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Benefits and Risks of Self Medication
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.
... Self-medication can readily relieve acute medical problems, save time spent waiting to see a doctor, be economical, and even save lives in acute conditions [5][6][7]. In many cases, self-medication can be an important initial response to illness or symptoms [1,5]. ...
... These are increasing the incidence of drug side effects and drug resistance, delaying the diagnosis and identification of clinically relevant illnesses, hence delaying appropriate care [6]. These would increase the disease burden due to morbidity and preventable mortality in the population [7]. Hence, it is imperative to understand the magnitude of selfmedication in certain local contexts, which helps identify the potentially preventable risk factors for targeted interven-tion on proper medication use [24]. ...
... Hence, decreased physical accessibility and the inability to get medication with ease due to poor regulatory mechanisms are encouraging customers to go for self-treatment [36,37]. The implementation of regulatory systems concerning the marketing of prescription-only drugs with potential harm to the user or the community should be strengthened [1,7,19,31,[33][34][35]37]. ...
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.
... As noted above, self-medication behavior, despite its potential benefits, has highly relevant risks (Hughes et al., 2001;Kretchy et al., 2021;Chiniard et al., 2023) and a high prevalence (Alhomoud et al., 2017;Alomaim et al., 2023). Despite this, explanations for such behavior are insufficient, as empirical approaches to its assessment are scarce. ...
... Indeed, self-medication is a form of self-care (Lifshitz et al., 2020). But in addition to self-care and the benefits related to the usefulness of self-medication to treat minor health problems, there may also be important risks (Hughes et al., 2001). The level of self-efficacy could influence how people assess these risks and benefits. ...
Introduction
Self-medication is a prevalent behavior with significant health implications. Understanding its psychosocial determinants can inform preventative strategies and interventions.
Methods
We evaluated the psychometric properties of the Self-Medication Behavior Inventory (SMBI-9) in a binational study with 779 Colombian and Mexican participants. Concurrent validity was assessed through correlations with related inventories, and confirmatory factor analysis tested the proposed four-factor model.
Results
The SMBI-9 demonstrated high model fit (CFI = 0.995, TLI = 0.991) and invariance across countries. The factors-Social Influence, Attitude toward Medicine, Avoidance, and Prevention-varied significantly with knowledge of medicine, schooling, health insurance status and gender, underscoring the role of social and personal beliefs in self-medication practices.
Discussion
SMBI-9 emerged as a reliable tool for capturing the multifaceted nature of self-medication behaviors. Findings highlight the influence of social norms and personal attitudes, suggesting targeted approaches for behavioral interventions.
... The use of self-medication has several personal and societal advantages. In nations with overloaded health systems, where scheduling an appointment with a doctor may be difficult, it promotes rapid access to medicine that provides rapid relief to the patient [9]. However, self-medication is also associated with a number of hazards for the patient who uses it and, in certain situations, for the community. ...
... According to Wazaify et al., pharmacists have observed the malpractice in community pharmacies related to Deanxit® dispensing and use [9,10]. Additionally, in 2022, Jordanians complained about the absence of Deanxit in pharmacies [11,12]. ...
Background
This study investigates the dispensing patterns and knowledge of community pharmacists regarding Deanxit®, a combination of melitracen and flupentixol approved for the treatment of depression and anxiety in Jordan.
Methods
This study employed a mixed-methods approach, involving 75 randomly selected pharmacies in two Jordanian governorates (Amman and Irbid). The investigation involved simulated patient scenarios and structured interviews employing a validated tool.
Results
The analysis revealed that 70.6% of pharmacists were willing to dispense Deanxit® based on simulated scenarios, indicating malpractice. The mean practice score was 0.5867 out of 18, underlining a substantial level of malpractice. Pharmacists demonstrated poor knowledge, with a median score of 2.0 out of 15, reflecting a lack of awareness about Deanxit's labeled indications. Furthermore, 96% reported dispensing without prescriptions, and 62.1% acknowledged encountering cases of improper Deanxit® use.
Conclusion
This study provides valuable insights into the current landscape of Deanxit® dispensing patterns, pharmacists' poor knowledge levels, and malpractices in Jordan. By identifying areas for improvement and offering recommendations for intervention, this study contributes to enhancing pharmacy practice and patient care outcomes in the region.
... The use of medications accurately matched to symptoms requires patient education. One of the advantages of self-medication is the quick and direct application of potentially effective treatment, which can prevent the development of symptoms 5,6 . On the other hand, there is a variety of risks coming along with the self-medication such as: incorrect choice of therapy, severe adverse effects, not realizing that the same active ingredient is being used under a different name, using an inappropriate dose, occurrence of interactions between drugs or medication and food or use of expired medications 5,6 . ...
... One of the advantages of self-medication is the quick and direct application of potentially effective treatment, which can prevent the development of symptoms 5,6 . On the other hand, there is a variety of risks coming along with the self-medication such as: incorrect choice of therapy, severe adverse effects, not realizing that the same active ingredient is being used under a different name, using an inappropriate dose, occurrence of interactions between drugs or medication and food or use of expired medications 5,6 . The behaviours exhibited by individuals with symptoms of acute pharyngitis vary depending on the place of residence, level of education, and the level of development of the inhabited country. ...
Background: Self-medicating with antibiotics is prevalent in low- and middle-income nations. This research sought to assess the perspectives on antibiotic usage and self-medication in case of acute pharyngitis, as well as the factors linked to self-medication among patients of a family doctor's clinic in Lublin, Poland. Methods: A original, fully anonymous survey was conducted among patients of a family doctor's clinic in Lublin. The descriptive statistics of answers in questionnaires and Automatic Linear Modeling Regression (LINEAR) was applied to point out the most significant predictors of the antibiotics misuse. Results: A response number of 262 participants was obtained. About 15,6% (41/262) respondents had self-medicated during the last year due to acute pharyngitis symptoms. We have identified the following important risk factors of anti-health behaviours connected with self-medication: frequent occurrence of symptoms of acute pharyngitis, frequent receiving antibiotics on prescription, frequent diagnosing a bacterial cause of sore throat, higher sensitivity to pain and lower education level. Surprisingly our research shows that women present lower sensitivity to pain than men in case of pain connected with acute pharyngitis. Conclusion: There is a need for greater attention paid to the education of the patients presenting the aforementioned risk factors. Education should focus on the risks to the patients connected with antimicrobial resistance.
... Informational sources that participants considered for selfmedication practicing An advice from a member of the family 13.600 % An advice from a friend 3.100 % Internet websites 9.000 % Previously experienced drugs 39.800 % Previously prescribed drugs 28.800 % Others like (physicians, pharmacists or nurses) 5.700 % Fig. 7. Participants' attitude towards practicing self-medication. [25,26]. Such attitude of the respondents comes from lack of awareness and information absence about disease developments, serious illnesses can be hidden behind simple symptoms which are eliminated by self-medication practices. ...
... There are many hazardous impacts can be came as a results of irrational usage of the mentioned medications (antibiotics) like firstly the resistance capability of normal flora against dangerous microorganisms can be affected in a bad way, secondly resistance to existed antibiotics can be developed which resulted in dangerous global impacts. Besides, addiction to such drugs and toxicity can be explored [26]. This attitude is similar to that attitude of countries like Sudan [27], Ethiopia [32] and India [33] which considered as developing countries since our country classified as one of them. ...
