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Alemanni M, de Salvo R, Moroni B, Ehret A. A real-world evidence study evaluating Geffer effervescent granules for the symptomatic relief of digestive symptoms. SAGE Open Med 2022; 10:20503121221088815. [PMID: 35371486 PMCID: PMC8968989 DOI: 10.1177/20503121221088815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 03/03/2022] [Indexed: 11/15/2022] Open
Abstract
Objectives Geffer effervescent granules (active ingredients: metoclopramide, dimethicone, and sodium bicarbonate) is an established over-the-counter medication available in Italy for the symptomatic treatment of hyperacidity (pain and/or heartburn) when accompanied by slowing of gastric transit, nausea, aerophagia, and bloating, all symptoms that can occur in functional dyspepsia and can negatively impact individuals' quality of life. The aim of this observational study was to explore the perceived benefits of, and consumer experience with, Geffer effervescent granules used for the symptomatic treatment of digestive disorders suggestive of functional dyspepsia under real-life conditions in Italy. Methods Adults (aged 35-65 years) experiencing symptoms suggestive of functional dyspepsia/indigestion at least once a month and who had used Geffer effervescent granules within the previous 6 months completed an online questionnaire eliciting information on symptom relief (speed of onset and duration) and quality of life. Results Geffer effervescent granules provided rapid onset of symptom relief, with 21% of respondents perceiving an effect within 10 min and 88% reporting an improvement in overall symptoms within 30 min. A similarly rapid onset of complete resolution of gastric pain/cramps, acidity, bloating, nausea, and bothersome fullness symptoms was reported by 65%-83% of respondents; 50%-59% of respondents were free from such symptoms for more than 3 h or until the next meal. Most participants (92%) reported that their quality of life improved when taking Geffer effervescent granules to treat hyperacidity symptoms. Overall, 95% of the respondents were satisfied with the effectiveness of Geffer effervescent granules on overall symptom relief. Conclusions In Italian consumers with digestive disorders likely due to functional dyspepsia, Geffer effervescent granules was associated with rapid, complete, and durable relief of symptoms of gastric pain/cramps, acidity, bloating, nausea, and bothersome fullness; an improvement in quality of life; and a high level of consumer satisfaction.
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Affiliation(s)
- Matteo Alemanni
- Bayer S.p.A., Milano, Italia
- Matteo Alemanni, Bayer S.p.A., V.le Certosa 130, 20156 Milano (MI), Italia.
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Darwish RM, Shehadeh M, Jalouqa S, Suaifan G. Users’ Knowledge and Self Medications in Relation to Gastric Problems among Adults in a Middle Income Country; Jordan. JOURNAL OF SUBSTANCE USE 2021. [DOI: 10.1080/14659891.2021.1961323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Rula M. Darwish
- Department of Pharmaceutics and Pharmaceutical Technology, The University of Jordan, Amman, Jordan
| | - Mayadah Shehadeh
- Department of Pharmaceutical Sciences, School of Pharmacy, The University of Jordan, Amman, Jordan
| | - Sara Jalouqa
- Department of Pharmaceutics and Pharmaceutical Technology, The University of Jordan, Amman, Jordan
| | - Ghadeer Suaifan
- Department of Pharmaceutical Sciences, School of Pharmacy, The University of Jordan, Amman, Jordan
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Niknam R, Mousavi S, Safarpour A, Mahmoudi L, Mahmoudi P. Self-medication of irritable bowel syndrome and dyspepsia: How appropriate is it? J Res Pharm Pract 2016; 5:121-5. [PMID: 27162806 PMCID: PMC4843581 DOI: 10.4103/2279-042x.179576] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Objective: Self-medication is common among patients with gastrointestinal (GI) symptoms. This study was performed to evaluate self-medication among patients who fulfilled irritable bowel syndrome (IBS) and dyspepsia diagnostic criteria and to investigate the appropriateness of self-medication with chemical and herbal drugs. Methods: A prospective, descriptive cross-sectional study was conducted in outpatient's GI clinics at Shiraz from November 2011 to May 2012. A GI specialist visited the patients and recruited those who had IBS (base on Rome III adapted criteria) or functional dyspepsia. We surveyed self-medication among these patients, using a questionnaire containing specific questions about self-medication. Findings: One thousand four hundred and forty-seven patients visited by the GI specialist during the study period. Seven hundred and forty-seven patients had the inclusion criteria, 337 of them fulfilled criteria for IBS, with IBS-mixed (52%) being the most prevalent subtype, and 410 patients had dyspepsia. Overall, 78.8% of the total participants had recently sought medical attention for their GI complaint. Twenty-eight percent of patients selected inappropriate medication for their GI complaints. The H2-blockers class were most common medicines reportedly used. We did not find any significant relationship between age, gender, level of education, marital status, and self-medication frequency. Conclusion: Patients who fulfilled criteria for IBS had a high tendency to self-treat their GI symptoms, use of acid-suppressive agents was common among patients. Around one-third of patients self-treated GI symptoms inappropriately. Consequently, the concept of self-medication among patients has to be revised. We recommend conduction of educational programs to improve self-medications selection and attitude among patients to reduce the burden on other health care resources.
