Access to Medicines via Non-Pharmacy Outlets in European Countries-A Review of Regulations and the Influence on the Self-Medication Phenomenon

Counselling with a focus on product and price transparency for over-the-counter headache medicines: A simulated patient study in community pharmacies in Munich, Germany

BACKGROUND

In Germany, over-the-counter (OTC) medicines may only be dispensed by community pharmacies (CPs). German CPs must ensure 'adequate' counselling, including the cost of medicines. Along with information gathering and advice giving as classic aspects of counselling, the aim was also to investigate counselling indicators of product and price transparency.

METHODS

The cross-sectional study was based on the covert simulated patient (SP) methodology and was conducted in a random sample of CPs stratified by districts in the major German city of Munich. Each of the 178 selected CPs was visited once by one of five trained female students. They simulated a symptom-based sub-scenario 1 with a request for an OTC medicine for a headache and a sub-scenario 2 with standardised information regarding product and price transparency. The assessment, completed immediately postvisit by the SPs, included a total of 23 items.

RESULTS

All 178 scheduled visits were completed successfully. The median counselling score with the classic items was 3.0 out of 12 points (interquartile range [IQR] 4.25) and when expanded by items for product and price transparency the score was 4.0 out of 14 points (IQR 4.00). A selection of medicines was offered unsolicited in 38.2% of the visits and in 5.6% of the visits voluntary price information was provided before the transaction. A request for a cheaper medicine led to a significant price reduction (Wilcoxon signed-rank test; p < 0.001, r = 0.869).

CONCLUSION

Due to the below-average level of counselling, the regional chambers of pharmacists are recommended to initiate measures for improvement. There is also potential for optimisation with regard to product and price transparency as an important extension of the classic counselling aspects. It is therefore recommended that the government raise customers' awareness of the cost of medicines.

Extent and Correlates of Self-Medication Practice among Community-Dwelling Adults in Eastern Ethiopia

Background

The use of medications without proper medical consultations poses significant health risks, drug resistance, and undiagnosed disease conditions, becoming a major pharmaceutical challenge in the 21st century. This study assessed the magnitude and associated factors of self-medication practice among adults in parts of Ethiopia.

Methods

A community-based cross-sectional study was conducted among 647 randomly selected adults residing in randomly selected households in eastern Ethiopia via a stratified sampling approach. A pretested interviewer-administered questionnaire was used to collect the data on self-medication practice. Data were presented using tables, frequencies, percentages, and graphs. A multivariable binary logistic regression was done to identify factors associated with self-medication practice and presented as an adjusted odds ratio along with its 95% CI. Associations with a p value below 5% were used to declare statistical significance.

Results

A total of 647 adults with a mean age of 41.7 (11.4) years were included. Overall, 15.8% (95% CI: 12.5-18.2) of them reported to have practiced self-medication in the past month, while 67.9% (95% CI: 64.1-74.7) have practiced self-medication, mainly due to the mild nature of the symptom (11%), intention to get a rapid cure (12.2%), physical accessibility (9.1%), and less confidence in the quality of health facility services (3.7%). The majority of the drugs were in the form of oral tablets in the antibiotic, antipain, and gastrointestinal categories. Female (AOR = 1.66 and 95% CI: 0.76-3.61), larger family size (AOR = 1.34 and 95% CI: 0.73-2.46), illiteracy (AOR = 4.47 and 95% CI: 1.17-17.1), poor socioeconomic class (AOR = 4.6795 and CI: 1.71-12.7), perceived health facility visit stay as long (AOR = 1.55 and 95% CI: 0.80-3.00), khat use (AOR = 2.86 and 95% CI: 1.27-6.47), cigarette smoking (AOR = 2.86 95% CI: 1.27-6.47), and poor knowledge on proper medication use (AOR = 7.98 and 95% CI: 4.61-13.8) were associated with increased odds of self-medication.

Conclusion

The practice of self-medication is a health concern and is associated with lower socioeconomic class, illiteracy, substance abuse, a perceived long stay at a health facility, and poor knowledge of medication use. Behavioral interventions targeting this segment of the population via various approaches would help.

