-to-consumer advertising (DTCA) of pharmaceutical products has increased over the past 30 years, including the promotion of OTC drugs. The influence of DTCA on OTC sinonasal remedies comprises several positive and negative effects. Favorable aspects of this influence include empowerment and promotion of autonomy among patients, avoidance of low-value clinical encounters, self-directed education, and decreased healthcare expenditures. This is balanced by potential concerns, including the lack of rigorous regulation of OTC drugs, the burden of self-diagnosis, the risk of unsupervised use resulting in adverse effects or drug interactions, and redistribution of pharmacy costs to the consumer. Despite the proliferation of product options and consumer-directed information, healthcare utilization and cost of treating sinonasal disease remains high. Moreover, the availability of OTC sinonasal remedies and exposure to DTCA has had mixed effects without apparent overall benefit to patient and consumer health. Laryngoscope, 130:2114-2119, 2020.

Evidence of Self-Medication with Chloroquine before Consultation for Malaria in the Southern Pacific Coast Region of Colombia

Self-medication with antimalarial drugs is a major factor in the development of drug resistance, exerting subtherapeutic drug pressure on circulating parasite populations. Data on self-medication with antimalarials from the Southern Pacific coast region of Colombia, where 4-aminoquinolines resistance and political instability prevail, are vital to elimination strategies. We present results of an exploratory study of 254 individuals having malaria symptoms who sought malaria diagnosis in two hospitals in Tumaco, Department of Nariño, Colombia. Thirty-two percent (82/254) of participants had positive Saker-Solomons urine tests, indicating self-medication with chloroquine (CQ) before consultation for diagnosis. Notably, among 30 pregnant women participating in the study, 43% were Saker--Solomons positive. Molecular analysis of the K76T position encoded by the pfcrt gene revealed the mutant allele in all four samples that were both positive for Plasmodium falciparum and positive for the Saker-Solomons test, suggesting persistent CQ pressure. The high frequency of self-medication, particularly among pregnant women merits attention by public health authorities and comprehensive investigation.

Antibiotic drug-resistance as a complex system driven by socio-economic growth and antibiotic misuse

Overwhelming antibiotic use poses a serious challenge today to the public-health policymakers worldwide. Many empirical studies pointed out this ever-increasing antibiotic consumption as primary driver of the community-acquired antibiotic drug-resistance, especially in the middle- and lower-income countries. The association is well documented across spatio-temporal gradients in many parts of the world, but there is rarely any study that emphasizes the mechanism of the association, which is important for combating drug-resistance. Formulating a mathematical model of emergence and transmission of drug-resistance, we in this paper, present how amalgamating three components: socio-economic growth, population ecology of infectious disease, and antibiotic misuse can instinctively incite proliferation of resistance in the society. We show that combined impact of economy, infections, and self-medication yield synergistic interactions through feedbacks on each other, presenting the emergence of drug-resistance as a self-reinforcing cycle in the population. Analysis of our model not only determines the threshold of antibiotic use beyond which the emergence of resistance may occur, but also characterizes how fast it develops depending on economic growth, and lack of education and awareness of the population. Our model illustrates that proper and timely government aid in population health can break the self-reinforcing process and reduce the burden of drug-resistance in the community.

Pharmacist Compliance With Therapeutic Guidelines on Diagnosis and Treatment Provision

IMPORTANCE

Misuse and overselling of over-the-counter pharmaceuticals poses a major burden on both private and public health expenditures.

OBJECTIVE

To seek evidence on whether over-the-counter medication dispensing behavior complies or conflicts with the protocols indicated in practice standards and guidelines of a national professional pharmacy organization.

DESIGN, SETTING, AND PARTICIPANTS

This quality improvement study was undertaken in 205 pharmacies in the wider Brisbane, Australia, area. Two standardized patient (SP) scenarios were developed to evaluate noncompliant behavior. Data collection for scenario 1 was conducted between November 23 and December 9, 2016. Data collection for scenario 2 was conducted between September 1 and 28, 2017. A 2-sample test of proportions and a probit regression model were used to evaluate the likelihood of noncompliant treatments and overtreatments in each case scenario. Statistical analysis was performed from January 30 to June 21, 2018, and revised in May 2019.

MAIN OUTCOMES AND MEASURES

Outcomes were the observed likelihood of noncompliant treatments and overtreatments. Noncompliance is defined as treatments not complying with practice standards and guidelines set by the professional pharmacy society. Noncompliant treatments include undertreatment (patient did not receive necessary treatment) and overtreatments (patient was supplied with more than sufficient treatments) in both scenarios.

RESULTS

In scenario 1, 9 trained female SPs visited 89 pharmacies to request emergency hormonal contraception from pharmacy staff. In 45 cases, SPs reported having unprotected intercourse within the last 24 hours (case 1A), and in 44 cases, SPs reported having unprotected intercourse more than 72 hours ago (case 1B), which is past the efficacy threshold of over-the-counter emergency hormonal contraception. In scenario 2, 11 SPs (5 male and 6 female) visited 150 pharmacies (154 visits in total) to request treatment for family members or a partner with symptoms indicating bacterial conjunctivitis (case 2A; n = 73) or viral conjunctivitis (case 2B; n = 81). In scenario 1-dispensing emergency hormonal contraception when physician referral is recommended-21 of 44 pharmacists (47.7%) in case 1B violated the recommendation by selling the over-the-counter medication. With the inclusion of both no physician referral and emergency hormonal contraception sold, this rate increased to 79.5% (35 of 44 pharmacists). In scenario 2-1 case each of bacterial and viral conjunctivitis-overtreatment occurred in 55 of 154 cases (35.7%). In both scenarios, 140 of 243 pharmacies (57.6%) followed dispensing behavior compliant with the protocol, while 76 of 243 pharmacies (31.3%) involved some form of overtreatment or overselling of medication. Some evidence of an association between sex of SP and pharmacist was also found.