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Affiliation(s)
- Ramin Niknam
- Gastroenterohepatology Research Center, Shiraz, Fasa, Iran; Department of Internal Medicine, Fasa University of Medical Sciences, Fasa, Iran
| | - Sarah Mousavi
- Department of Clinical Pharmacy and Pharmacy Practice, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Laleh Mahmoudi
- Department of Clinical Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Paria Mahmoudi
- Pharmaceutical Science Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Tiihonen M, Leppänen HM, Heikkinen AM, Ahonen R. Hormonal contraceptive users' self-reported benefits, adverse reactions, and fears in 2001 and 2007. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2012; 1:173-80. [PMID: 22272924 DOI: 10.2165/1312067-200801030-00004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND Hormonal contraceptives (HCs) are the most common contraceptive method in western countries. The fears and problems experienced by users of HCs can have an impact on their quality of life, and lead to abortions and unwanted pregnancies. OBJECTIVE To investigate whether experiences and perceptions of HC users in Finland have changed from 2001 to 2007. METHODS Data were collected using questionnaire surveys of women using HCs in 2001 and 2007. In Finland, HCs are available with a physician's prescription, and are only supplied in community and university pharmacies. University pharmacies in 12 large cities across Finland were selected to distribute the questionnaires. The response rate was 53% (n = 264) in 2001 and 55% (n = 436) in 2007. The average age of the respondents was 26 years in both surveys. The surveys measured self-reported benefits and adverse reactions, preconceptions, fears, knowledge, and opinions. RESULTS The number of HC users reporting fears increased from 2001 to 2007 (p = 0.002), whereas the number of HC users reporting adverse reactions decreased (p = 0.013). In both surveys, the most common fear was infertility after HC use (17% vs 26% for 2001 and 2007, respectively). In both surveys, the most common benefits were efficacy and regular menstrual cycle, and the most common adverse reactions were mood swings, lowered libido, and weight gain. CONCLUSIONS Our study suggests that, although women using HCs were convinced about their benefits, and the number of users reporting adverse reactions had decreased from 2001 to 2007, the number of users reporting fears had increased. Healthcare professionals need to provide counseling in order to alleviate women's fears and to correct false perceptions of HCs.
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Affiliation(s)
- Miia Tiihonen
- 1 Department of Social Pharmacy, University of Kuopio, Kuopio, Finland 2 Department of Gynaecology and Obstetrics, Kuopio University Hospital, Kuopio, Finland
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Mahadeva S, Yadav H, Everett SM, Goh KL. Factors influencing dyspepsia-related consultation: differences between a rural and an urban population. Neurogastroenterol Motil 2011; 23:846-53. [PMID: 21740483 DOI: 10.1111/j.1365-2982.2011.01746.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Dyspepsia is a common, chronic condition but medical consultation rates for symptoms remain variable. We aimed to examine two populations with varied health-care provision to determine predictive factors for dyspepsia-related consultation. METHODS A cross-sectional, population-based study in both an urban and a rural community within a single Asian country was conducted. Details on dyspepsia-related consultation rates over a fixed period and independent factors influencing them were identified. KEY RESULTS A total of 4039/5370 (75.2%) adults from representative rural and urban areas in this country agreed to participate in the study. Although mean ages of respondents were similar (40.4years), the demographics of both populations varied in terms of gender (62.7% female, rural vs 55.7% female, urban, P<0.0001), marital status (75.4% rural vs 70.5% urban, P=0.002), ethnicity, (79% Malay rural vs 45.3% Malays urban, P<0.0001) and socio-economic status (professional occupation 7.1% rural vs 47.3% urban, P<0.0001). Dyspepsia-related consultation rates were found to be higher among rural compared to urban adults (41.4%vs 28.7%, P<0.0001). Over-the-counter medication consumption was higher among urban compared to rural dyspepsia sufferers (n=157 vs n=35, P<0.0001). Following logistic regression, rural population (OR 3.14, 95% CI=1.65-6.0), low quality of life (OR 1.90, 95% CI=1.17-3.10), and self-medication (OR 0.40, 95% CI=0.25-0.62) were found to independently predict dyspepsia-related consultation. CONCLUSIONS & INFERENCES Dyspepsia-related consultation varied significantly between urban and rural communities. Factors within the rural population, self-medication practices, and a low quality of life independently influenced dyspepsia-related consultation.
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Affiliation(s)
- S Mahadeva
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, International Medical University, Kuala Lumpur, Malaysia.