Consumption of Non-Prescribed Drugs in Portugal During the Pandemic in 2021

Objectives: Portugal liberalised the over-the-counter drugs market in 2005 and provides universal healthcare coverage in a mainly Beveridge-type health system. However, the COVID-19 pandemic has forced healthcare to change how services were delivered, especially increasing remote consultations in primary care. This analysis aims to find the drivers for taking non-prescribed drugs during the pandemic in Portugal. Specifically, it seeks to understand the role of taking prescribed drugs and attending remote medical appointments in the self-medication decision. Methods: In this observational study, we used data collected during the pandemic in Centre Region of Portugal and estimated logistic regression for the whole sample and stratified by sex. Results: The main findings show that people taking prescribed medications and attending a remote consultation are more likely to take non-prescribed drugs. Also, reporting unmet healthcare needs seems to motivate people to choose self-medication. Conclusion: Policy implications are pointed out concerning the health risks raised from self-medication, the role of the pharmacist advising non-prescribed drugs, and the related health risks arising from unmet healthcare needs.

Oral emergency contraception practices of community pharmacies: a mystery caller study in the capital of Germany, Berlin

BACKGROUND

In Germany, oral emergency contraception (EC) with the active ingredients levonorgestrel (LNG) and ulipristal acetate (UPA) is available as over-the-counter (OTC) medicine only from community pharmacies (CPs). Because of the window of effect, which is limited to only a few days, CPs have a great responsibility to provide rapid and unimpeded access, while also ensuring "adequate" counseling. The aim was-for the first time in Europe and thus also in Germany for the methodology used in this study-to investigate immediate availability, pricing, and aspects of counseling.

METHODS

Covert mystery calls were conducted in a random sample of CPs stratified by districts in the German capital Berlin. Each of the 263 CPs included was called once at random by one of two trained female student mystery callers. They simulated a product-based scenario for the UPA original ellaOne^®, citing a contraceptive failure one day ago as the reason.

RESULTS

Of 257 successfully called CPs, UPA preparations were immediately available in 98.4% (253/257) and LNG preparations in 86.8% (184/212) of CPs. Prices for UPA preparations varied from €15.95 to €42.95 (∆ 169%; median €35.00 [interquartile range (IQR) €5.91]) and for LNG preparations from €10.60 to €32.49 (Δ 207%; median €22.00 [IQR €5.76]). Information about the correct different window of effect of UPA and LNG preparations was provided in 69.8% (127/182) of CPs. UPA preparations were recommended in 63.1% (111/176) and LNG preparations in 17.2% (30/174) of CPs. Information was provided on how to take them as soon as possible in 30.8% (44/143) of CPs and on how to use them after vomiting in 46.0% (64/139).

CONCLUSIONS

Berlin CPs support access through high immediate availability, especially to UPA preparations. However, access is hampered by high absolute price ranges of both UPA and LNG preparations, which could ideally be minimized by a comparison app. It is positive that CPs promote the benefits of UPA preparations by recommending them noticeably more often than LNG preparations. However, there are deficiencies in giving advice, so there is a need to raise awareness among pharmacy staff to ensure "adequate" counseling in advance over the phone.

The Costs Of Disparities In Preventable Heart Failure Hospitalizations In The US South, 2015-17

Black Americans in the US South have high rates of preventable heart failure hospitalizations, which reflects systemic inequities that also produce economic costs. We measured the direct medical costs of disparities in preventable heart failure admissions (that is, excess admissions) among Medicare beneficiaries living in six states in the US South (Kentucky, Arkansas, Florida, Georgia, Mississippi, and North Carolina). We used 2015-17 data from the Healthcare Cost and Utilization Project and constructed negative binomial models with state-level fixed effects to calculate adjusted admission rates with heart failure as the principal diagnosis. We calculated the number of these admissions that would have been avoided if Black, Hispanic, Asian/Pacific Islander, and American Indian/Alaska Native Medicare beneficiaries had the same admission rates as White beneficiaries. We found 28,213 excess admissions (48 percent excess) with $60,845,855 annual costs among Black beneficiaries, 3,499 (14 percent excess) with $8,179,381 annual costs among Hispanic beneficiaries, and 550 (51 percent excess) with $1,093,472 in annual costs among American Indian/Alaska Native beneficiaries. Failure to address heart failure treatment inequities in the community has a high opportunity cost.