CONCLUSIONS AND RELEVANCE

Although the market for dispensing over-the-counter medication in Australia is regulated, relatively high rates of overtreatment and some cases of undertreatment were observed in this study. Given the unintended adverse effects, including overuse of antibiotics and corticosteroids, these observations suggest the advisability of regulatory intervention ensuring compliance with professional protocols.

A Theory Based Intervention to Enhance Information Exchange during Over-The-Counter Consultations in Community Pharmacy: A Feasibility Study

Background: Management of minor ailments through self-care and self-medication brings both benefits and risks that can be mitigated if consumers and pharmacy personnel engage in information exchange during over-the-counter (OTC) consultations. Objective: Explore the feasibility of interventions using situational cues to promote information exchange between pharmacy personnel and consumers, during OTC consultations. Methods: Intervention tools were developed prior to conducting the study, in two community pharmacies in Perth, Western Australia. The situational cues included two posters and individual position badges. Data were collected from audio-recording OTC consultations, consumer questionnaires and interviews, and pharmacy personnel interviews. Results: Space required for posters and for researchers conducting interviews was challenging in the retail environment. Pharmacy personnel perceived that the badges positively impacted -consumers’ ability to identify the position of personnel they engaged with. Data collection methods were deemed practical and acceptable. Conclusions: The proposed interventions and evaluation methods were feasible. The use of posters and badges as situational cues to address the barriers to information exchange during OTC consultations was found to be practical, in a community pharmacy setting. There is potential to use situational cues to address other barriers identified to information exchange, to add to the effectiveness of the intervention. With growing emphasis on self-care and self-medication, effective interventions are necessary to promote information exchange to enhance appropriate management in community pharmacies.

Australian pharmacy perspectives on increasing access to medicines through reclassification

OBJECTIVES

Availability of medicines without prescription can increase consumers' timely access to treatment and promote self-management of minor ailments and adherence to long-term medications. Globally, access to relevant medicines has improved through increased reclassification of medicines from prescription to non-prescription availability. However, Australian reclassification lags behind countries with comparable health systems, and the factors influencing this are poorly understood.

METHODS

Semi-structured interviews were conducted during May 2015 to explore the perspectives of Australian pharmacists and support staff on future reclassification. Interview responses were transcribed verbatim, and the data were analysed thematically, primarily informed by the general inductive approach.

RESULTS

Participants identified a broad range of medicines as candidates for future reclassification by applying risk versus benefit judgements, assessing any medicines with potential for misuse and hazardous medicines as unsuitable. Key drivers for change in classification were underpinned by participants' desire to support consumers' management of minor ailments and adherence for those on long-term therapy. Barriers to reclassification were identified by pharmacy staff as internal, negatively impacting pharmacists' readiness for reclassification and external, negatively impacting the overall progress of change.

CONCLUSIONS

While the research provided valuable insights to inform the ongoing discussion on future reclassification, a larger, more representative sample is needed to confirm these findings.

Prevalence and Determinants of Antibiotic Self-Medication among Adult Patients with Respiratory Tract Infections in the Mboppi Baptist Hospital, Douala, Cameroon: A Cross-Sectional Study

Antibiotic self-medication in patients with respiratory tract infections (RTI) is increasing globally and has been reported to be one of the prime contributors to antimicrobial resistance (AMR). Our study aims to provide data on the prevalence of antibiotic self-medication and identify the factors contributing to self-medication in adult patients with respiratory tract infection in an urban setting in Cameroon. This was cross-sectional study carried out at Mboppi Baptist Hospital, Douala, Cameroon. A validated structured questionnaire was administered to 308 consenting participants with diagnosed RTIs, to collect data on socio-demographic characteristics and history of antibiotic self-medication. Significance was set at a p-value < 0.05. The prevalence of antibiotic self-medication amongst individuals with RTIs was 41.9% (95% CI 36.5% to 47.5%). Patients with a history of pulmonary tuberculosis (TB) were significantly less likely to self-medicate with antibiotics (p-value = 0.043). The most common source of antibiotic self-medication was pharmacies (62%) and Cotrimoxazole and Amoxicillin were the most commonly used antibiotics (38.8% (50), 26.4% (34), respectively). Self-medication with antibiotics in adult patients with RTIs is common in Cameroon. Control of the use of antibiotics, organisation of medication stewardship programs, and education of the general population on the adverse consequences of antibiotic self-medication are required.

Interventions to enhance effective communication during over-the-counter consultations in the community pharmacy setting: A systematic review

BACKGROUND

Easy access to effective over-the-counter (OTC) treatments allows self-management of some conditions, however inappropriate or incorrect supply or use of OTC medicines can cause harm. Pharmacy personnel should support consumers in their health-seeking behaviour by utilising effective communication skills underpinned by clinical knowledge.

OBJECTIVE

To identify interventions targeted towards improving communication between consumers and pharmacy personnel during OTC consultations in the community pharmacy setting.

METHODS

Systematic review and narrative analysis. Databases searched were MEDLINE, EMBASE, Psycinfo, Cochrane Central Register and Cochrane Database of Systematic Reviews for literature published between 2000 and 30 October 2014, as well as reference lists of included articles. The search was re-run on 18 January 2016 and 25 September 2017 to maximise the currency. Two reviewers independently screened retrieved articles for inclusion, assessed study quality and extracted data. Full publications of intervention studies were included. Participants were community pharmacy personnel and/or consumers involved in OTC consultations. Interventions which aimed to improve communication during OTC consultations in the community pharmacy setting were included if they involved a direct measurable communication outcome. Studies reporting attitudes and measures not quantifiable were excluded. The protocol was published on Prospero Database of Systematic Reviews.

RESULTS

Of 4978 records identified, 11 studies met inclusion criteria. Interventions evaluated were: face-to-face training sessions (n = 10); role-plays (n = 9); a software decision making program (n = 1); and simulated patient (SP) visits followed by immediate feedback (n = 1). Outcomes were measured using: SP methodology (n = 10) and a survey (n = 1), with most (n = 10) reporting a level of improvement in some communication behaviours.