... Self-medication involves users treating their diseases with officially permitted drugs without obtaining previous medical advice and is defined as the use of commercial or homemade drugs without a doctor's prescription in an attempt to treat symptoms or self-diagnosed medical conditions (World Health Organization, 2000). It is accepted as a kind of self-care by patients who depend on medical practitioners to diagnose or prevent illnesses using over-the-counter or prescription-only medications (Hughes et al., 2001). This therapy practice poses a significant risk of drug interactions, polypharmacy, misdiagnosis, inappropriate dose, extended usage, wrong drug selection, uncommon but severe side effects, dependency or addiction, and increasing antimicrobial resistance (Hardon and Geest, 1987;World Health Organization, 2000;Hughes et al., 2001). ...
... It is accepted as a kind of self-care by patients who depend on medical practitioners to diagnose or prevent illnesses using over-the-counter or prescription-only medications (Hughes et al., 2001). This therapy practice poses a significant risk of drug interactions, polypharmacy, misdiagnosis, inappropriate dose, extended usage, wrong drug selection, uncommon but severe side effects, dependency or addiction, and increasing antimicrobial resistance (Hardon and Geest, 1987;World Health Organization, 2000;Hughes et al., 2001). The number of individuals who self-medicate varies wildly by country. ...
Background: Self-medication among pregnant women represents a serious risk to the mother’s and child’s health. It is a global concern that requires careful attention from professionals in healthcare. In Morocco, there is a lack of available data on self-medication and predicting variables among pregnant and postpartum women. The purpose of this study was to determine the incidence of self-medication and the factors that contributed to it among pregnant and postpartum women in the Sous Massa Regional Hospital.
Methods: A cross-sectional study was conducted using a pretested questionnaire among 420 pregnant and postpartum women who were attending the regional hospital center of the Sous Massa region from April to December 2022. Statistical analysis was performed using Jamovi Software. The logistic regression analysis was used to determine the significance of the association between the outcome and independent variables.
Results: The research enrolled 420 pregnant and postpartum women. During the current pregnancy, 24.8% of the women used self-medication. The leading common causes/symptoms that necessitate self-medication among pregnant and postpartum women were Anemia (84.8%), epigastralgia (16.8%), vomiting, pyrosis (15.2%), and urinary and vaginal infections The therapeutic families concerned with self-medication practice were Analgesics (41.4%), Antacids (20.3%), antimicrobials (13.5%), and Vitamin supplements (9%). According to the findings, the most frequent sources of information were pharmacists (45.6%), followed by physicians (44.3%). The primary reasons given by respondents for self-medication were the need for rapid release (51.7%), previous treatments with the same drugs (31.7%), and 20% reported difficulty of access to healthcare professionals. Out of 95.9% of the participants reported that they knew the dangers of self-medication and 96% of them were informed and received information about the dangers and contraindications of self-medication during pregnancy. This was significantly statistically associated with self-medication respectively with p -value = 0.031 and p -value = 0.005.
Conclusion: The findings of the present study provide an initial awareness of the state of self-medication among pregnant and postpartum women attending the regional hospital centers. It is recommended that healthcare professionals increase their interventions to improve the consciousness of pregnant women; this might require implementing suitable strategies to regulate the commercialization, delivery, and use of conventional medications.
... Seam et al [5] linked the increase in self-medication activities to a number of different reasons such as the free accessibility of OTC drugs in the local market, insufficient medical facilities, lack of time to visit a physician, long distance between hospitals and clinics and places of residence, high costs of medical consultations, mildness of illness and finally, the absence of strict drug regulatory policies. Nowadays, the practice of self-medication is increasingly becoming a part of self-care [2,6,7] . Moreover, responsible selfmedication has been encouraged by the World Health Organization (WHO) for preventing and treating minor diseases at an affordable cost [1,8] . ...
... Well-practiced self-medication cannot only relieve acute pain, but it can reduce treatment costs, save time and be more convenient [9] . However, when irresponsibly practiced, it could mask signs and symptoms of serious diseases that require quick medical intervention and professional care [6] . Moreover, it could increase the risks of drug abuse and misuse and adverse drug reactions [2] . ...
Irresponsible self-medication is associated with many potential risks such as antimicrobial resistance, adverse drug reactions, drug dependence, prolonged patient suffering and waste of resources. This practice is commonly reported among university students. This study was undertaken to determine the patterns of self-medication among undergraduate pharmacy students at the University of Benghazi, Libya. A cross-sectional survey via a self-administered questionnaire was carried out at the Faculty of Pharmacy at the University of Benghazi, Libya over a period of three months. Students were asked about their patterns of self-medication in the last 12 months preceding the study. The participants were asked questions related to several areas, such as symptoms that provoked self-medication, classes of self-administered medications, reasons for indulging in the practice and sources of advice regarding self-medication. The prevalence of self-medication in the study's population was found to be at 87.9%. Headache, cold, cough and fever were the most commonly self- medicated symptoms. The major classes of self-administered medications were analgesics, cold and cough preparations and antipyretics. The study also revealed that most participants indulged in self-medication because they believed their illness was minor and the majority obtained the necessary medication information from pharmacists. The study revealed that self-medication is widely practised among the study population. Future recommendations include more efficient education programmes as well as stricter applications of the regulations of dispensing medication.
... In our research report, it was stated that the insignificance of the sickness, which did not necessitate a doctor's appointment, was the most frequent reason for self-treatment with medications. The study carried out in India [25] revealed similar results. As previously mentioned, the most frequent groups of medications that almost all of the respondents in our survey self-prescribed for therapy were antipyretics, analgesics, antacids, and antidiarrheal medications. ...
... As previously mentioned, the most frequent groups of medications that almost all of the respondents in our survey self-prescribed for therapy were antipyretics, analgesics, antacids, and antidiarrheal medications. Nearly findings were discovered in research carried out in India [26], Pakistan [25], Iran [27], and Ethiopia [13]. ...
The use of over-the-counter (OTC) medications is a global phenomenon, particularly among people in general in developing nations. This kind of drug can be used without a prescription. Alarmingly the use of medication without prescriptions among the general people for longer duration is increasing day by day. The study was meant to evaluate the prevalence of non-prescribed medications among people living in the Gazipur city corporation of Bangladesh. From January to March 2023, a cross-sectional survey was carried out in the Gazipur City Corporation (GCC). Data were gathered from patients and non-patients who self-administered medications using a semi-structured questionnaire, and descriptive statistics were used to analyze the results. Total study population were 300, among them 261 were non-prescription medicine user, of which participants were Govt. Job holder (16.8%), garments worker (11.1%), housewife (7.7%) and students (64.3%). Aged between 22 and 45 years, there were 56.3% males and 43.7% females. Mostly used medication groups were Anthelmintic 33% NSAIDs (24%), antacids (8.5%) and antibiotics (17%). The compliance was rated as excellent (13.4%) and good (55.5%). Unexpectedly, the majority of people regularly take anti-gut worm medications because they virtually always develop at the same period in almost everyone. They believe a prescription is not necessary in order to take an anthelmintic medication at any time.