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John DN, Krska J, Hansford D. Are customers requesting medicines by name less likely to be advised or referred? Provision of over-the-counter H2-receptor antagonists and alginate products from pharmacies. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2010. [DOI: 10.1211/002235702793] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Abstract
Objectives
To identify selected factors which may influence the provision of over-the-counter alginate and H2-receptor antagonist (H2RA) products, advice and referral from community pharmacies, and to establish if referrals of customers with dyspepsia made by pharmacy staff were in line with published referral guidelines.
Setting
Customers supplied with over-the-counter alginates or H2RAs by 39 community pharmacies in Scotland and Wales in a six-month period.
Method
A structured questionnaire was issued to customers provided with an alginate or H2RA from community pharmacies, with one reminder sent to non-responders.
Key findings
A total of 608 completed questionnaires were returned (79 per cent response): 523 customers (86 per cent) stated they requested the product they were supplied with by name, with previous use being the most frequently cited reason. Customers who requested a product by name were less likely to receive advice about the supplied medicine, less likely to be referred to a medical practitioner (GP) and also less likely to receive lifestyle advice than customers who did not request a named product. Overall, only 30 per cent of patients who met criteria for referral to a GP were referred.
Conclusion
The findings of this study suggest that more emphasis should be placed on referrals by pharmacy staff and on the provision of lifestyle and product-specific advice, particularly when products are requested by name. The acceptability of these actions to pharmacy customers is not known.
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Tiihonen M, Heikkinen AM, Leppänen HM, Ahonen R. Information sources used by women in Finland who use hormonal contraceptives. ACTA ACUST UNITED AC 2009; 32:66-72. [PMID: 19876757 DOI: 10.1007/s11096-009-9344-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2009] [Accepted: 10/12/2009] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this study was to examine information sources used by women who use hormonal contraceptives (HCs), and how information source affected women's attitudes and perceptions in 2001 and 2007. SETTING The questionnaires were distributed from university pharmacies in 12 large cities across Finland. METHOD The data were collected with two questionnaire surveys among women who used hormonal contraceptives in 2001 and 2007. In the 2001 survey the response rate was 53% (n = 264) and in the 2007 survey 55% (n = 436). RESULTS The number of respondents who considered professional information sources the most important information sources was markedly bigger in 2007 than in 2001 (P = 0.005). The most common source of information concerning the benefits of hormonal contraceptives was a physician (2001: 43%, 2007: 53%). The most common source of information concerning the risks of hormonal contraceptives was friends and relatives (43%) in 2001 and physician in 2007 (35%). Only a few percent of the respondents considered a pharmacy the most important information source both the 2001 and 2007 surveys. CONCLUSION The importance of health care professionals as sources of information concerning hormonal contraceptives has increased. However, role of pharmacists as information source was surprisingly small. Women who use hormonal contraceptives need more information from professional sources to alleviate possible fears associated with use.
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Affiliation(s)
- Miia Tiihonen
- Department of Social Pharmacy, University of Kuopio, P.O. Box 1627, 70211, Kuopio, Finland.
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Mehuys E, Bortel LV, Bolle LD, Tongelen IV, Remon JP, Looze DD. Self-Medication of Upper Gastrointestinal Symptoms: A Community Pharmacy Study. Ann Pharmacother 2009; 43:890-8. [DOI: 10.1345/aph.1l647] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Upper gastrointestinal (GI) symptoms are a common reason for self-treatment with over-the-counter (OTC) medication. However, data are scarce on the typology of GI complaints for which individuals seek self-medication and, more importantly, on the prevalence of alarm symptoms in this population. Objective To investigate: (1) the nature of GI symptoms that people intend to self-medicate, (2) prevalence of alarm symptoms, (3) adherence to referral advice given by the pharmacist, and (4) self-reported efficacy and frequency of use of OTC medication for minor complaints. Methods This descriptive study was performed in 63 community pharmacies. Participants (N = 592, aged 18–82 y) completed a questionnaire to assess symptom characteristics and previous medical consulting. Based on this information, the pharmacist referred subjects to a physician or advised self-treatment. Four weeks later, participants were presented a follow-up questionnaire evaluating their adherence to referral advice or efficacy of self-treatment. Results The most frequently reported GI symptoms were burning retrosternal discomfort (49.2%), acid regurgitation (53.2%), and bothersome postprandial fullness (51.2%). At least one alarm symptom was present in 22.4% of the individuals, with difficulty in swallowing being the most prevalent (15.4%). Although 21% of the customers were referred, only 51.7% of these contacted a physician. Almost all (95.1%) of the remaining customers who were advised self-treatment reported symptom relief with the OTC drug obtained. Conclusions Mild GI symptoms will mostly resolve with self-treatment. Yet, the value of pharmacist counseling on OTC treatment should be recognized, as community pharmacists can play an important role in distinguishing symptoms that warrant further medical examination.