CONCLUSION

Empirical evaluation of interventions using active learning techniques such as face-to-face training with role-play can improve some communication skills. However interventions that are not fully described limit the ability for replication and/or generalisability. This review identified interventions targeting pharmacy personnel. Future interventions to improve communication should consider the consumer's role in OTC consultations.

The Impact of State Medical Malpractice Reform on Individual-Level Health Care Expenditures

BACKGROUND

Past studies of the impact of state-level medical malpractice reforms on health spending produced mixed findings. Particularly salient is the evidence gap concerning the effect of different types of malpractice reform. This study aims to fill the gap. It extends the literature by examining the general population, not a subgroup or a specific health condition, and controlling for individual-level sociodemographic and health status.

METHODS

We merged the Database of State Tort Law Reforms with the Medical Expenditure Panel Survey between 1996 and 2012. We took a difference-in-differences approach to specify a two-part model for analyzing individual-level health spending. We applied the recycled prediction method and the bootstrapping technique to examining the difference in health spending growth between states with and without a reform. All expenditures were converted to 2010 U.S. dollars.

RESULTS

Only two of the 10 major state-level malpractice reforms had significant impacts on the growth of individual-level health expenditures. The average annual expenditures in states with caps on attorney contingency fees increased less than that in states without the reform (p < .05). Compared with states with traditional contributory negligence rule, the average annual expenditures increased more in both states with a pure comparative fault reform (p < .05) and states with a comparative fault reform that barred recovery if the plaintiff's fault was equal to or greater than the defendant's (p < .05).

CONCLUSIONS

A few state-level malpractice reforms had significantly affected the growth of individual-level health spending, and the direction and magnitude of the effects differed by type of reform.

Patients' intention to consume prescribed and non-prescribed medicines: A study based on the theory of planned behaviour in selected European countries

WHAT IS KNOWN AND OBJECTIVE

Polypharmacy has a significant impact on patients' health with overall expenditure on over-the-counter (OTC) medicines representing a substantial burden in terms of cost of treatment. The aim of this study, which was conducted within the framework of a European Project funded by the European Union under the Seventh Framework Programme and was entitled OTC-SOCIOMED, was to report on possible determinants of patient behaviour regarding the consumption of medicines, and particularly OTCs, in the context of primary care.

METHODS

A multicentre, cross-sectional study was designed and implemented in well-defined primary healthcare settings in Cyprus, the Czech Republic, France, Greece, Malta and Turkey. Patients completed a questionnaire constructed on the basis of the theory of planned behaviour (TPB), which was administered via face-to-face interviews.

RESULTS AND DISCUSSION

The percentage of patients who had consumed prescribed medicines over a 6-month period was consistently high, ranging from 79% in the Czech Republic and 82% in Turkey to 97% in Malta and 100% in Cyprus. Reported non-prescribed medicine consumption ranged from 33% in Turkey to 92% in the Czech Republic and 97% in Cyprus. TPB behavioural antecedents explained 43% of the variability of patients' intention to consume medicines in Malta and 24% in Greece, but only 3% in Turkey. Subjective norm was a significant predictor of the intention to consume medicines in all three countries (Greece, Malta and Turkey), whereas attitude towards consumption was a significant predictor of the expectation to consume medicines, if needed.

WHAT IS NEW AND CONCLUSION

This study shows that parameters such as patients' beliefs and influence from family and friends could be determining factors in explaining the high rates of medicine consumption. Factors that affect patients' behavioural intention towards medicine consumption may assist in the formulation of evidence-based policy proposals and inform initiatives and interventions aimed at increasing the appropriate use of medicines.

Self-medication misuse in the Middle East: a systematic literature review

Regulations usually distinguish between prescription‐only (POM) and over‐the‐counter (OTC) medicines. The former requires medical prescription; the latter are available for SM of common minor or easily treated ailments. However, in the Eastern Mediterranean countries, theoretical prescription medicines can easily be purchased without a prescription, as self‐medication (SM) resulting in potential misuse and unnecessary risk for patients. The magnitude of this activity is uncertain. The aim of this article, therefore, is to undertake a comprehensive review to identify the different types of medicines that can easily be purchased as SM in Middle East and recognized as misused. An extensive review of the published literature (1990–2015) was conducted using Pubmed, web of science, Cochrane, and Google Scholar databases, for OTC medicine misuse in the Middle East. A total of 72 papers were identified. Medicines involved in misuse included: codeine containing products, topical anesthetics, topical corticosteroids, antimalarial, and antibiotics. Self‐medication misuse of medicines seemed widespread. Individual treatment patterns were not clearly identified. Studies were not standardized, limiting the comparability between studies and the estimation of the scale of misuse. Pharmacists, friends, or parents were found to be the main sources of SMs. Knowledge and attitudes are an important contributing factor in the misuse of these medications. Strategies and interventions to limit misuse were rarely identified in literature. In conclusion, a massive problem involving a range of medicines was found in Middle East. Standardization of studies is a prerequisite to the understanding and prevention of misuse of self‐medication.

Perceptions and attitudes of community pharmacists toward professional ethics and ethical dilemmas in the workplace

BACKGROUND

Formal training in pharmacy ethics is relatively new in Croatia, and the professional code of ethics is more than 20 years old. Very little is known about how practicing pharmacists implement ethical considerations and relevant professional guidelines in their work.

OBJECTIVES

This study aimed to provide the first description of the perceptions and attitudes of Croatian community pharmacists toward ethics in pharmacy practice, how often they face certain ethical dilemmas and how they resolve them.

METHODS

A cross-sectional survey of 252 community pharmacists, including community pharmacists and pre-licensing trainees, was conducted in Zagreb, Croatia. This group accounts for 18% of licensed pharmacists in Croatia. The survey questions included four sections: general sociodemographic information, multiple-choice questions, pre-defined ethical scenarios, and ethical scenarios filled in by respondents.