Prevalence of Self-Medication Among Female University Students During Examinations: A Cross-Sectional Study in Saudi Arabia

Introduction Those who practice self-care using over-the-counter (OTC) products believe that these medications are relatively safe. They can be used to treat mild illnesses that do not require medical consultation. However, improper self-medication using OTC medicines because of inadequate knowledge of their side effects and interactions can result in drug-related issues and even death. The current study was performed using the foundation year students of Princess Nourah Bint Abdul Rahman University (PNU) as subjects, to examine the use of OTC medicines during examination times. Methods This cross-sectional study was done on 213 (response rates 87.7%) foundation-year female students in the Health Colleges at PNU in Riyadh. Using a 26-item, self-administered, online questionnaire, data were collected. Results It was found that more than 50% of the students used OTC medicines habitually during exam periods. A majority (90.6%; p< 0.0001) of the students mentioned that the overuse of Panadol Extra was very safe while 67.6% (p< 0.0001) of them declared that nonsteroidal anti-inflammatory drugs (NSAIDs) would not induce stomach ulcer formation. A higher percentage (67.6%; p<0.0001) of the students confirmed using OTC medicines during exam time for headache relief. A higher percentage (72.8%; p< 0.0001) of the students indicated that because the OTC medications were readily available and they believed these drugs were safe, they used sizable quantities during the time of the examinations. Furthermore, 69% (p< 0.0001) of the students confessed that because of a friend's recommendations, they started trying OTC medicine. Above 67% (p< 0.0001) stated that OTC medications are inexpensive and easily available in Saudi Arabia. Conclusion To conclude, the findings of this study reiterated the high usage of OTC medicines by female students during the time of examination, and the highest used were painkillers.

Designing for health equity: A mixed method study exploring community experiences and perceptions of pharmacists' role in minor ailment care

BACKGROUND

Minor ailments are self-limiting, easily diagnosable and treatable conditions. Funded pharmacist minor ailments services (PMAS) have been posited to improve medicines access equity and, despite ethnic minorities across the globe experiencing reduced access to medicines and health care, PMAS internationally have not explicitly centered ethnic equity in service design or outcome measurement.

OBJECTIVE

To explore Māori experiences of minor ailments care and perceptions of the pharmacists' role.

METHODS

This mixed methods study collected data through facilitated wānanga (collaborative knowledge-sharing group discussions). Eligible participants (Māori, 18 years plus, obtained medicine from pharmacy in last 3 years) were recruited through local pharmacist networks using convenience sampling. Wānanga included qualitative data collection through discussion using a topic guide and a quantitative questionnaire. Indigenous theory was applied within a general inductive approach to thematic development to analyze qualitative data. Quantitative data was reported using simple descriptive statistics.

RESULTS

Thirteen wānanga (3 in-person, 10 online) were conducted from September 2021-February 2022 with 62 participants from seven New Zealand regions. The minor ailments that participants were most likely to seek treatment from pharmacy first, instead of a doctor, were eczema (87.2%), coughs and colds (85.7%), headlice (85.7%), insect bites (83.9%), and hayfever (83.9%). Four themes were generated from the qualitative data: designing the right environment for minor ailment care; clinically and culturally safe care; moving from stigmatizing to strengths-based services; the benefits of PMAS. Participant-informed ideas for PMAS service development centered on Māori aspirations included: developing clinically and culturally safe pharmacy environments, enabling medicine supply outside of the physical pharmacy setting, avoiding stigmatizing language when promoting PMAS availability, and collaborative practice with other health providers.

CONCLUSION

This study provides important recommendations when developing PMAS to increase the likelihood of delivering equitable care, and has international application across multiple pharmacy and health service settings.

A quantitative classification of OTC medicines regulations in 30 European countries: dispensing restrictions, distribution, pharmacy ownership, and pricing systems

BACKGROUND

This paper reviews the regulations of over-the-counter (OTC) medicines in 30 European countries with the goal of identifying the regulatory trends and clusters as of May 2022.

METHODS

To that end, we reviewed the regulation that directly or indirectly might have an impact on OTC medicines. The data were gathered from the national legislation, reports from international organizations, and the existent literature. The 12 regulatory items obtained were classified into four categories: price, pharmacy ownership, distribution modes, and dispensing restrictions. In addition, these items were also employed in the cluster analysis.