... Self-medication can be defined as getting and consuming drugs without the guidance of a physician for diagnosis, treatment, or supervision of the treatment [1]. It involves obtaining medication without a prescription and taking medicines on the advice of and from friends and relatives. ...
... If self-medication is practised correctly, it has a positive impact on individuals and health care systems. It also allows patients to take responsibility, build confidence to manage their own health and save time spent waiting for a doctor, and it may help to decrease healthcare costs [1]. Nevertheless, self-medication practice is highly prone to inappropriate use and has its own drawbacks resulting in wastage of resources, increased resistance to pathogens, and increased adverse reactions [4] In France, 80% of the population uses self-medication and 20% of the population suffers from rheumatic diseases [5]. ...
Self-medication in Uganda is becoming alarming and 7 out of every 10 Ugandan students practice self-medication to assess self-medication practices and its associated factors among first-year medical students of KIU₋WC Bushenyi district western Uganda. This was a cross-sectional study conducted among 196 registered first-year medical students of KIU-WC who consented to participate anonymously in the study. Data was collected from them with the help of questionnaires which were coded and entered in SPSS version 25 for analysis. Data was then presented in form tables. The majority 90(45.9%) were between the ages of 21 and 24, the majority 72 (36.5%) were Catholics, and the majority 96(56.5%) were males. The prevalence of self-medication was 98.5%. Many 95 (49.2%) got information about self-medication from family and friends, that the majority 86 (44.6%) used strong pain relievers to self-medicate, and that pharmacies/drug stores were the most common source of drugs used in self-medication, as suggested by 143 (74.1%). The majority of 134 (69.4%) asked someone before self-medicating, with pharmacists being the most frequently questioned 60 (31.1%). Finally, many 99 (51.3%) of those respondents had no idea whether the drugs they purchased could treat their condition. Many 129 (65.8%) self-medicate only for minor medical conditions, the majority 129 (65.8%) say they get better when they self-medicate, many 72 (36.7%) say it is cheap, and the majority 85 (43.4%) say it is convenient. Of the 193 participants who have ever self-medicated, 62 (32.1%) experienced side effects from the drugs they self-medicated with, and the most common side effect was an allergic reaction, as reported by 26/62 (41.9%). The drugs that caused the most side effects were strong pain relievers and antimalarials, as indicated by 20/62 (32.3%) for each category of drugs. The prevalence of self-medication among first-year medical students at KIUWC Bushenyi in western Uganda is high. The common source of information were friends and family, analgesics or painkillers were commonly used drugs and they commonly asked pharmacists before self-medication. The factors associated with self-medication include being 21-24 years, being male, having easy access to drugs or cheap drugs, prior experience with the illness, medical knowledge as well as self-belief in drugs used.
... It is an alarming problem among resource limited countries in the global south. Even though self-medication has the potential of reducing health care expenditure [44], it has its own associated cost, among which, is the dampening effect it has on health policy interventions towards the control of infectious diseases. Selfmedication as applied in our context of study can range from having faith that one will heal from the disease without ingesting any form of medicines to application of herbal medicine or over the counter drugs. ...
Objective
To assess the impact of self-medication on the transmission dynamics of COVID-19 across different age groups, examine the interplay of vaccination and self-medication in disease spread, and identify the age group most prone to self-medication.
Methods
We developed an age-structured compartmentalized epidemiological model to track the early dynamics of COVID-19. Age-structured data from the Government of Gauteng, encompassing the reported cumulative number of cases and daily confirmed cases, were used to calibrate the model through a Markov Chain Monte Carlo (MCMC) framework. Subsequently, uncertainty and sensitivity analyses were conducted on the model parameters.
Results
We found that self-medication is predominant among the age group 15-64 (74.52%), followed by the age group 0-14 (34.02%), and then the age group 65+ (11.41%). The mean values of the basic reproduction number, the size of the first epidemic peak (the highest magnitude of the disease), and the time of the first epidemic peak (when the first highest magnitude occurs) are 4.16499, 241,715 cases, and 190.376 days, respectively. Moreover, we observed that self-medication among individuals aged 15-64 results in the highest spreading rate of COVID-19 at the onset of the outbreak and has the greatest impact on the first epidemic peak and its timing.
Conclusion
Studies aiming to understand the dynamics of diseases in areas prone to self-medication should account for this practice. There is a need for a campaign against COVID-19-related self-medication, specifically targeting the active population (ages 15-64).
... Being ill is an unpleasant and possibly a life threatening experience. Once it starts, there may be little that one can do about it except to retire to bed, go to the hospital, take medication and wait to get better [1]. In our contemporary society, there has been an upsurge of drug abuse, attributable to "over-the-counter drugs" dispensing, which are bought by members of the public without any restriction. ...
The study examines the relationship between self-medication and patronage of orthodox medical facilities in Yakurr Local Government Area, Cross River State, Nigeria. Three research objectives were drawn which guided the formulation of three null hypotheses from the independent variable. The study adopted descriptive survey design. 17-item questionnaires entitled “Self-medication. And Patronage of Orthodox Medical Facilities (SMPOMF)” were distributed to four hundred and forty-eight (448) respondents selected through simple random sampling technique from the study area. In addition, key informants (KII) were used as data collection instrument. The reliability test of the instrument was conducted using the Cronbach reliability method. Data were gathered through primary and secondary sources and were analyzed using Pearson Product Moment Correlation Coefficient and One-way ANOVA statistical techniques. The three hypotheses, tested at 0.5 level of significance, revealed that, there is a significant relationship between belief system, level of awareness (p=.337), proximity to medical facility and self-medication in Yakurr Local Government Area, Cross River State, Nigeria (p=.325). This confirms that, there is a significant relationship between self-medication and patronage of orthodox medical facilities in the study area. The study recommends among other things, that, traditional medical practice should be integrated into the primary healthcare system to grant it a formal status in the healthcare delivery system in Nigeria. In addition, the safety and regulation of traditional medicine should be assessed to improve its standard and efficacy. Furthermore, government should build more medical facilities in the study area to encourage people to patronize these facilities when faced with health challenges; rather than reverting to traditional medicine and self-medication, which in most times are ineffective.
... So it is advisable to assess people knowledge and understanding about OTC drugs. [4] OVER THE COUNTER DRUGS: HISTORICAL BACKGROUND Before FDA existed, just about anything could be put in a bottle and sold as a surefire cure. Alcohol, cocaine and opium were included in some OTC products without notification to users. ...
The increasing trend in self-medication with over-the-counter drugs may raise the interactions, adverse reactions and misuse / abuse of such products. Hence the aim of the study was to investigate the self-medication patterns as well as the general public's opinion and perceptions regarding safety, potency and effectiveness of OTC medicines. Study was carried out as a structured interview technique by using a questionnaire. Out of 250 participants, at most one-third of the participants (27.38%) reported buying OTC drugs monthly and the majority (77%) always or often follow the directions on the packages. The main factor which most frequently influence the choice of OTC medications was the previous usage of medication (50.39 %). This study revealed that OTC stockage at home was very common. Regarding safety, potency and effectiveness showed that about (77.38%) participants agreed the longer usage may cause dependency or addiction, incorrect usage produce serious problems (76.19%) followed by (72.22%) participants reported continuous usage may lose the effectiveness of the OTC drugs. This survey revealed that general public had a high level of awareness about safety, potency and effectiveness of OTC medication.