RESULTS

More than half of pharmacists (62.7%) face ethical dilemmas in everyday work. Nearly all (94.4%) are familiar with the current professional code of ethics in Croatia, but only 47.6% think that the code reflects the changes that the pharmacy profession faces today. Most pharmacists (83.3%) solve ethical dilemmas on their own, while nearly the same proportion (75.4%) think that they are not adequately trained to deal with ethical dilemmas. The pre-defined ethical scenarios experienced by the largest proportion of pharmacists are being asked to dispense a drug to someone other than the patient (93.3%), an unnecessary over-the-counter medicine (84.3%), a generic medicine clinically equivalent to the prescribed one (79.4%), or hormonal contraception over the counter (70.4%).

CONCLUSIONS

The results demonstrate a need to improve formal pharmacy ethics education and training in how to assess ethical issues and make appropriate decisions, which implies the need for stronger collaboration between pharmacists and their professional association. Our results also highlight an urgent need to revise and update the Croatian code of ethics for pharmacists.

Receipt and use of spoken and written over-the-counter medicine information: insights into Australian and UK consumers' experiences

OBJECTIVES

To explore Australian and UK consumers' receipt and use of spoken and written medicine information and examine the role of leaflets for consumers of over-the-counter (OTC) medicines.

METHODS

Semistructured interviews were conducted with 37 Australian and 39 UK consumers to explore information received with their most recent OTC medicine purchase, and how information was used at different times post-purchase. Interviews were audio-recorded, transcribed verbatim and thematically analysed.

KEY FINDINGS

Similarities were evident between the key themes identified from Australian and UK consumers' experiences. Consumers infrequently sought spoken information and reported that pharmacy staff provided minimal spoken information for OTC medicines. Leaflets were not always received or wanted and had a less salient role as an information source for repeat OTC purchases. Consumers tended not to read OTC labels or leaflets. Product familiarity led to consumers tending not to seek information on labels or leaflets. When labels were consulted, directions for use were commonly read. However, OTC medicine information in general was infrequently revisited.

CONCLUSIONS

As familiarity is not an infallible proxy for safe and effective medication use, strategies to promote the value and use of these OTC medicine information sources are important and needed. Minimal spoken information provision coupled with limited written information use may adversely impact medication safety in self-management.

The prevalence, characteristics, and factors associated with purchasing Chinese herbal medicine among adults in Taiwan

Background

The objective of this study was to investigate the prevalence and factors associated with purchasing Chinese herbal medicine (CHM) without a physician’s prescription among adults.

Methods

Using data from the 2005 National Health Interview Survey and National Health Insurance, we identified 16,756 individuals aged 20 years and older. Socio-demographic factors, lifestyle, medical services utilization and health behaviors were compared between people with and without a history of purchasing CHM by calculating adjusted odds ratios (ORs) and 95% confidence intervals (CIs) in a multiple logistic regression analysis.

Results

The one-month prevalence of purchasing CHM without a physician’ prescription was 5.2% in Taiwan. People more likely to purchase CHM included people aged ≥70 years (OR 2.84, 95% CI 2.03-3.99), women (OR 1.28, 95% CI 1.11-1.48), non-indigenous people (OR 2.61, 95% CI 1.29–5.30), and people with an illness not receiving medical care (OR 2.69, 95% CI 2.19-3.31).

Conclusion

The prevalence of purchasing CHM without a physician’s prescription is high in Taiwan and is correlated with factors such as socio-demographics, disease history, and behaviors surrounding the utilization of medical care.

Assessing prescription drug abuse using functional principal component analysis (FPCA) of wastewater data

BACKGROUND

Wastewater-based epidemiology is an alternative method for estimating the collective drug use in a community. We applied functional data analysis, a statistical framework developed for analysing curve data, to investigate weekly temporal patterns in wastewater measurements of three prescription drugs with known abuse potential: methadone, oxazepam and methylphenidate, comparing them to positive and negative control drugs.

METHODS

Sewage samples were collected in February 2014 from a wastewater treatment plant in Oslo, Norway. The weekly pattern of each drug was extracted by fitting of generalized additive models, using trigonometric functions to model the cyclic behaviour. From the weekly component, the main temporal features were then extracted using functional principal component analysis. Results are presented through the functional principal components (FPCs) and corresponding FPC scores.

RESULTS

Clinically, the most important weekly feature of the wastewater-based epidemiology data was the second FPC, representing the difference between average midweek level and a peak during the weekend, representing possible recreational use of a drug in the weekend. Estimated scores on this FPC indicated recreational use of methylphenidate, with a high weekend peak, but not for methadone and oxazepam.

CONCLUSION

The functional principal component analysis uncovered clinically important temporal features of the weekly patterns of the use of prescription drugs detected from wastewater analysis. This may be used as a post-marketing surveillance method to monitor prescription drugs with abuse potential. Copyright © 2016 John Wiley & Sons, Ltd.

The Dependent Consumer: Reflections on Accounts of the Risks of Non-Prescription Medicines

Although academic writing about risk as a conceptual and theoretical category has burgeoned in recent years, debates about the characteristics of the risk society have tended to by-pass more mundane but ubiquitous dimensions of health and health-related behaviour. In this article, we argue that focusing on lay people’s understanding of the risks of a relatively commonplace example of modern medical technology (the use of non-prescription medicines for the self-medication of minor ailments) provides an insight and a challenge to what theorists of the risk society have described as the existential contours of life in late modernity.

In the context of an empirical study detailing consumer responses to a naturally occurring risk, we explore some of the arguments proposed by Ulrich Beck and amplified by Anthony Giddens concerning the characteristics of the risk society. We provide evidence both for and against the propositions described by these authors and posit a more nuanced understanding of the risks of scientific medicine which acknowledges both lay expertise over medicines usage coupled with dependence on medicine and medical technology as forms of healing.

Is 'self-medication' a useful term to retrieve related publications in the literature? A systematic exploration of related terms

BACKGROUND

Self-Medication (SM), i.e. using medications to treat oneself, is a major concern for health researchers and policy makers. The terms "self medication" or "self-medication" (SM terms) have been used to explain various concepts while several terms have also been employed to define this practice. Hence, retrieving relevant publications would require exhaustive literature screening. So, we assessed the current situation of SM terms in the literature to improve the relevancy of search outcomes.