RESULTS

Pharmacy ownership is mainly private, and in the majority of countries, OTC medicines are not subject to any pricing system. Almost every country studied allows online selling of OTC medicines, and 16 countries allow non-pharmacy retail to sell OTC medicines as well. The dispensing restrictions applicable in pharmacy retail are similar in the countries studied: they rely on the staff, OTC medicines are placed behind the counter and the doses dispensed tend to be restricted. Concerning non-pharmacy retail, additional dispensing restrictions might be imposed, such as the establishment of buyers' minimum age, the requirement of a pharmacist to supervise the operations, a regulation on the location in the store, and further restrictions on the package sizes, strength, or pharmaceutical form. The cluster analysis resulted in an initial division between countries that widely allow the sale of OTC medicines in non-pharmacy retail and countries, where pharmacy retail has an OTC monopoly. Based on the regulations, 7 subsequent groups were identified evidencing wide regulatory heterogeneity within the countries studied.

CONCLUSIONS

Our findings point out that OTC medicines are in general not subject to pricing systems, selling is allowed online, and ownership of pharmacies is mostly private. However, regarding dispensing restrictions, pharmacy chains, and establishment restrictions of pharmacies, we found heterogeneity that is also visible in our cluster analysis, since we identified 7 clusters.

Access to non-prescription medicines via vending machines: key considerations to help transfer the self-care concept to the next generation while managing safety risks

Objectives

Non-prescription vending machines are automated self-service systems that are increasingly used to dispense these medicines. Whilst regulatory health academics have devoted considerable attention to non-pharmacy medication outlets in Gulf Cooperation Council countries and others, the public health literature on these vending machines remains lacking. Whilst non-prescription vending machines undoubtedly provide a number of benefits, they are not without their risks, which include polypharmacy and medication interactions.

Methods

The purpose of this article is to provide a framework for further investigation of the function, advantages, and practical constraints of non-prescription vending machines.

Key findings

Overall, more research is required to determine the optimal balance between achieving the benefits of non-prescription vending machines whilst avoiding unnecessary constraints on regulatory bodies and vending machine providers but minimizing patient harm.

Conclusions

Further studies are also required to assess the consequences of these policy experiments. Specifically, there is a need to better understand the extent to which vending machines can provide beneficial and reasonable access to non-prescription medicines to enhance the quality of life of the population especially during pandemics.

Attitudes and behaviors regarding online pharmacies in the aftermath of COVID-19 pandemic: At the tipping point towards the new normal

The COVID-19 pandemic accelerated the online purchase of goods and services in which today's e-pharmacy is now an integral part of healthcare provisions in developed countries. The aim of our research was to assess the frequency and attitudes of European consumers purchasing medications online prior to and following the pandemic in the Visegrad Group countries (V4). An online cross-sectional study was conducted between May-August 2022. A 25-item questionnaire with single choice and 5-point Likert scale answers was used and implemented in Google forms and Pollfish. A sampling of 2087 responses was collected. A majority (92.8%) of the respondents were aware medicines can be purchased online, yet prefer traditional pharmacies (4.6 ± 0.8) and somewhat oppose the internet channel (2.8 ± 1.3). Following the outbreak of COVID-19 pandemic, respondents' attitude towards purchasing consumer goods (3.65 ± 0.89) and medications (3.26 ± 0.91) online increased, however, the change regarding medications is significantly smaller (p < 0.01). A distinct increase in the frequency of buying medicines (from 49.16% to 55.48%) and health products (from 60.61% to 63.0%) online was measured since the breakout of the COVID-19 pandemic (p < 0.05). Despite the relatively high prevalence witnessed in previous purchases, our results highlight the trend in which 18.3% of participants will definitely purchase medications online while a proportionate 17.7% will not in the future. Although long-term post-COVID attitudes towards the internet pharmacy channel have modestly increased, in comparison to previously published research the frequency of purchasing medications online has significantly increased during the past years. As national legislation in V4 countries permit only non-prescription online sales, our findings are primarily applicable to countries with similar regulatory environment. The rapid global spread of the coronavirus has transitionally affected medicinal purchase behaviors, augmenting potential public health concerns related to online sourcing. Consequently, public awareness campaigns are needed to promote verified online pharmacies and prevent the utilization of illicit websites and the use of unregistered, substandard and falsified medicinal products.