... The trend of this self-medication has been reported by some researchers to have increased worldwide based on the number of Google searches since the pandemic started [10]. This trend has also resulted to a tremendous medical challenge [11,12] because the various prescription drugs currently approved for COVID-19 symptoms carry adverse drug reactions [10]. Considering the danger placed on the population to self-medicate due to the pandemic, it is therefore necessary to understand the self-medication practices of individuals in our immediate communities. ...
Aims: The prevalence of self-medication worldwide has been on the increase especially with the outbreak of the COVID-19 pandemic. Even though self-medication can reduce pressure on the healthcare, the seeming downsides is overwhelming especially with the lockdown in the COVID-19 era. This study is thus set to understand the prevalence and nature of self-medication against COVID-19 among Individuals in Nsukka Town. Methods: A cross-sectional survey based on descriptive non-experimental research designed to investigate the prevalence and practices of self-medication against COVID-19 was conducted within the Nsukka town of Enugu state, Nigeria. A 20-item structured, self-administered questionnaire was administered to a population consisting of Health workers, Road Transport workers and market women. Microsoft Excel 2016 and SPSS version 21.0 were used to analyze the data. Descriptive and inferential statistics were used to summarize the data. Results: A total of 840 responses were received. Participants aged 35-44 (262, 29.6%) and males (592, 67%) were the highest in the study. A 38.0% of the respondents have a tertiary education certificate while a 36.5% are traders. Nearly half (45.5%) of the participants were married. Participants indulgence in general self-medication (439, 49.7%) was higher than indulged in self-medication to prevent COVID-19 (415, 46.9%). Most self-medication was done largely to prevent COVID-19 infection. Among the drugs commonly self-medicated are dexamethasone (6.2%) and vitamin C (6%) closely followed prednisolone (3.8%). A few of the participants had “no trust in doctor” (1.8%) while an equal number “have medicines of family members” (1.8%). Conclusion: Approximately half of the respondents reported to have self-medicated to prevent COVID-19. Dexamethasone and Vitamin C were most commonly used drugs. The only factor associated with COVID-19 self-medication was gender where being a female was associated with self-medicating against COVID-19. Concerted efforts are needed to educate the public on the dangers of self-medication and the need to access medical attention and information from healthcare professionals during pandemics.
... Attitude towards ADR AT-2 Positive (4-9), Undecided (10)(11)(12)(13)(14), Negative (15)(16)(17)(18)(19)(20) ADR reporting by the public is necessary AT-2-1 www.nature.com/scientificreports/ Similarly, knowledge about the eight most commonly consumed medicine groups 57,58 was assessed using a five-point Likert scale score ranging from 10 to 40. ...
Self-medication is a prevalent practice among university students globally and is a significant public health concern. However, previous research has been limited in scope, focusing primarily on adolescents or the general public, leaving a gap in understanding the causal relationships associated with self-medication; thus, this study aimed to investigate the factors influencing self-medication practices among university students in Bangladesh by developing a comprehensive causal model. Data from 417 students across five public universities were collected using the simple random walk technique by a team of 10 members. The study utilized constructs of knowledge, attitude, and convenience related to self-medication as independent variables, while self-medication practice as the dependent variable. One-way ANOVA and structural equation modeling (SEM) were employed to develop a causal model of self-medication practice among university students in Bangladesh. The findings revealed that students with better medication knowledge and adverse drug reactions (ADRs) were more likely to practice self-medication. A positive attitude towards self-medication and ADRs was also significantly associated with higher self-medication practice scores. Additionally, those who perceived self-medication as convenient and prescribed medication as inconvenient had higher self-medication practice scores. The attitude towards self-medication had the most substantial negative effect on self-medication practice, followed by the inconvenience of prescribed medication and the convenience of self-medication. The model explained 87% of the variance in self-medication practice, indicating a good fit for the data. University students in Bangladesh possess intermediate knowledge of medication and primary knowledge of ADRs. They exhibit a positive attitude towards self-medication and ADRs. Physical convenience favors self-medication, while the inconvenience of prescribed medication contributes to its lower preference. Policymakers should focus on evidence-based guidelines to reduce the extent of unnecessary self-medication practice and to enhance the quantity and accessibility of prescribed medications to address the issue effectively.
... SM, when implemented properly, can be more appropriate, may alleviate acute pain, and lower treatment cost and doctor communication periods [19]. Nevertheless, it can threaten individual health and result in severe complications when applied improperly, such as practicing SM by using prescription-only medications [20]. For example, developing medication resistance is of huge concern with the recurrent and incorrect use of antibiotics that could be accessible without a prescription. ...
Background: Self-medication (SM) may be a common habit globally and also the unauthorized use of medication could be a reason for concern. Developing authorization, as a result of improved academic levels and larger access to data, combined with an extreme pursuit of personal health, is leading to a growing demand for direct involvement in health-care decisions. Most medications will have important unwanted side effects and this might result in clinical consequences with potential life threatening complications. The aim of this study is to estimate the prevalence of SM practice of undergraduate medical students listed at Saudi Arabian Medical schools.
... It is very common in China, where people can easily access drug information through various media channels. Self-medication can help protect health and save medical costs, but it can also pose significant health risks (Hughes et al., 2001;Stosic et al., 2011). Many surveys and studies have shown that Chinese residents often use drugs improperly because of factors such as socioeconomic level, cognitive level, traditional culture, personal experiences, limited medication knowledge, and false advertising. ...
Objective
Unsafe medication practices and medication errors are a major cause of harm in healthcare systems around the world. This study aimed to explore the factors that influence the risk of medication and provide medication risk evaluation model for adults in Shanxi province, China.
Methods
The data was obtained from the provincial questionnaire from May to December 2022, relying on the random distribution of questionnaires and online questionnaires by four hospitals in Shanxi Province. Multiple linear regression analysis was used to explore the factors affecting the KAP score of residents. Univariate and multivariate logistic regression was used to determine the independent risk factors, and the nomogram was verified by receiver operating characteristic curve, calibration and decision curve analysis.
Results
A total of 3,388 questionnaires were collected, including 3,272 valid questionnaires. The average scores of drugs KAP were 63.2 ± 23.04, 33.05 ± 9.60, 23.67 ± 6.75 and 33.16 ± 10.87, respectively. On the evaluation criteria of the questionnaire, knowledge was scored “fair”, attitude and practice were scored “good”. Sex, monthly income, place of residence, insurance status, education level, and employment were regarded as independent risk factors for medication and a nomogram was established by them.
Conclusion
Males, low-income, and low-educated people are important factors affecting the risk of medication. The application of the model can help residents understand the risk of their own medication behavior and reduce the harm of medication.
... For instance, they may over the dose of drug or extend period of time to cure their symptoms. Another concern with SM is they delay seeing doctor if the symptoms or diseases are more serious than they think (Hughes et al., 2001). ...
... It may lead to an incorrect diagnosis, mask underlying illness, antimicrobial resistance, drug dependence, drug abuse, and severe adverse effects due to excessive drug dosage and drug reactions. 2,3 A meta-analysis reported SM in approximately 38.8% (95% CI: 29.5-48.1) of the 31,340 participants from developing countries. 4 This study reported a wide variation of SM prevalence across developing countries. ...