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Affiliation(s)
- Els Mehuys
- Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Luc Van Bortel
- Heymans Institute of Pharmacology, Faculty of Medicine and Health Sciences, Ghent University
| | - Leen De Bolle
- Faculty of Pharmaceutical Sciences, Ghent University
| | | | | | - Danny De Looze
- Department of Gastroenterology, Ghent University Hospital
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Van Vliet EPM, Kuipers EJ, Steyerberg EW, Siersema PD. Users and utilization patterns of over-the-counter acid inhibitors and antacids in The Netherlands. Scand J Gastroenterol 2008; 43:662-8. [PMID: 18569982 DOI: 10.1080/00365520701885499] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE General practitioners (GPs) are the first-line physicians who are consulted for upper digestive symptoms. Persons with symptoms may, however, prefer to buy acid inhibitors or antacids in drugstores or pharmacies and bypass a GP. The aim of this work was to study users, reasons for use, and utilization patterns of over-the-counter (OTC) acid inhibitors and antacids in The Netherlands. We also studied factors that were associated with the substitution of OTC acid inhibitors or antacid use for consultation with a GP. MATERIAL AND METHODS From July 2005 to January 2006, persons buying OTC acid inhibitors or antacids in 12 pharmacies and 4 drugstores were asked to complete a questionnaire. A total of 82/160 (51%) questionnaires were returned. RESULTS Heartburn was the main symptom for buying an acid inhibitor or antacid. Seventy-one (87%) participants substituted OTC drug use for a GP consultation. The most commonly reported reason was the belief that symptoms were not serious enough to seek medical care. Exploratory analyses showed that substitution was less common in participants with comorbidity, a history of upper gastrointestinal disorder, use of an acid inhibitor or antacid previously prescribed by a physician, alarm symptoms (such as pain and nausea), and with being symptomatic for >4 days/week. CONCLUSIONS Although the reasons for substitution of OTC acid inhibitor or antacid use for a GP consultation in The Netherlands do not suggest an a priori increased risk of an underlying serious disorder, it may be advisable for staff in drugstores and pharmacies to provide users with information on appropriate use and when to consult a GP.
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Heikkilä R, Mäntyselkä P, Hartikainen-Herranen K, Ahonen R. Customers’ and physicians’ opinions of and experiences with generic substitution during the first year in Finland. Health Policy 2007; 82:366-74. [PMID: 17141355 DOI: 10.1016/j.healthpol.2006.10.006] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2006] [Revised: 10/29/2006] [Accepted: 10/30/2006] [Indexed: 11/22/2022]
Abstract
Medicine expenditures have continuously increased in Finland over the past 25 years. Generic substitution was introduced in Finland in the beginning of April 2003 with the aim of curbing the rise in the medical expenses of society and individuals. Pharmacists are obligated to substitute the cheapest or close to the cheapest medicine for prescribed medicine unless the customer refuses or the physician forbids substitution, which the physician can do for medical or therapeutic reasons. In this study, we explored how customers and physicians view the 2003 reform via two customer questionnaires and by interviewing physicians. The first questionnaires were handed out in 15 pharmacies in 5 geographical areas (hospital districts) in Finland to customers (n=1243, response rate 44%) who had refused generic substitution, and the second in 18 pharmacies in 6 geographical areas to customers (n=453, response rate 47%) who had accepted substituted medicines at least once. The physician interview study was directed to psychiatrists, geriatrists, internists and general practitioners (n=49). Most customers and physicians think generic substitution is a good reform measure. The main reason mentioned for substitution was to save money. The most important reason given for refusing substitution was the customers' positive experiences with medicines they had used previously. About half of the physicians thought not all interchangeable medicines are effective and safe.
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Affiliation(s)
- Reeta Heikkilä
- Department of Social Pharmacy, School of Public Health and Clinical Nutrition, University of Kuopio, and Unit of General Practice, Kuopio University Hospital, Finland.
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Tiihonen MJ, Heikkinen AM, Ahonen RS. Do Finnish women using hormone replacement therapy need more information about risks. ACTA ACUST UNITED AC 2007; 29:635-40. [PMID: 17431814 DOI: 10.1007/s11096-007-9115-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2006] [Accepted: 02/27/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE In 1998, the Women's Health Initiative (WHI) in 2002 and the Million Women Study (MWS) in 2003 have shown a need for re-evaluation of the benefits and adverse reactions of hormone replacement therapy (HRT). Consequently the authorities in Europe and USA have issued new recommendations against the use of HRT. The aim of this study was to examine women's perceptions of HRT since the publication of the Women's Health Initiative study and the Million Women Study, and the kind of sources women use to obtain information about HRT. METHOD The data was collected with questionnaire survey in the autumn 2003 among 315 women using HRT. RESULTS One third of the respondents (35%) had experienced fears concerning HRT use, and more than half (52%) reported that the debate in the media had markedly influenced them; they have experienced fears or worries, considered discontinuation or discussed with the physician. Whereas the most common source of information concerning the benefits of HRT was the physician (74%), the most common source of information concerning the risks of HRT was the media (78%). CONCLUSION This study shows that women using HRT should get more information about the risks from health care professionals. Physicians and pharmacists have an opportunity to alleviate fears and to help women to critically evaluate the information they get from the media. Such discussions are also important to women who have been using HRT for years.