Factors Contributing to Self-Medication and Consumption of Non-Prescribed Drugs in Portugal

Objectives: This work sets out to find the relationship between taking non-prescribed drugs and predisposing, enabling and need factors. Specifically, our main aim is to find the relationship between taking non-prescribed drugs and the lack of health care. Methods: We used data from the last 2019 National Health Survey and estimate logistic regressions for the whole sample and stratified by sex. Results: The most striking finding is that people self-medicating with non-prescribed drugs seem to be replacing health care when this is not used because of financial constraints or distance from provider. This suggests that non-prescribed drugs are a fast, affordable, alternative to health care. Other findings show that income and the financial resources to cope with unexpected expenditure are considerations in taking these drugs. Health and needs are other factors triggering their consumption. Conclusion: Policy measures need to be aimed at improving access to medical care, providing responses to health needs such as those arising from chronic pain, and improving health literacy.

Trends in counterfeit drugs and pharmaceuticals before and during COVID-19 pandemic

Counterfeit, fake, adulterated or falsified drugs and pharmaceuticals, could be branded or generic drugs, excipients and active substances (in drugs and vaccines), medical supplies and devices, etc, intended to pass as the original. Counterfeits are always inferior in terms of quality, safety and efficacy compared to the original pharmaceuticals, and subsequently, they pose an unpredictable risk to public health and lead to loss of confidence in medicines, healthcare providers, and health systems. In the decades before the outbreak of the COVID-19 pandemic, a constant trend of increased trafficking was reported. However, the pandemic created a combination of public health emergency, economic distress, and misinformation-driven panic that made problematic the access and supply of high quality essential medicines and health products, and pushed consumers and vendors even more towards counterfeit pharmaceuticals. This contribution aims to review the trends in counterfeit drugs and pharmaceuticals trafficking, the health impact of their use, as well as, measures and actions implemented to restrict their proliferation, before and during COVID-19 pandemic; the relative recommendations, the expressed perspectives and the existing limitations are thoroughly discussed.

Ibuprofen exposure in Europe; ePiE as an alternative to costly environmental monitoring

The EU Water Framework Directive and Priority Substance Directive provide a framework to identify substances that potentially pose a risk to surface waters and provide a legal basis whereby member states are required to monitor and comply with environmental quality standards (EQSs) set for those substances. The cost and effort to continuously measure and analyse real world concentrations in all water bodies across Europe are high. Establishing the reliability of environmental exposure models to predict concentrations of priority substances is key, both to fill data gaps left by monitoring campaigns, and to predict the outcomes of actions that might be taken to reduce exposure. In this study, we aimed to validate the ePiE model for the pharmaceutical ibuprofen by comparing predictions made using the best possible consumption data with measured river concentrations. The results demonstrate that the ePiE model makes useful, conservative exposure predictions for ibuprofen, typically within a factor of 3 of mean measured values. This exercise was performed across a number of basins within Europe, representative of varying conditions, including consumption rates, population densities and climates. Incorporating specific information pertaining to the basin or country being assessed, such as custom WWTP removal rates, was found to improve the realism and accuracy of predictions. We found that the extrapolation of consumption data between countries should be kept to a minimum when modelling the exposure of pharmaceuticals, with the per capita consumption of ibuprofen varying by nearly a factor of 10.

Crosslinked 4-Vinylpyridine Monodisperse Functional Microspheres for Sorption of Ibuprofen and Ketoprofen

Nowadays, ibuprofen and ketoprofen are widely used over-the-counter medications to treat inflammation, fever, or pain. Their high consumption and improper disposal cause them to get into the environment and often pollute surface water. In this study, the new polymeric porous microspheres based on 4-vinylpyridine (4VP) are presented as effective sorbents for ibuprofen and ketoprofen preconcentration and removal. The porous microspheres were obtained via seed swelling polymerization with the use of two types of methacrylate crosslinkers, i.e., trimethylolpropane trimethacrylate (TRIM) and 1,4-dimethacryloiloxybenzene (14DMB). Additionally, as a reference sorbent, a copolymer of styrene and divinylbenzene was obtained. Porous structure investigations showed that the microspheres possess a specific surface area of about 100 m²/g, but noticeable differences were observed in their internal topography depending on the type of crosslinker used. Moreover, the porous structure of dry and swollen microspheres differs significantly. Swollen copolymers reveal the presence of micropores. The 4VP microspheres are characterized by high thermal stability; their initial decomposition temperature is about 300 °C. The performance of the 4VP copolymers as sorbents in aqueous solutions of drugs was evaluated in static and dynamic modes at three pH values of 3, 7, and 11. The highest sorption efficiency was obtained for ibuprofen and ketoprofen in pH 3. Both 4VP copolymers indicate the high sorption capacity in a static sorption as follows: towards ketoprofen of about 40 mg/g whereas towards ibuprofen of about 90 mg/g and 75 mg/g on copolymer crosslinked with trimethylolpropane trimethacrylate and 1,4-dimethacryloiloxybenzene, respectively. The recovery of ibuprofen and ketoprofen after dynamic sorption experiments was higher than 90%.