METHODS

In this Systematic exploration, SM terms were searched in the 6 following databases and publisher's portals till April 2012: Web of Science, Scopus, PubMed, Google scholar, ScienceDirect, and Wiley. A simple search query was used to include only publications with SM terms. We used Relative-Risk (RR) to estimate the probability of SM terms use in related compared to unrelated publications. Sensitivity and specificity of SM terms as keywords in search query were also calculated. Relevant terms to SM practice were extracted and their Likelihood Ratio positive and negative (LR+/-) were calculated to assess their effect on the probability of search outcomes relevancy in addition to previous search queries. We also evaluated the content of unrelated publications. All mentioned steps were performed in title (TI) and title or abstract (TIAB) of publications.

RESULTS

1999 related and 1917 unrelated publications were found. SM terms RR was 4.5 in TI and 2.1 in TIAB. SM terms sensitivity and specificity respectively were 55.4% and 87.7% in TI and 84.0% and 59.5% in TIAB. "OTC" and "Over-The-Counter Medication", with LR+ 16.78 and 16.30 respectively, provided the most conclusive increase in the probability of the relevancy of publications. The most common unrelated SM themes were self-medication hypothesis, drug abuse and Zoopharmacognosy.

CONCLUSIONS

Due to relatively low specificity or sensitivity of SM terms, relevant terms should be employed in search queries and clear definitions of SM applications should be applied to improve the relevancy of publications.

Community pharmacist perception and attitude toward ethical issues at community pharmacy setting in central Saudi Arabia

OBJECTIVE

The purpose of this study is to identify the community pharmacist perceptions and attitudes toward ethical issues at community pharmacy setting in Saudi Arabia.

METHOD

A cross-sectional, descriptive, and qualitative survey of community pharmacists was conducted and the survey questions were pre-tested by a pharmacist with extensive experience in ethical issues. Based on the result of a pilot study the questionnaire was used with some modifications and the final questionnaire was sent to the participants by handing over in person, mail or Email.

RESULTS

45.7% Often discuss ethical issues with their patients, while only 2.1% never discuss it. 40.6% often record the ethical concern whereas only 1.9% of them never do so. 31.5% reported that patients initiate ethical issues.

DISCUSSION

28.3% of the pharmacists initiate the discussion. The barriers that limit discussing ethical issues with their patients were lack of time due to other obligations assigned to the community pharmacist (69.2%), lack of reliable resources (10.7%), not interested in the subject (10.1%), lack of knowledge on ethical issues (4.8%), and other reasons (5.3%). Recourses are books (37.7%), internet web sites (31.1%), and brochures (26.8%). Only a minority of respondents had access to computer databases (15.8%) and other resources (1.3%). Most perceived ethical problems were: being asked for hormonal contraception, dispensing a drug for unreported indication (69.2%), dispensing dose of medicine for a child that is outside the SNF limits (68.9%), unwanted professional behavior about controlled drugs (66.6%), a colleague insisting on unethical behavior (65.0%), a colleague has done something unethical for the first time (64.7%), suspecting that a child is being abused (63.3%) prescribing on private scripts for suspected medications of possible abuse (60.7%) and terminally ill patient asks for a diagnosis or prognosis (52.9%).

CONCLUSION

The findings of this study assured the need of Saudi health authorities to implement a code of ethics for pharmacy practicing to cover all aspects of ethical issues.

Does evidence drive pharmacist over-the-counter product recommendations?

RATIONALE, AIMS AND OBJECTIVES

To explore how community pharmacists use evidence to inform their practice when recommending or selling over-the-counter medicines.

METHODS

Semi-structured face-to-face interviews were conducted during February 2013 and analysed using the principles of content analysis.

RESULTS

Sixteen pharmacists were interviewed. Pharmacists were aware of evidence-based medicine and practice but relied on personal judgement augmented with patient feedback to make product recommendations. This was primarily due to the acknowledgement that many non-prescription medicines either had no or little evidence of efficacy. Pharmacists did and would use evidence to inform product selection if available, but acknowledged that ineffective products were sold, especially when consumers asked for a named product. This was tempered by their attempts to inform the consumer of the products' effectiveness, or lack of, or in the knowledge that it would cause them no harm.

CONCLUSIONS

Pharmacists took a pragmatic approach to product recommendation in light of the lack of clinical evidence to support their efficacy.

Self-medication with anti-malarials is a common practice in rural communities of Kilosa district in Tanzania despite the reported decline of malaria

Background

Self-medication has been widely practiced worldwide particularly in developing countries including Tanzania. In sub-Saharan Africa high incidences of malaria have contributed to self-medication with anti-malarial drugs. In recent years, there has been a gain in malaria control, which has led to decreased malaria transmission, morbidity and mortality. Therefore, understanding the patterns of self-medication during this period when most instances of fever are presumed to be due to non-malaria febrile illnesses is important. In this study, self-medication practice was assessed among community members and information on the habit of self-medication was gathered from health workers.

Methods

Twelve focus group discussions (FGD) with members of communities and 14 in-depth interviews (IDI) with health workers were conducted in Kilosa district, Tanzania. The transcripts were coded into different categories by MaxQDA software and then analysed through thematic content analysis.

Results

The study revealed that self-medication was a common practice among FGD participants. Anti-malarial drugs including sulphadoxine-pyrimethamine and quinine were frequently used by the participants for treatment of fever. Study participants reported that they visited health facilities following failure of self-medication or if there was no significant improvement after self-medication. The common reported reasons for self-medication were shortages of drugs at health facilities, long waiting time at health facilities, long distance to health facilities, inability to pay for health care charges and the freedom to choose the preferred drugs.

Conclusion

This study demonstrated that self-medication practice is common among rural communities in the study area. The need for community awareness is emphasized for correct and comprehensive information about drawbacks associated with self-medication practices. Deliberate efforts by the government and other stakeholders to improve health care services, particularly at primary health care facilities will help to reduce self-medication practices.