Objectives
This study aimed to determine self-medication prevalence and its associated factors.
Methods
A community-based cross-sectional study was conducted in the urban and rural catchment areas of Uttar Pradesh, India, among 440 adults using a pretested, semistructured questionnaire. The Chi-square test and logistic regression were used to determine the association of self-medication prevalence with various independent variables. The associations were reported as adjusted odds ratios and 95% confidence intervals.
Results
The prevalence of medication use was 66.4%. The majority of participants (45%) took medicine for fever, cough (40.1%), and cold (31.8%). Allopathy (83.2%) was the most common medicine system used for self-medication. More than half reported taking medicine such as paracetamol (52%), followed by cough syrup (21%) and antihistaminic (17%). Convenience (46%) and lack of time (35.3%) were commonly cited reasons for self-medication. Also, 64.4% of the respondents practiced self-medication on the pharmacist’s recommendation. Urban participants (adjusted odds ratio: 9.85, 95% confidence interval: 5.32–18.23), females (adjusted odds ratio: 2.32, 95% confidence interval: 1.18–4.57), skilled workers (adjusted odds ratio: 5.62, 95% confidence interval: 1.80–17.5), and those who completed primary school (adjusted odds ratio: 2.48, 95% confidence interval: 1.16–5.25) were more likely to self-medicate than rural, male, unemployed, and illiterate participants, respectively. Also, participants whose income was 30,000 Indian rupees (adjusted odds ratio: 3.21, 95% confidence interval: 1.00–10.21) were more likely to self-medicate than those whose income was less than 4000.
Conclusions
A high prevalence of self-medication was found, particularly in urban areas. Convenience and lack of time were commonly cited reasons for self-medication. Allopathy was the most widely used medicine system for self-medication. Antipyretics, cough syrups, and antiallergics were most commonly self-medicated. Gender, education, and income were associated with self-medication. The study highlighted the increased usage among females which could be further explored and role of pharmacists’ recommendation as a major driver for self-medication.
... While previous studies have indicated that international students tend not to actively seek healthcare (Masai et al., 2021;Skromanis et al., 2018), relying instead on self-medication, this study found that transnational ties can serve as a coping strategy against barriers to healthcare utilization in Korea. However, this strategy also poses potential risks to students' health in the long term due to misdiagnosis, overdose, or prolonged medication duration (Hughes et al., 2001). Therefore, policymakers should take steps to promote access to healthcare while also educating international students on the potential dangers of self-medication. ...
The present study aimed to understand how Chinese international students perceived and experience healthcare utilization in Korea and to broaden Andersen’s framework in the age of globalization, allowing easier maintenance of transnational relationships with one’s native country. We analyzed the in-depth personal interviews with 31 Chinese international students. The grounded theory was employed to analyze the interview data. Among factors suggested by Andersen, predisposing (perceptions about the Korean healthcare system) and enabling (financial barriers, language barriers, and lack of social support) factors contributed to healthcare utilization among Chinese international students in Korea. Self-medication via broad medical transnational ties with the home country (bringing medications from home) impeded their healthcare utilization. We highlighted the roles of their campus health center to promote optimal healthcare utilization for Chinese international students. It is important to educate international students about the risks or negative effects of self-medication.
... To address the issue of resistance and to ensure the prudent use of medications, particularly antibiotics, it is necessary to define the role of clinical and community pharmacists in such a situation. To reduce hazards and ensure the wise use of antibiotics, programmes for education and communication between doctors and patients, patients and pharmacists and pharmacists and doctors are necessary [53]. To lessen the financial burden on patients and to advance the pharmacy profession and the legacy of a pharmacist in Pakistan, the government of Pakistan and draP should implement policies that ensure the sale of antibiotics only by generic-based prescription [54]. ...
... Self-medication has been defined as the consumption of medication (modern and/or traditional) for self-treatment without consulting a medical practitioner either for diagnosis, prescription, or medical supervision (Hughes et al., 2001;Zafar et al., 2008). It involves obtaining medication without a prescription, also taking medicines on the advice of friends and/or relatives, or using previous treatment experience ( Klemenc-Ketis et al., 2010;Adeel et al., 2023). ...
Background: Self-medication with antibiotics is a global phenomenon and a potential contributor to human pathogen resistance to antibiotics. It involves obtaining medication without a prescription, taking medicines based on the advice of friends and relatives, or previous treatment experience. Self-medication is common in both developed and developing countries; however, the prevalence of self-medication is higher in developing countries. The aim of this study was to determine the characteristics of antimicrobial self-medication in Georgia and its potential to influence the overall situation regarding antimicrobial consumption in the country.
Methods: We conducted a cross-sectional study using a random sampling method and developed a self-administered questionnaire to collect the data. The survey was conducted via the Internet using the Google Forms platform.
Results: The overall number of respondents was 742 adults living in Georgia. The results showed that 23.8% (n = 177) of adults had consumed antibiotics without a doctor’s prescription, and 12.7% (n = 94) confirmed the use of antibiotics by their own decision to treat minor family members. The total prevalence of self-medication was 32.6%. The data analysis revealed a correlation between factor F1 (“personal experience”) and gender (p = 0.042, F = 2.6), and between age and factor F2 (“lack of trust in medical practitioners”) (p = 0.047, F = 2.691). The correlation was stronger among young adults (aged 18–24) and senior adults (aged 60+). The correlation between the level of education and factor F2 was stronger (p = 0.00; F1 = 7.9) than with factor F1 (p = 0.04; F = 2.2).
Conclusion: Self-medication is prevalent in Georgia; pharmacies are the main sources of antimicrobials. No correlation was found between factor F2, pertaining to “lack of trust in medical practitioners” and gender, between age and factor F1, linked to “personal experience.” The study uncovered a lack of knowledge about self-medication with antibiotics and emphasized the importance of public awareness campaigns and implementing effective interventions to regulate the sales of antibiotics without a doctor’s prescription.
... La literatura refiere que la práctica de automedicación, puede enmascarar una enfermedad, retrasar la asistencia médica oportuna si el cuadro clínico se agrava, desencadenar reacciones adversas e interacciones medicamentosas, resistencia asociada con antibióticos y farmacodependencia. (Hughes et al., 2001;Alós, 2015;Fariña, 2016;Organización Mundial de la Salud, 2017). ...
Introducción: Las altas tasas de automedicación generan un grave problema de salud pública por el aumento de la morbilidad y mortalidad. Durante la pandemia generada por infecciones debidas a SARS-CoV-2, la automedicación fue muy frecuente debido a los altos índices de defunción y por el desconocimiento de un tratamiento eficaz. Caracterizar la población que se automedica es importante para poder intervenir con programas de prevención dirigidos al uso seguro y efectivo de medicamentos en esta enfermedad. Objetivo: Caracterizar la automedicación en estudiantes de Licenciatura en Farmacia infectados por SARS-CoV-2 mediante una encuesta on line para el establecimiento de programas que permitan la automedicación responsable en esta población. Metodología: Estudio descriptivo y transversal en 167 estudiantes de la Licenciatura en Farmacia que aceptaron el llenado de una encuesta en google forms, durante el período de febrero a julio del 2022. Resultados: El 44.3% de los estudiantes encuestados se infectó por SARS-CoV-2 y el 74.3% se automedicó. El hábito prevaleció en el sexo femenino (74.2%). El motivo más frecuente de automedicación fue el dolor (40.3%) y el medicamento más usado fue el Paracetamol (26.6%). Se reportaron 33 reacciones adversas, presentándose en el 42.4% reacciones adversas a las tabletas del día siguiente. Conclusiones: La prevalencia de automedicación en esta población fue alta, se usaron y combinaron medicamentos que provocaron reacciones adversas y fueron usados medicamentos que requerían receta médica, por lo que es necesario implementar un programa de prevención dirigido al uso seguro y efectivo de medicamentos en esta población.