Contextualizing National Policies Regulating Access to Low-Dose Aspirin in America and Europe Using the Full Report of a Transatlantic Patient Survey of Aspirin in Preventive Cardiology

Background Aspirin is widely administered to prevent cardiovascular disease (CVD). However, appropriate use of aspirin depends on patient understanding of its risks, benefits, and indications, especially where aspirin is available over the counter (OTC). Methods and Results We did a survey of patient-reported 10-year cardiovascular risk; aspirin therapy status; form of aspirin access (OTC versus prescription); and knowledge of the risks, benefits, and role of aspirin in CVD prevention. Consecutive adults aged ≥50 years with ≥1 cardiovascular risk factor attending outpatient clinics in America and Europe were recruited. We also systematically reviewed national policies regulating access to low-dose aspirin for CVD prevention. At each site, 150 responses were obtained (300 total). Mean±SD age was 65±10 years, 40% were women, and 41% were secondary prevention patients. More than half of the participants at both sites did not know (1) their own level of 10-year CVD risk, (2) the expected magnitude of reduction in CVD risk with aspirin, or (3) aspirin's bleeding risks. Only 62% of all participants reported that aspirin was routinely indicated for secondary prevention, whereas 47% believed it was routinely indicated for primary prevention (P=0.048). In America, 83.5% participants obtained aspirin OTC compared with 2.5% in Europe (P<0.001). Finally, our review of European national policies found only 2 countries where low-dose aspirin was available OTC. Conclusions Many patients have poor insight into their objectively calculated 10-year cardiovascular risk and do not know the risks, benefits, and role of aspirin in CVD prevention. Aspirin is mainly obtained OTC in America in contrast to Europe, where most countries restrict access to low-dose aspirin.

The Quality of Counseling for Headache OTC Medications in German Community Pharmacies Using a Simulated Patient Approach: Are There Differences between Self-Purchase and Purchase for a Third Party?

Background

In Germany—as worldwide—headache is one of the most frequent causes of self-medication. The dispensing of over-the-counter (OTC) medications may only be carried out by community pharmacies (CPs). In doing so, CPs have to ensure “adequate” counseling, for both self-purchase and purchase for a third party, which also occurs in everyday pharmacy practice. The aim of this study was to evaluate the quality of counseling for headache OTC medications in German CPs and, as the first study worldwide, to analyze whether and to what extent there are differences in counseling between self-purchase and purchase for a third party.

Methods

A cross-sectional study was carried out using the covert simulated patient methodology (SPM) in all 42 CPs in the German big city Potsdam. With the help of 8 trained simulated patients (SPs), each CP was visited four times by a different SP. The SPs simulated in each CP two scenarios two times with the demand for an OTC medication against headache, which differed only in whether the demand was for themselves or for their boyfriend/girlfriend.

Results

All 168 planned pharmacy visits (84 visits per scenario) were successfully carried out. Overall, the median counseling score was 3.0 out of 9 points (interquartile range [IQR 2.0]). There were no significant differences between the two scenarios (Wilcoxon signed-rank test; p=0.495, r = 0.053). In a multivariate binary logistic regression analysis, the counseling level and the different scenarios were not significantly associated (adjusted odds ratio [AOR] = 1.635, 95% CI = 0.673–3.972, p=0.278).

Conclusions

Due to the partly considerable deficits in counseling of German CPs, policy-makers and the regional chambers of pharmacists are called upon to take appropriate measures to improve the quality of counseling. It is positive that no differences in counseling between self-purchase and purchase for a third party were found, but further verifying studies with a modified methodology are recommended.