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Affiliation(s)
- Miia J Tiihonen
- Department of Social Pharmacy, University of Kuopio, P.O.B 1627, 70211, Kuopio, Finland.
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Urquhart G, Sinclair HK, Hannaford PC. The use of non-prescription medicines by general practitioner attendees. Pharmacoepidemiol Drug Saf 2005; 13:773-9. [PMID: 15386694 DOI: 10.1002/pds.996] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE Against a background of increasing availability and use of non-prescription medicines, this study set out to explore: use of such medicines by patients seeing their general practitioner (GP); frequency of GP enquiry about such use; and frequency of recommendations to use a non-prescription medicine. METHOD Patients attending four general practices in Aberdeen, Scotland, completed separate questionnaires (before and after seeing their GP). RESULTS Some 461 individuals waiting to see their GP were invited to participate: 427 (93%) completed the pre-consultation questionnaire and 305 (71% of questionnaires issued) completed the post-consultation questionnaire. Almost half (45%) of all participants reported using non-prescription medicines in the 7 days prior to visiting their doctor; with 20% of the medicines purchased from non-pharmacy retail outlets. Thirteen per cent of participants were asked about their use of non-prescribed medicines by their GP. Eight per cent of participants were recommended to use a non-prescription medicine by their GP. CONCLUSION Although there was a high level of recent use of non-prescribed medicines by the general practice attenders, relatively few reported being asked about such use, or were recommended to use such medicines by their GP.
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Affiliation(s)
- Gordon Urquhart
- Department of General Practice and Primary Care, University of Aberdeen, Westburn Road, Aberdeen, AB25 2AY, Scotland
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Närhi U, Vanakoski J, Sihvo S. Switching of H2-Receptor Antagonists to Over-the-Counter Status in Finland. Clin Drug Investig 2005; 25:243-8. [PMID: 17523774 DOI: 10.2165/00044011-200525040-00003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To evaluate the consumption and safety of H(2)-receptor antagonists after switching ranitidine and famotidine to over-the-counter (OTC) status. METHODS The Finnish drug consumption data, based on the sales of medicines, and the national register for adverse drug reactions (ADRs) from 1990 to 2003 were used. We studied the consumption of H(2)-receptor antagonists, proton pump inhibitors, sucralfate and antacids (A02BA, A02BC, A02BX02 and A02A, respectively, according to the Anatomical Therapeutic Chemical [ATC] classification). We compared the ADRs of H(2)-receptor antagonists with proton pump inhibitors. RESULTS The total consumption of medicines for the treatment of peptic ulcer disease and gastro-oesophageal reflux disease increased more than 2-fold from 1990 to 2003 (from 12.8 daily defined doses [DDD]/1000 inhabitants/day to 29.6 DDD/1000 inhabitants/day). Initially, switching ranitidine and famotidine to OTC status in 1996 increased their consumption. Since 1998, proton pump inhibitors have been the most commonly used drug group for the treatment of peptic ulcer and gastro-oesophageal reflux disease in Finland. In 2003, the consumption of proton pump inhibitors was 75% (22.2 DDD/1000 inhabitants/day) of the total consumption of drugs for the treatment of peptic ulcer and gastro-oesophageal reflux disease. Switching ranitidine and famotidine to OTC status did not affect the number of reported adverse reactions to these drugs. CONCLUSIONS According to information collected from the Finnish consumption and ADR databases, H(2)-receptor antagonists are very often used in self-medication and they do not have serious adverse effects. However, the total number of reports concerning these ATC groups in the national ADR database is not very high, and therefore patient-based surveys are needed to verify this finding.
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Affiliation(s)
- Ulla Närhi
- National Agency for Medicines, Helsinki, Finland
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Krol N, Muris JWM, Schattenberg G, Grol R, Wensing M. Use of prescribed and non-prescribed medication for dyspepsia. Scand J Prim Health Care 2004; 22:163-7. [PMID: 15370793 DOI: 10.1080/02813430410006495] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE To explore patient factors related to the use of prescribed and non-prescribed drugs for dyspepsia in The Netherlands. DESIGN Patient survey study. SETTING AND SUBJECTS Questionnaires sent to patients who had a prescription for dyspepsia medication from their general practitioner. MAIN OUTCOME MEASURES Patient factors related to the on-demand use of prescribed medication and the use of non-prescribed medication for dyspepsia. RESULTS 74% of the (n=518) patients had been receiving prescribed medication for dyspepsia for more than one year. A quarter of the patients were using the prescribed medication "on demand" instead of adhering to the instructions on the prescription. PPI prescriptions reduced the probability of using the medication on demand, compared with other prescribed drugs (OR 0.39). Some 19% of the patients were using non-prescribed drugs for dyspepsia. More of the patients who had visited their general practitioner in the previous 12 months were using their drugs on demand (OR 2.27) and were using non-prescribed drugs (OR 2.40) than the patients who had not visited their GP. CONCLUSION Clear information for patients on how to use their medication for dyspepsia may contribute to decreasing unnecessary drug use. Communication about (in)appropriate use of drugs "on demand", non-prescribed drugs, and health education should be addressed to all patient groups. Further studies on these topics should aim to improve medical care based on shared decision-making for patients with dyspepsia.