... 4 Self-medication has also determined as the prime cause for delay in reaching the healthcare facilities for early diagnosis and prompt medical intervention; hence it is also known as one of the reasons for poor prognosis among such individuals. 5 Illogical utilization of antibiotics without medical prescription has also led to significant anti-microbial resistance in the community; hence necessitates discouragement at mass media level for health promotion and protection of our people from this menace. 6 Taking medication for self-diagnosed ailment by general public is associated with certain health-related risks particularly drug interaction, poly-pharmacy and drug dependence. ...
Objective: To analyse self-medication practice and its determinants among non-medical adult population of Rawalpindi. Study type, settings & duration: A cross-sectional descriptive study was carried out in Rawalpindi city from April to September 2022. Methodology: The 382 non-medical adults were enrolled through consecutive non-probability sampling. Self-administered structured questionnaire was used to gather the information pertinent to demographics of study subjects, distance from healthcare facility, access to medicines, ways of demanding medicine from pharmacist, reasons/ ailments for self-medication and source of information about drug. The data was analysed by using SPSS version 25.0 and Microsoft Excel 2016. Chi-square test was applied to determine the association of self-medication practice with education and socioeconomic status. p < 0.05 was considered significant. Results: Out of 382 study subjects, most (54.2%) were females with mean age of 22.46±0.79 years. About 83% respondents were indulged in self-medication practice and 31.8% of them did self-medication due to quick relief from symptoms while 43.3% of the 65 persons did not indulge in self-medication due to fear of wrong use of drug. Low and middle social class had statistically significant association (p <0.001) with self-medication practice. Similarly educational level has non-significant association (p >0.05) with self-medication practice. Almost 61.8% of respondents were urban dwellers and 70% were students. About 40.14% were practicing self-medication in compliance with previous prescription. Conclusion: Female students are more indulged in self-medication practice for getting relief of their symptoms from previously prescribed medications.
... Responsible self-medication has advantages such as reduced doctor visits, reduced burden on the health system, and access to effective treatment (10). Conversely, irresponsible self-medication leads to misdiagnosis, adverse drug reactions and drug-drug interactions (11). ...
... Swamedikasi memungkinkan pasien untuk mengambil tanggung jawab dan membangun kepercayaan diri untuk mengelola kesehatan mereka sendiri, dengan demikian, meningkatkan pemberdayaan diri. Selain itu, dapat menghemat waktu yang dihabiskan untuk menunggu dokter, mungkin ekonomis, dan juga menghemat skema medis dan sistem kesehatan nasional (Hughes et al., 2001). Pola pengobatan sendiri bervariasi antar populasi dan dipengaruhi oleh banyak faktor seperti usia, jenis kelamin, pendapatan dan pengeluaran, orientasi perawatan diri, tingkat pendidikan, pengetahuan medis, kepuasan dan persepsi penyakit (Aljinović-Vučić et al., 2005). ...
Child Welfare Institution (CWI) managers often provide self-treatment or self-medication when foster children experience mild symptoms of illness. In its implementation, self-medication often results in inaccuracies. For this reason, it is necessary to increase the self-medication knowledge capacity of CWI managers in Bengkulu City. The aim of this activity is to increase knowledge about self-medication by CWI managers. This activity provides knowledge about how to manage medicines properly and correctly. The training was given using the Active Human Learning Method which was attended by 30 people. Based on the pretest results, the average score was 5.73, while the posttest results showed an increase in the average score to 7.27 and was tested by an independent t-test (p=0.000). Increasing this knowledge is important in supporting rational drug use programs. Keywords: Child Welfare Institutions, knowledge, self-medication.
... Preventive medication for COVID-19 was consumed by 5.6% of the study population and was associated with age, a higher educational level, having a chronic disease, residing in an urban area, and not having a state of poverty, while being a woman, residing in the highlands, and not having a landline, cell phone, TV or internet were associated with a lower prevalence of drug use. The misuse of medications can lead to health consequences, by increasing the risk of drug interactions and adverse reactions due to inadequate dosing (i.e., QT interval prolongation, bleeding, diarrhea, nausea), [26][27][28][29] and the use of antibiotics exacerbates the rise in antimicrobial resistance. 30,31 Thus, it is noteworthy that even after one year of the pandemic and strong recommendations against the use of many of the "preventive" drugs by international guidelines, their consumption is still prevalent in the Peruvian population. ...
Objective: The objective of this study was to identify the prevalence and factors associated with the use of drugs without evidence for the prevention of COVID-19 in Peruvians without symptoms or diagnosis, using the National Household Survey (ENAHO) 2021. Methods: A secondary analysis was made of the ENAHO 2021. We evaluated participants older than 18 years who did not undergo any test to diagnose COVID-19 and used any drug to prevent COVID-19. Adjusted prevalence ratios (aPRs) were estimated to determine the associated factors. Results: Among the 69,815 participants analyzed, the prevalence of taking a drug 4 weeks prior to the survey was 5.64%. Factors associated with drug consumption were: age 30-59 years (aPR 1.47; 95% confidence interval [CI]: 1.32-1.65); having a higher education (aPR 1.73; 95% CI:1.28-2.33); having a chronic disease (aPR 1.40; 95% CI: 1.26-1.56); not having poverty status (aPR 1.40; 95% CI: 1.26-1.56); living in an urban area (aPR 1.61; 95% CI: 1.31-1.99). Meanwhile, living in the highlands (aPR 0.77; 95% CI: 0.60-0.97) and not having a landline, cell phone, television or internet at home (aPR 0.65; 95% CI: 0.43-0.98) were protective factors from unnecessary drug consumption. Conclusion: It is concerning that even after one year of living with the pandemic and having refuted the utility of medications such as ivermectin and azithromycin, these drugs are still widely consumed by a sector of the population without symptoms or a diagnosis of COVID-19. Therefore, it is necessary to formulate and implement public health measures that address this problem, taking into account the associated factors to reduce this consumption.
... Simple medications that are commonly used are available without a medical prescription in pharmacies in some countries [3]. SM may include the use of herbal medicines [4]. There are many forms of SM, including using medications without a medical prescription, using previously prescribed medications, and prescribing medicines to other persons [5]. ...
Background: Self-medication with ophthalmic medications is a common practice; however, it raises concerns about the safety and appropriateness of treatment. Therefore, the current study aims to evaluate the knowledge, attitudes, and approaches toward self-medicating eye symptoms in the Jazan region.