Assessment of Pharmacists' Willingness to Conduct Medication Use Reviews in Poland

Introduction. Pharmacists play an important role in healthcare. Their functions are evolving and, in many countries, they actively participate in interdisciplinary patient treatment. One of the most common services provided by pharmacists as part of pharmaceutical care in community pharmacies involves medication reviews. Objective. The objective of this study was to evaluate the readiness of pharmacists to conduct medication reviews in community pharmacies. Materials and methods. This study comprises 493 pharmacists from community pharmacies in Poland. A questionnaire (developed for the purposes of this study) was used. It consisted of eight questions regarding readiness to conduct medication reviews, along with personal data. Results. A total of 63.9% of the pharmacists were ready to conduct medication reviews, and 23.1% already had experience in this area. Participants were of the opinion that this service should be funded by the Ministry of Health or a third-party public payer, and overall was valued by the participants at PLN 169.04 (SD = 280.77) net per patient. Conclusions. Pharmacists in Poland have expressed their readiness to conduct medical reviews. Implementation of this service in community pharmacies in Poland can have a significant impact on optimising patient health outcomes.

Extent of and Factors Associated with Self-Medication among Clients Visiting Community Pharmacies in the Era of COVID-19: Does It Relieve the Possible Impact of the Pandemic on the Health-Care System?

Background

Self-medication is one aspect of self-care that has been shown to benefit primary health care. When done correctly, it provides significant benefits to customers, such as self-reliance and cost savings. Inappropriate methods, on the other hand, such as incorrect self-diagnosis and therapy selection, can be disastrous. The COVID-19 pandemic context may benefit the community in easing the burden on the health system. There have been no studies conducted on this possibility in the context of COVID-19 in a selected area, hence the purpose of this study was to determine the extent of and factors associated with self-medication among clients visiting community pharmacies in west Harerghe, Ethiopia from June 1 to 30, 2020.

Methods

This institution-based cross-sectional study used a systemic random sample of 416 community-pharmacy clients. To collect data, face-to-face interviews were conducted using pretested semistructured questionnaires modified from established techniques. EpiData 3.1 was used to enter data and SPSS 24 for analysis. To determine factors associated with self-medications, bivariate and multivariate logistic regression analyses were performed. AORs with 95% CIs are used to report associations, and the level of significance was set at P<0.05.

Results

The proportion of people self-medicating was 73.6% (95% CI 69.2%–77.9%). Self-medications were significantly associated with age 18–24 years (AOR 9.28, 95% CI 3.56–24.21) and 25–34 years (AOR 3.54, 95% CI 1.35–9.27), Amhara ethnicity (AOR 1.72, 95% CI 1.01–2.94), current single status (AOR 0.28, 95% CI 0.15–0.51), government employment (AOR 0.31, 95% CI 0.12–0.82), and limited knowledge (AOR 2.31, 95% CI 1.40–3.79).

Conclusion

Three in four participants practiced self-medication in the era of COVID-19. Repetition was significantly associated with age, ethnicity, current marital status, type of occupation, and knowledge about self-medications. An alternative medical care–delivery system by all health-care providers and increasing community awareness should be promoted.

Dispensing and Variabilities in Pricing of Headache OTC Medicines by Community Pharmacies in a German Big City: A Simulated Patient Approach

Background

In Germany, over-the-counter (OTC) medicines for self-medication may only be dispensed by community pharmacies (CPs). From the customer's point of view, "adequate" counseling includes not only the recommendation of medicines that meet guidelines, but ao the dispensing of low-priced medicines. This is all the more important in Germany against the background of free pricing and a lack of obligation to display prices. The aim was to analyze the dispensing and possible price variability of OTC medicines for headache.

Methods

The cross-sectional design of the study based on the simulated patient methodology (SPM) included all 42 CPs of the German big city Potsdam and used eight trained simulated patients (SPs). Between October and December 2020, four different SPs visited each CP four times with two almost identical scenarios with the demand for a medicine for headache.

Results

All 168 planned visits were successfully completed and ibuprofen (60.1%) was dispensed most frequently. Across all dispensed medicines, prices varied from €0.93 to €9.97 (∆ 972%; median €3.46 [interquartile range (IQR) €2.25]). For repeated dispensing of the same CPs, the price variability was a maximum of €8.77. In addition, packs with ≤10 tablets were dispensed in 47.6%, with 11 to 20 tablets in 50.6%, and with >20 tablets in 1.8% of visits.

Conclusion

Increasing price transparency and strengthening price competition could make it easier for customers to access OTC medicines according to their personal needs.