Self-medication among undergraduate medical students in Kuwait with reference to the role of the pharmacist

Objective:

The practice of self-medication is growing world-wide. It is associated with problems that may lead to potentially life-threatening complications represent a priority to be investigated. The aim of this study was to estimate the prevalence of self-medication among undergraduate medical students and to evaluate the possible role of the pharmacist in self-medication in Kuwait.

Methods:

A descriptive cross-sectional study was performed, using the questionnaire on a sample of 900 male and female students randomly selected from three health faculties in Kuwait. The prevalence of self-medication, as well as the contribution of pharmacist in self-medication was assessed. In addition, the role of the pharmacist as drug consultant for the students after getting the medication was evaluated.

Findings:

The overall prevalence of self-medication was 97.8%. The age was significantly inversely proportional to self-medication. There was a significant difference between male and female students in self-medication practice. Headache was the highest health conditions that most frequently motivated self-medication with 90.1% prevalence, followed by 84.7% for dysmenorrhea and 60.3% for constipation. Contribution of the pharmacist as a part of self-medication care was low totally, with the highest rate for cough conditions 40.1%. However, the role of the pharmacist as a drug consultant was more noticeable after obtaining the drug, not before. Around 80.1% of the students request information from the pharmacist about doses, duration of treatments and side-effects.

Conclusion:

The prevalence of self-medication among undergraduate students in Kuwait is high and there were significant differences for age and gender. The contribution of the pharmacist was low in self-medication, while it was high after getting the drugs for obtaining drug related information. The practice of self-medication is alarming. Improved awareness about the role of pharmacist as a drug consultant for careful and cautious use of medicines available for self-medication would be strongly recommended.

Treatment approaches and antibiotic use for emergency dental treatment in Turkey

The purpose of this study was to gather information about Turkish general dental practitioners’ treatment approaches towards endodontic emergencies, antibiotic-prescribing habits, and their participation in lifelong learning programs. Questionnaires were given to dentists who attended the 16th National Congress organized by the Turkish Dental Association. From 1,400 questionnaires distributed, 589 (43%) were deemed usable in this study. This survey dealt with questions that were subdivided into two main topics: dental emergency treatment approaches, and antibiotic prescription and information on lifelong learning program participation. The statistical analysis was conducted with a χ² test at a significance level of P<0.05. For irreversible pulpitis cases in vital teeth, most of the dental practitioners (65.3%) preferred single-visit root canal treatments. For teeth presenting a periapical lesion, the preferred treatment approach was root canal treatment (91.5%). The rate of prescription of analgesics and antibiotics was 21.7% in untreated acute apical periodontitis cases and 41% in acute apical abscess cases. Frequently prescribed antibiotics were amoxicillin–clavulanate (61.8%) and amoxicillin (46.5%). There was a tendency for practitioners to attend congresses as their years of professional practice increased (P<0.0001). There have been discrepancies between taught and observed practice. Educational initiatives are needed to prevent inappropriate prescription of antibiotics.

Where to buy OTC medications? A cross-sectional survey investigating consumers' confidence in over-the-counter (OTC) skills and their attitudes towards the availability of OTC painkillers

OBJECTIVE

To examine consumers' confidence in their own, and also in other people's, over-the-counter (OTC) skills and to describe their attitude towards the availability of OTC painkillers. Moreover we examined the association between confidence in OTC skills and attitudes.

DESIGN

Cross-sectional survey. Mixed methods (postal and electronic) self-administered questionnaire.

PARTICIPANTS

Members of the Dutch Health Care Consumer Panel.

MAIN OUTCOME MEASURES

Consumers' confidence in their own, and in other people's, OTC skills was examined. Confidence was measured by three questions regarding obtaining information on, choosing and using OTC medication. Consumers' attitudes towards availability were assessed using six safety profiles, by asking which channel consumers prefer for each profile.

RESULTS

The response rate was 68% (n=972). Consumers feel confident about their own OTC skills (mean 3.74; 95% CI 3.69 to 3.79, on a 5-point Likert scale), but have less confidence in OTC skills of others (mean 2.92; 95% CI 2.88 to 2.96). Consumers are conservative in their attitudes towards the availability of OTC painkillers. Most consumers prefer painkillers to be available exclusively in pharmacies (41-71% per profile indicated pharmacy only). Moreover, there is an association between confidence in OTC skills and attitudes (p=0.005; β=-0.114). Consumers who are more confident about their own OTC skills prefer OTC painkillers to be more generally available.

CONCLUSIONS

Consumers feel confident about their own OTC skills. However, they would prefer painkillers with safety profiles resembling those currently available OTC, to be available as OTC in pharmacies exclusively. Consumers' confidence in the OTC skills of others is more consistent with their attitudes towards availability of OTC painkillers. Until consumers themselves realise that they are also one of the others, they may overestimate their own OTC skills, which may entail health risks.

A qualitative interview study: patient accounts of medication use in early rheumatoid arthritis from symptom onset to early postdiagnosis

OBJECTIVE

To examine accounts of medication use in participants with early rheumatoid arthritis (RA) from symptom onset to early postdiagnosis.

DESIGN

Qualitative study with in-depth, personal interviews.

PARTICIPANTS

37 women and one man, aged 30-70s, with a diagnosis of RA <12 months.

MAIN OUTCOME MEASURE

Participants' experiences and feelings of medication use in early RA.

SETTING

British Columbia, Canada.

RESULTS

Medications were central to how people managed symptoms and disease. Two main themes were identified, showing that optimum medication use was hampered, and how this related to delayed diagnosis and effective care. The first theme, 'paradox of prediagnosis reliance on over the counter (OTC) medications', describes how people's self-management with OTC medications was 'effective'. Participants relied extensively on OTC medications for pain relief and to maintain 'normal life'. However, as this contributed to delayed medical consultation, diagnosis and effective treatment, OTC medication was also potentially detrimental to disease outcome. The second theme, 'ambivalence around prescription medications post diagnosis', describes how adherence was hindered by patient beliefs, priorities and ambivalence towards medications.