... Attitude towards ADR AT-2 Positive (4-9), Undecided (10)(11)(12)(13)(14), Negative (15)(16)(17)(18)(19)(20) ADR reporting by the public is necessary AT-2- ...
Self-medication is a prevalent practice among university students globally and is a significant public health concern. However, previous research has been limited in scope, focusing primarily on specific student groups or the general public, leaving a gap in understanding the causal relationships associated with self-medication; this study aims to investigate the factors influencing self-medication practices among university students in Bangladesh by developing a comprehensive causal model. Data from 417 students across five public universities were collected using the random walk technique by a team of 10 members. The study utilized constructs of knowledge, attitude, and convenience related to self-medication as independent variables, with self-medication practice as the dependent variable. One-way ANOVA and structural equation modeling were employed to develop a causal model of self-medication practice among university students in Bangladesh. The findings revealed that students with better medication knowledge and adverse drug reactions (ADRs) were more likely to practice self-medication. A positive attitude towards self-medication and ADRs was also significantly associated with higher self-medication practice scores. Additionally, those who perceived self-medication as convenient and prescribed medication as inconvenient had higher self-medication practice scores. The attitude towards self-medication had the most substantial negative effect on self-medication practice, followed by the inconvenience of prescribed medication and the convenience of self-medication. The model explained 87% of the variance in self-medication practice, indicating a good fit for the data. University students in Bangladesh possess intermediate knowledge of medication and primary knowledge of ADRs. They exhibit a positive attitude towards self-medication and ADRs. Physical convenience favors self-medication, while the inconvenience of prescribed medication contributes to its lower preference. Policymakers should focus on evidence-based guidelines for self-medication and enhance the quantity and accessibility of prescribed medications to address the issue effectively.
... Mistakes such as misdiagnosis, overdose, and delays in seeking medical care are more likely to occur if one attempts to self-treat without having a clear understanding of their condition and the potential risks associated with their chosen approach. Inaccurate or incomplete treatments may result in prolonged suffering, worsening of the condition, and unforeseen side effects, as well as potentially increasing overall costs [1,2]. ...
... Such drugs are labeled as "over the counter" (OTC) drugs and their availability, consumption, and provision of such drugs vary as per the health system and regulation of each country. For example, in the United States, OTC drugs are available at both the drug and general store, while in the United Kingdom, OTC drugs are only available to the drug store with some exception, where few OTC drugs could be found at general store (Hughes et al. 2001). ...
... While independent self-care reduces demand on healthcare services, it is associated with misdiagnosis, and incorrect use of medicines (prolonged duration, excessive dosage, etc.), which can exacerbate long-term conditions or result in delayed access to treatment. This can contribute to increased demand on services and increased morbidity; therefore, there are benefits to pharmacists supporting self-care in many cases, particularly where health literacy is low [10,11]. Funded minor ailment services have been shown to be cost-effective when compared with usual self-care through pharmacy, both in terms of symptoms resolution and Quality-Adjusted Life Year (QALY) gains [12]. ...
Objectives
Since 2013 community pharmacies in Wales have been commissioned to provide a common ailments service (CAS), providing pharmacy medicine without charge to patients. In the first review of national pharmacy data, this study aimed to describe the relationship between provision of CAS and deprivation.
Methods
A retrospective observational study, using CAS claims data from April 2022 to March 2023 collected as part of routine service delivery. Consultation data were matched to the index of multiple deprivation (IMD) decile of the providing pharmacy. Linear regression was used to describe the correlation between CAS claims data and IMD deciles of the pharmacy postcode.
Key findings
In the study period, 239 028 consultations were recorded. More than twice as many consultations were carried out in pharmacies located in the most deprived decile (33 950) than in pharmacies in the least deprived decile (14 465). Linear regression demonstrated a significant correlation r(10) = −0.927, P < 0.001. There was a strong relationship between greater numbers of consultations and greater deprivation of the pharmacy postcode (R2 = 0.887). This significant correlation with deprivation was also found in the majority of individual conditions. There was no significant correlation between deprivation decile and the number of consultations per patient.
Conclusions
Community pharmacies offer a key resource for tackling health inequalities. Patients in those areas with the greatest need are those most likely to use the CAS in pharmacies and receive the care they need. Commissioning services like this naturally supports deprived communities, through a combination of patient behaviours, location, and accessibility.
... The parameter settings are as follows: as the drugs involved in this article are used to treat common illnesses, the wholesale price is set at w = 100 ; based on the price list published by the Beijing Price Bureau (Chen, 2017). The outpatient fee is set at o h = 50 ; as the self-treatment accuracy for common illnesses ranges from 70% to 90% (Hughes, 2001). We assume the safety of self-medication l = 80% ;given the doctors' tendency to err on the side of caution, a referral rate d of 40% is established. ...
In the current era of e-commerce, the pharmaceutical industry has not experienced the same level of growth as regular commodities due to the high costs associated with home delivery and the perceived risks associated with purchasing drugs online. This paper proposes an omni-channel strategy to address these challenges, involving an “order online, home-delivery offline” approach between e-pharmacies and drugstores, with telemedicine serving as a coordination mechanism between e-pharmacies and hospital doctors. The proposed strategy achieves a seamless patient experience during online diagnosis. To analyze its feasibility, the paper employs optimization techniques to compare the profits of supply chain members in both omni-channel and non-omni-channel scenarios. The results demonstrate that the proposed strategy is both practical and efficient, boosting patients' trust in e-commerce and improving the profitability of the pharmaceutical industry.
... Self-medication has become a common practice in health care, allowing patients to manage minor illnesses independently and reduce clinical visits. However, self-medication also carries risks such as misdiagnosis, drug interactions, misuse of drugs, ADRs, and polypharmacy [19] . ...
Background
Self-medication is a global phenomenon that can lead to adverse consequences. This study was conducted to assess the self-medication status among international students in Pakistan so that rational use of medicines (RUM) can be assured with effective interventions.
Methods
A web-based cross-sectional survey was conducted among 317 international students in different universities in Pakistan. The original Bloom’s cutoff point was utilized to categorize the participants’ overall knowledge, attitude, and practice. The χ ² test was used to test for group differences. For binary logistic regression analyses, the odds ratio (OR) was calculated at 95% CI. Spearman rank correlation coefficient test was used to assess the relationships among the knowledge, attitude, and/or practice scores.
Results
The participants demonstrated overall good knowledge (85.5%), positive attitude (83.9%), and good practice (78.5%) towards self-medication. None of the demographic parameters were found statistically significant with knowledge, attitude, and practice about self-medication. The participants with good knowledge and positive attitude had more than 7 and 30 times high odds of good practice (OR: 7.97, 95% CI: 4.06–15.65, P < 0.001 and OR: 30.91, 95% CI: 14.26–67.00, P < 0.001) than those without good knowledge and positive attitude, respectively.
Conclusion
Good knowledge, positive attitude, and good practice towards self-medication show the value of education and awareness towards RUM. The interventions to halt the irrational practice of self-medication, expanding awareness, and executing legislation to upgrade the judicious use of self-medication practices are indicated for the RUM at the national level.
... 1,2 The use of medications without a doctor's prescription is another way of defining self-medication. 3 Over-thecounter (OTC) and nonprescription medicines are those that are sold without a doctor's prescription for selfmedication. Prescription products are those medications that require a doctor's prescription (Rx products). ...