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Affiliation(s)
- Nicole Krol
- Centre for Quality of Care Research, University Medical Centre St Radboud, Nijmegen 6500HB, The Netherlands.
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Shi CW, Gralnek IM, Dulai GS, Towfigh A, Asch S. Consumer usage patterns of nonprescription histamine2-receptor antagonists. Am J Gastroenterol 2004; 99:606-10. [PMID: 15089889 DOI: 10.1111/j.1572-0241.2004.04130.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Prescription to over-the-counter (OTC) drug switches are increasingly common. Yet little is known about how the public uses these reclassified products. Histamine2-receptor antagonists (H2RAs) are popular examples, although they may be supplanted by OTC proton pump inhibitors (PPIs). We examined the extent to which consumers substitute OTC H2RAs for physician care and/or engage in off-label use of these medications. METHODS Self-administered anonymous survey of 1,116 adult OTC H2RA consumers in a random sample of 20 Los Angeles pharmacies from a major retail chain. Off-label use was defined by FDA warning label (e.g., bloody stools, dysphagia). Substitution was defined by intent to use H2RA instead of going to a physician. RESULTS Forty-six percent engaged in off-label use of OTC H2RAs. Off-label use was independently associated with lower income, substitution for physician care, prior gastrointestinal disease, and past prescription H2RA use. Thirty-four percent substituted OTC H2RA use for physician care, and 54% of these met the criteria for off-label use. Substitution was associated with lack of health insurance, lack of time to see a physician, the belief that OTC H2RA was cheaper than clinic visits, and nonwhite race. CONCLUSION Almost one-half of adult consumers reported using OTC H2RAs in a manner inconsistent with FDA labeling, and this off-label use was associated with substitution for physician care. Traditionally vulnerable populations were more prone to off-label use and to substituting H2RAs for physician care. Further studies are needed to assess patient outcomes, identify remedies, and explore implications for the reclassification of PPIs.
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Affiliation(s)
- Chih-Wen Shi
- Department of Family and Preventive Medicine, UC San Diego, La Jolla, California 92093, USA
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Marklund B, Westerlund T, Brånstad JO, Sjöblom M. Referrals of dyspeptic self-care patients from pharmacies to physicians, supported by clinical guidelines. PHARMACY WORLD & SCIENCE : PWS 2003; 25:168-72. [PMID: 12964496 DOI: 10.1023/a:1024834327811] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE It is important that self-medication customers with potentially serious diseases are correctly referred from pharmacies to physicians. The aim of this study was to determine the appropriateness of pharmacy practitioners in referring customers suffering from dyspepsia to a general practitioner (GP). METHOD Practitioners in 12 pharmacies, supported by clinical guidelines and training, recorded information regarding the dyspeptic customers they referred to a physician on a data collection card. The card was sent to a GP participating in the study, who did a regular medical history of the referred customer over the phone and assessed whether the referral was appropriate or not. RESULTS Out of 133 referred customers with dyspepsia, 132 completed the study. The GPs found that 119 (90%) needed a medical examination and/or prescription drugs and thus assessed these referrals as appropriate. In three cases (2%) the referral was doubtful and in ten cases (8%) not adequate, as the symptoms were more likely to come from an irritable bowel syndrome than dyspepsia. CONCLUSION The results confirm the role of pharmacy practitioners as important members of the primary health care team. Provided with the appropriate referral guidelines and training, they are in a position to operate as 'filters', promoting the adequate use of other primary care services.