CONCLUSIONS

This study highlights how people use medications in early RA and contributes to a better understanding of medication use that may transfer to other conditions. Given the drive towards active self-management in healthcare and patients' ambivalence about using strong medications, an in-depth understanding of how these combined factors impact patient experiences will help healthcare providers to support effective medication practices. The reported extensive reliance on OTC medications may speak to a care gap needing further investigation in the context of health behaviours and outcomes of patient self-management.

Pharmacists' counseling protocols for minor ailments: a structure-based analysis

BACKGROUND

Self-medication is an important component of health care. To optimize pharmacists' over-the-counter counseling, there are several guidelines and protocols used in practice. In a self-care environment, protocols should comprise items related to patients' autonomy. The structure of self-medication protocols, among other elements, should present steps to facilitate patients' participation.

OBJECTIVE

To analyze structural differences between existing community pharmacy minor ailment protocols, including those related to patient autonomy and empowerment in self-medication conditions.

METHODS

The study design followed a cross-sectional descriptive approach. Self-medication protocols were systematically collected from 3 different professional sources (Pharmaceutical Society [OF], National Pharmacies Association [ANF], and Grupo Holon [GH]). A structural-based analysis, by comparison with the general self-medication OF standard protocol, produced outcome measures such as frequencies of flowchart critical steps, active pharmaceutical substances, dosage forms, and posologies. Simple scores were computed to assess protocols' structural quality, as well as differences between protocols, produced by each professional organization.

RESULTS

Forty-four protocols presented on average 8 counseling steps toward 10 different active substances, 7 dosages forms, and 14 posologic schemes. From a maximum of 30 critical items, 1 protocol scored 24, 7 scored 23, and 5 scored less than 15 items. Significant differences were found between protocols' structural components from different sources, particularly between GHs' protocols compared with those produced by OF and ANF.

CONCLUSIONS

In general, all protocols matched the OF standard for ailment characterization but fell short on steps related to medicine information and selection. Steps for patient participation and agreement were absent, as was pharmacists' expected role of outcomes monitoring. It might be appropriate to redesign self-medication protocols, preferably through a consensus process that includes not only professionals' but also patients' preferences, starting from the prevalent conditions in Portuguese pharmacy practice.

Nature and frequency of drug-related problems in self-medication (over-the-counter drugs) in daily community pharmacy practice in Germany

PURPOSE

To quantify drug-related problems (DRPs) in self-medication (over-the-counter [OTC] drug use) identified by community pharmacists (CPs) in Germany at the time the drug is dispensed.

METHODS

One hundred CPs were asked to document 100 consecutive customers presenting symptoms or requesting OTC drugs using a standardized documentation form. The number of 10,000 encounters seemed reasonable to evaluate the set objective. For each encounter, data such as age, sex, and first or repeated request and the availability of a patient file in the pharmacy including drug history were documented. Furthermore, identified DRPs, problem descriptions, and solutions were documented. Data were transcribed electronically, coded, checked for validity, and analyzed.

RESULTS

In total, 109 CPs documented 12,567 encounters identifying DRPs in 17.6% of all cases. Four indications comprised more than 70% of all DRPs: pain, respiratory, gastrointestinal, and skin disorders. Four DRPs were responsible for almost 75% of all DRPs identified: self-medication inappropriate (29.7%), requested product inappropriate (20.5%), intended duration of drug use too high including abuse (17.1%), and wrong dosage (6.8%). If a drug history was available, significantly more cases with wrong dosage (p < 0.05) and drug-drug interactions (p < 0.001) were detected. All patients with identified DRPs were counseled accordingly. Furthermore, the most frequent interventions were referral to a physician (39.5%) and switching to a more appropriate drug (28.1%).

CONCLUSIONS

In nearly one of five encounters, a direct pharmacist-patient interaction about self-medication revealed relevant DRPs. Having access to patient files including data on prescription and OTC drugs may increase patient safety.

Determinants of self medication practices among pregnant women in Ibadan, Nigeria

OBJECTIVE

To assess the frequency and evaluate the factors underlining self-medication with orthodox and herbal medicines among pregnant women in Ibadan, Nigeria. Setting Antenatal clinics at the major antenatal care facility in Ibadan, south-western Nigeria.

METHODS

A prospective cross-sectional study with a pre-tested 15-item structured questionnaire over a 12 week period among 1,650 pregnant women who attended antenatal clinics at a major antenatal care facility in Ibadan, south-western Nigeria. Data analysis was done with Chi-square, multivariate logistic regression and summary statistics.

MAIN OUTCOME MEASURE

Frequency and major factors associated with self-medication in pregnancy.

RESULTS

The response and completion rate was 96.6% (1,594) [mean age ± SD 27 ± 5.3 years]. The majority of the respondents were literate (92.6%), self-employed (61.5%) and in the third trimester (49.5%). A significant majority (63.8%) used self-medication (orthodox and herbal medicines) as their first response to perceived ill-health (P < 0.001). Self-medication in pregnancy was strongly associated with self-employment (OR: 3.8 (2.6-4.7), unemployment (OR: 2.6 (1.4-4.2) and third trimester of pregnancy (OR: 4.2 (3.1-5.6). The major over-the-counter medicines and potentially harmful prescription medicines kept at home for self-medication were Paracetamol, vitamins and haematinics; and piroxicam, dipyrone, chloramphenicol and Diazepam respectively. About one-third of the respondents who self-medicated (1,017) used local herbs (31.2%). The most frequent source of the medicines purchased during self-medication was patent medicine stores (55%). Mothers-in-law and relatives (41.3%) were the most frequently cited sources of advice during self-medication. Miscarriage/bleeding (44.3%) was the most frequently cited potential adverse effect that could occur with the use of certain medicines during pregnancy. Only 32% of respondents could identify medicines that are potentially harmful in pregnancy.

CONCLUSION

Poorly guided self-medication with prescription, over-the-counter and herbal medicines is pervasive and significantly associated with gestational age and occupational pattern among pregnant women in Ibadan, south-western. A majority lacked the knowledge of potential adverse outcomes associated with the use of certain medicines, and the potentially harmful medicines to avoid during pregnancy.

Public's views on making decisions about over-the-counter medication and their attitudes towards evidence of effectiveness: a cross-sectional questionnaire study

OBJECTIVE

To explore factors which may influence consumers when making decisions in relation to over-the-counter (OTC) medication.

METHODS

Data were collected from members of the public using a face-to-face interviewer-administered structured questionnaire in 10 shopping centres.

RESULTS

1461 people participated (18.8% males, 81.2% females; ages ranged from under 20 to over 60). Perceived effectiveness, familiarity with the name or brand and safety of the medicine influenced decisions when buying an OTC medicine. Almost all respondents reported that knowledge of effectiveness of OTC medicines was based on previous use. If there was no scientific evidence from drug trials to support effectiveness of a product, but it would not cause harm, two-thirds would still try the product. Over 70% 'agreed/strongly agreed' that people should be able to decide for themselves what OTC medicine they want, irrespective of scientific evidence.

CONCLUSION

There was ambivalence regarding need for evidence of effectiveness when choosing an OTC medicine, with individual autonomy and safety taking precedence over evidence.

PRACTICE IMPLICATIONS

Pharmacists should be aware that patients' expectations in relation to OTC medicines may be in conflict with evidence-based practice.

Non-prescription medicines and Australian community pharmacy interventions: rates and clinical significance

OBJECTIVE

To quantify pharmacy intervention rates for non-prescription medications (pharmacist-only and pharmacy medicines), to document the clinical significance of these interventions and to determine the adverse health consequences and subsequent health care avoided as a result of the interventions.

METHODS

Non-prescription medicines interventions undertaken by community pharmacy staff were recorded in two field studies: a study of all Australian pharmacies to determine incidence rates for low-incidence, highly significant interventions, and a study of a sample of pharmacies to collect data on all non-prescription interventions. Recorded interventions were assessed by a clinical panel for clinical significance, potential adverse health consequence avoided, probability and likely duration of the adverse health consequence.

KEY FINDINGS

The rate of professional intervention that occurs in Australia for pharmacist-only and pharmacy medicines is 5.66 per 1000 unit sales (95% confidence interval 4.79-6.64). Rates of intervention varied by clinical significance. When considering health care avoided, the main impact of the interventions was avoidance of urgent general practitioner (GP) visits, followed by avoidance of regular GP visits and accident and emergency treatment. The most common adverse health consequences avoided were exacerbations of an existing condition (e.g. hypertension, asthma) and adverse drug effects.

CONCLUSIONS

This study demonstrates the way in which community pharmacy encourages appropriate non-prescription medicine use and prevents harm through intervening at the point of supply. It was estimated that Australian pharmacies perform 485912 interventions per annum when dealing with non-prescription medicines, with 101324 per annum being interventions that avert emergency medical attention or serious harm, or which are potentially life saving.

An Assessment of the Health Behaviors of Dorm Students in Bangladesh

The objective of the present study was to investigate three kinds of health behaviors—treatment-seeking behavior during sickness, self-medication, and noncompliance of both prescription and over-the-counter drugs—of 1,809 nonmedical dorm students of Dhaka University and Jahangirnagar University, two public universities located in Dhaka and Savar, respectively, Bangladesh. In this study, decreased treatment cost and short duration of illness strongly correlated with self-medication incidences ( p < .5). Noncompliance was found to be significantly more prevalent among those who were younger and newcomers to the dorms, of male gender, and those who were ill for short durations. Bangladesh government should recognize and enforce the distinction between prescription and nonprescription medicines and ensure that the users of self-medication are well informed and protected from its possible harm or long-term negative effects.

The community pharmacist as a member of a primary health care team in South Africa — perceptions of pharmacists, doctors and nurses

The growing emphasis on primary health care (PHC) has drawn increased attention to disease prevention and health promotion activities from many health professionals, among them pharmacists. This paper explores the role of the community pharmacist as a member of the PHC team in South Africa, through the perceptions of pharmacists, nurses and doctors. Data were collected by survey and interviews. The results reveal a scenario where pharmacists are eager to engage in PHC activities, whereas nurses and doctors are more cautious in their support. Although they see pharmacists as health professionals, and are of the opinion that they should play a part in the PHC team, doctors and nurses strongly protect their own domains when it comes to allocation of potential tasks. This raises some difficulties with regard to the effective implementation of PHC. Based on the South African reality and a literature review, suggestions are made to develop models of PHC centres which would potentially overcome some of the problems raised.

Role of pharmacies and general practitioners in the management of dermatological conditions

Interviewers in the three community pharmacies in Maryborough, Central Victoria, Australia, collected data over four weeks from 830 people obtaining 1,011 skin related products. At the same time, the general practitioners in the area recorded all patients seen with skin related conditions, the management they required and the diseases for which they were treated. Over 70 per cent of the products obtained were non-prescription items, the sources of recommendation for these being pharmacy staff (39 per cent), family (27 per cent), medical practitioner (19 per cent) and other sources (15 per cent). Purchasers of one-third of the OTC products had already sought advice at some stage from their medical practitioner; 57 per cent of these products were subsequently bought on advice from sources other than their medical practitioner. For 34 per cent of the OTC purchases the consumers had described their symptoms to pharmacy staff, and in one third of these the consumer had at some stage seen a medical practitioner about the condition. Of those who described symptoms within the pharmacy, 55 per cent were seen only by a pharmacy assistant, the remainder being seen at some stage by the pharmacist. More consumers with inflammatory skin diseases purchased an OTC product from a pharmacy than visited their GP. All people with suspected neoplasms consulted a GP rather than a pharmacist. Education programmes are required to ensure that pharmacists have adequate knowledge of the conditions for which OTC skin products are available. Public education is required to ensure that consumers who seek advice for skin disease in the pharmacy do so from the person in that environment who is appropriately qualified to give it.