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Affiliation(s)
- Bertil Marklund
- Research and Development Unit, Primary Health Care County, Halland, Falkenberg, Sweden
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Shi CW, Asch SM, Fielder E, Gelberg L, Brook RH, Leake B, Shapiro MF, Dowling P, Nichol M. Usage patterns of over-the-counter phenazopyridine (pyridium). J Gen Intern Med 2003; 18:281-7. [PMID: 12709095 PMCID: PMC1494847 DOI: 10.1046/j.1525-1497.2003.20709.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Little is known about how the public uses formerly prescription medications that are available over-the-counter (OTC). This study examines whether consumers inappropriately use and substitute a recently widely distributed OTC urinary analgesic, phenazopyridine, for provider care. DESIGN/SETTING We conducted a cross-sectional survey of a stratified cluster random sample of OTC phenazopyridine purchasers (N = 434) in 31 Los Angeles retail pharmacies over 5 months. Recruited by shelf advertisements, participants were 18 years or older who purchased a phenazopyridine product. Each completed a 25-item self-administered anonymous questionnaire. Inappropriate use was defined as 1) having medical contraindications to phenazopyridine, or 2) not having concurrent antibiotic and/or provider evaluation for the urinary symptoms. RESULTS The survey response rate was 58%. Fifty-one percent of the respondents used OTC phenazopyridine inappropriately, and 38% substituted it for medical care. Multiple logistic regression analyses revealed that inappropriate use was correlated with having little time to see a provider (odds ratio [OR], 1.57; 95% confidence interval [95% CI], 1.26 to 1.96), receiving friend's or family's advice (OR, 1.25; 95% CI, 1.05 to 1.47), having prior urinary tract infections (OR, 0.49; 95% CI, 0.30 to 0.80), having used prescription phenazopyridine, (OR, 0.40; 95% CI, 0.25 to 0.63), and having back pain (OR, 0.34; 95% CI, 0.16 to 0.74). Similar correlates were found in those who substituted OTC phenazopyridine for provider care. Respondents with incorrect knowledge about phenazopyridine's mode of action had 1.9 times greater odds of inappropriate use and 2.2 times greater odds of substitution than those who had correct knowledge about this drug. CONCLUSION Inappropriate use of OTC phenazopyridine appears common. Increasing the public's knowledge about reclassified drugs may help to mitigate this problem.
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Affiliation(s)
- Chih-Wen Shi
- University of California-Los Angeles, Departments of Family Medicine, Los Angeles, Calif. 90095, USA.
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Abstract
Self medication is becoming an increasingly important area within healthcare. It moves patients towards greater independence in making decisions about management of minor illnesses, thereby promoting empowerment. Self medication also has advantages for healthcare systems as it facilitates better use of clinical skills, increases access to medication and may contribute to reducing prescribed drug costs associated with publicly funded health programmes. However, self medication is associated with risks such as misdiagnosis, use of excessive drug dosage, prolonged duration of use, drug interactions and polypharmacy. The latter may be particularly problematic in the elderly. Monitoring systems, a partnership between patients, physicians and pharmacists and the provision of education and information to all concerned on safe self medication, are proposed strategies for maximising benefit and minimising risk.
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Affiliation(s)
- C M Hughes
- School of Pharmacy, The Queen s University of Belfast, Belfast, Northern Ireland
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Westerlund LT, Marklund BR, Handl WH, Thunberg ME, Allebeck P. Nonprescription drug-related problems and pharmacy interventions. Ann Pharmacother 2001; 35:1343-9. [PMID: 11724080 DOI: 10.1345/aph.1a065] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To document the number and types of drug-related problems (DRPs) identified in customers purchasing nonprescription products in Swedish pharmacies; describe the distribution of DRPs by customer's gender, age, underlying ailment, and class of drug; determine whether problems are identified to the same extent in pharmacies with staffed nonprescription self-service departments as in pharmacies with over-the-counter sales; and document the number and types of pharmacy interventions to prevent or resolve DRPs, including reasons for drug switches and referrals to physicians. METHODS A computerized instrument for documentation of DRPs and pharmacy interventions was developed. The study was conducted in 45 volunteer pharmacies in Sweden during 10 weeks in late 1999. RESULTS A total of 1,425 problems and 2,040 interventions were recorded by 308 pharmacy practitioners. Relatively fewer DRPs were documented in pharmacies with self-service departments. The most common DRPs were uncertainty about the indication for the drug (33.5%) and therapy failure (19.5%). Dyspepsia was the most frequently specified symptom (11.4%). Consumers of dermatologic products had significantly higher rates of problems than expected in relation to sales volume. The most common ways of responding to a problem were with consumer drug counseling (61.1%), switching of drugs (43.9%), and referral to a physician (27.5%). CONCLUSIONS The study has demonstrated a need for more professional attention and intervention by pharmacy staff to prevent and rectify DRPs in nonprescription consumers. It seems especially important to make sure that consumers receive the appropriate drugs for their current ailments.
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Affiliation(s)
- L T Westerlund
- National Corporation of Swedish Pharmacies (Apoteket AB) and Department of Social Medicine, Göteborg University
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Krska J, John DN, Hansford D, Kennedy EJ. Drug utilization evaluation of nonprescription H2-receptor antagonists and alginate-containing preparations for dyspepsia. Br J Clin Pharmacol 2000; 49:363-8. [PMID: 10759692 PMCID: PMC2014936 DOI: 10.1046/j.1365-2125.2000.00160.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
AIMS To evaluate the use, efficacy and adverse effects of nonprescription H2-receptor antagonists and alginate-containing preparations obtained from community pharmacies. METHODS Questionnaires were distributed to customers from 39 pharmacies in Scotland and Wales. RESULTS Of 767 customers recruited, 608 (79.3%) returned an initial questionnaire and 472 (61.5%) customers a second questionnaire. The vast majority of respondents (424, 69.7%) had suffered their symptoms on three or more occasions and 369 (60.7%) had previously tried medicines to relieve their symptoms. Referrals to a doctor were less frequent than recommended in guidelines and few of those who were referred actually saw a doctor. Over a quarter of those returning the second questionnaire claimed to be taking more than one product simultaneously for symptom control. Eight customers who were taking prescribed ulcer-healing drugs obtained H2-receptor antagonists. The majority of respondents (355/472, 75. 2%) obtained some or complete symptom relief using the product obtained and 369/472 (78.2%) were completely satisfied with their product. H2-receptor antagonists were more likely to produce complete relief of symptoms than alginate-containing preparations (P < 0.05). Only 14 respondents (3.0%) reported side-effects from the product used which were mostly gastro-intestinal. CONCLUSIONS The study demonstrated that drug utilization studies are feasible to carry out in a community pharmacy setting. While the results support published evidence of the efficacy and minimal toxicity of these products, they also highlight the possibility of H2-receptor antagonists being used outwith their licenced indications.
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Affiliation(s)
- J Krska
- Welsh School of Pharmacy, Cardiff University, Cardiff and The Robert Gordon University, Aberdeen, UK
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Furu K, Straume B. Use of antacids in a general population: the impact of health-related variables, lifestyle and sociodemographic characteristics. J Clin Epidemiol 1999; 52:509-16. [PMID: 10408989 DOI: 10.1016/s0895-4356(99)00020-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Self-medication with antacids is very common in patients with less severe forms of dyspepsia, but we know very little about the users of antacids and their incentive to take them. The aim of this study was to analyze the relationship between self-reported use of antacids and health-related variables, lifestyle, and sociodemographic characteristics in order to characterize the use of antacids in a general population. The use of antacids was assessed by a questionnaire answered by men and women aged 20-62 years (n = 15,986; response rate 75.9%). Logistic regression analysis was used to quantify the relationships between the use of antacids and health-related variables, lifestyle, and sociodemographic characteristics. Approximately 10% of the population had used antacids during the preceding 14 days. There was no overall gender difference. Among those who had no dyspeptic symptoms, 1.5% reported use of antacids, whereas among those who had all three dyspeptic symptoms (heartburn, epigastric pain, peptic ulcer), 46.5% had used antacids. Heartburn was the most important predictor for antacid use in both men (odds ratio [OR] = 8.57 [6.65-11.04]) and women (OR = 9.35 [7.16-12.221) followed by self-reported epigastric pain and peptic ulcer (both: OR = approximately 2). The importance of these self-reported health conditions remained unchanged after adjusting for lifestyle and sociodemographic variables. There were fewer antacid users among unmarried women than married women, and coffee-drinking was inversely associated with antacid use. These findings were consistent in both bivariate and multivariate analysis. The present study provides population-based information showing that self-medication with antacids in Norway appeared to be appropriate. Because dyspeptic symptoms play a major role in the consumption of antacids, this study shows the importance of including information about specific clinical variables in the analysis and interpretation of patterns of drug use.
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Affiliation(s)
- K Furu
- Research Center for Epidemiology, Institute of General Practice, and Community Medicine, University of Oslo, Norway
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Sihvo S, Hemminki E. Self medication and health habits in the management of upper gastrointestinal symptoms. PATIENT EDUCATION AND COUNSELING 1999; 37:55-63. [PMID: 10640120 DOI: 10.1016/s0738-3991(98)00103-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Upper gastrointestinal symptoms are a common complaint among the general population but only a small proportion of sufferers seek medical advice. The aim of this study was to examine what kind of perceptions persons using self medication have about the causes of their gastrointestinal symptoms, whether they have made any health-related lifestyle changes, and whether visits to a physician are related to lifestyle changes. A pharmacy-based survey was done in 10 pharmacies in the Helsinki area in 1995. The questionnaire was completed by 292 customers. The response rate was 53%. Respondents in a population-based health interview survey (n = 10,410) were used as a comparison group for poor health-behavior (consumption of tobacco, alcohol, coffee). The most common perceived causes of gastrointestinal symptoms were poor diet, coffee, and stress. Ignorance about possible causes of symptoms was especially common among less educated respondents and among those persons who had never visited a physician due to their symptoms. Respondents were significantly more often smokers and they had attempted to reduce their coffee and alcohol consumption more often than the general population. Those who had visited a physician during past year, less often had poor health-behavior and they had better knowledge about the possible causes of their symptoms. They had also made lifestyle changes more often, but after adjustment for background characteristics, physician visits were positively correlated only with coffee reduction. Counseling about healthy lifestyles, especially about smoking, should be increased in physician consultations and in pharmacies for all patients and customers having gastrointestinal problems.
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Affiliation(s)
- S Sihvo
- Stakes (National Research and Development Centre for Welfare and Health), Helsinki, Finland.
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