Self-medication is thought to be very widespread, especially among adults and teenagers. It is the practice of using medications to treat conditions or symptoms that one has recognized or diagnosed oneself. The area of healthcare involving self-medication is becoming more and more significant. Self-medication is widely used for many common illnesses, including headaches, common cold, flu and diarrhea. During the COVID-19 pandemic, self-medication was also discovered to be very prevalent. However, self-medication with antibiotics is not considered as safe. People may self-medicate due to socioeconomic factors like lifestyle, drug availability, or financial hardship. Individuals who cannot afford the cost of a doctor's visit or clinical services can self-medicate because it is a less expensive option. Self-medication does, however, come with risks, such as the potential for prolonged use, misdiagnosis, overdosing, polypharmacy and drug interactions. This review describes the use of various drugs as self-medications in general ailments, in COVID-19 as well as use of antibiotics as self-medication and various risks associated with the self-medication.
... It is defined as "the use of medicinal products by the consumer to treat self-recognized disorders or symptoms, or the intermittent or continued use of a medication prescribed by a physician for chronic or recurring diseases or symptoms" [1]. Responsible self-medication can promote a long, healthy life, and many healthcare programs have claimed that appropriate self-care and self-medication should be the first step of effective treatment [1,2]. However, inappropriate self-mediation can lead to many health risks, such as delayed diagnosis and treatment, undue therapy, pathogen resistance, and drug interactions [1,3]. ...
Parents self-medicating their children with antibiotics (SMA) without consulting healthcare professionals is a common practice in China. Previous research has focused primarily on examining the socioeconomic factors that contribute to the prevalence of SMA. This study adopts and extends the theory of planned behavior to understand the cognitive and emotional factors that are associated with parental SMA in China. The responses to an online survey were collected from 961 parents of children aged 6–12 years old, primarily from Gansu, Shandong, and Shaanxi provinces. More than half of the participants (66.5%) engaged in parental SMA. Amoxicillin, Cephradine, and Azithromycin were the most frequently selected antibiotics used for children. Structural equation modeling showed that uncertainty was positively associated with negative emotions, which were in turn positively associated with attitude toward SMA. Uncertainty was also negatively associated with perceived behavioral control (PBC), but the association between PBC and SMA behavior was not significant. Attitude and subjective norm were both positively associated with SMA behavior. The relationship between subjective norm and attitude was also positive. Understanding the psychological factors driving parental SMA may inform tailored interventions to promote responsible antibiotic use among parents.
... This is due to the wide variety of possible adverse health effects associated with this behaviour, which change with the specific drugs involved and the individual's sensitivity to them. There are a wide variety of negative health outcomes that can result from drug abuse, including but not limited to: increased resistance to certain types of medication; decreased treatment efficacy due to inappropriate use; delayed proper diagnosis; severe medication side effects; toxicity; dangerous drug interactions; drug dependence; hypersensitivity to certain drugs; withdrawal symptoms from resistance; and many more (Bennadi, 2014; Hughes et al., 2001;WHO, 2000b). However, the World Health Organization (WHO) has highlighted that responsible self-medication does offer the benefit of avoiding and treating those diseases which do not require prior medical consultation and has the potential to give a cheaper alternative for treating common sickness (WHO, 2000a). ...
Across the globe, people are increasingly turning to self-medication as a form of self-care. "Self-medication" refers to the practise of obtaining and using medication without a doctor's supervision. The purpose of this research was to examine the frequency and nature of self-medication among medical students, as well as the factors that contribute to this trend. With the help of a systemic random sample method and a tried-and-true semi-structured proforma, researchers were able to perform a cross-sectional descriptive study with 200 medical students. Statistical analysis was performed using Chi-square and odds ratio (OR): This cross-sectional study uses a stratified and proportional sampling strategy to recruit 840 students from a single university in Portugal. In addition to standard socio-demographic questions, a self-administered questionnaire probed respondents' levels of self-medication knowledge (a 14.488), attitudes toward self-medication (a 14.708), and self-medication practise patterns (a 14.445). Using t-tests and analysis of variance, we compared demographics and outcomes. Self-medication predictors were identified using a generalised linear model.
... This is something that an individual never learns at school despite of the fact that he/she will need to use this in many stages throughout their life. Home remedies and medications at home first are very advantageous to people, it facilitates use of clinical skills efficiently, increases access to and exposure to medicines and help economically as well in reducing prescribed drug costs (Hughes et al., 2001). Our analysis suggests that learners should be exposed to environment as much as possible even in the formal setting of education. ...
This research study aims to understand and explore the role of informally taught values and skills which are required to have for living in a society and a culture. Therefore the main purpose of this research is to highlight those skills and values which are being taught informally to the individuals. These informal ways might include teachings of older family members in the form of versatile knowledge and numerous vocational skills which are not formally taught in classrooms and are very much necessary for individuals to be efficient at life and mentally sound in every aspect. In addition to this, through the literature review it also covers the comparison between the informal and the modern/formal teachings to educate a child. Furthermore, this study intends to identify the role of informal ways and behaviors, social and cultural interactions of individuals and informal remedies and advices in the upbringing and education of an individual. Considering the nature of the research topic, this is a qualitative exploratory research in which three data collection tools have been used which includes semi structured interviews, participatory observation and focused group.
... without a prescription), as their use is believed to be safe even over long periods [2]. Moreover, purchasing an analgesic without a prescription is considered by many members of the public to be less time-consuming, less costly, and result in faster pain relief compared to visiting an emergency room or making an appointment to be examined by a general physician [3]. ...
Background: Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly utilized to reduce pain, inflammation, and fever. This study aimed to assess patterns of use and awareness of NSAID-related side-effects in an adult Jordanian. And the associations with sociodemographic factors. Methods: This cross-sectional study among a representative sample of 604 adults >18 years. A validated, self-administered questionnaire was used to collect basic sociodemographic data from the participants, as well as information regarding NSAID use. Results: Most respondents were NSAID users (65.7%), female (53.4%) and under 50 years of age (74.5%). Overall, 42.6% had been prescribed NSAIDs by a physician. Male gender and smoking were negatively correlated with NSAIDs use (multivariable odds ratio [OR]: 0.5, 95% confidence interval [CI]: 0.4–0.8, p = 0.001 and OR: 0.6, 95% CI 0.4–0.8, p = 0.003). In contrast, the Ministry of Health Insurance was associated with NSAIDs use with OR: 1.6, 95% CI: 1.1–2.6, p = 0.03. Overall, 65.1% were aware of kidney NSAID-related side-effects and 22.4% were aware of the increased risk of asthma and allergy. Conclusion: Despite the high frequency of NSAID use in the Jordanian general population, there is limited knowledge of their side-effects as well as drug interactions. This is cause for concern, particularly as many participants reported having been prescribed NSAIDs by physicians without adequate patient safety education.
This study examined self-medication as a response to illness situations and its implications for healthy living among undergraduate students of the Federal University of Lafia (FULafia), Nasarawa State, Nigeria. The study adopted the Theory of Reasoned Action. A cross sectional research design was used in the study and was carried out at the Federal University of Lafia among undergraduate students of the University. A purposive sampling technique was implemented for the selection of respondents. A sample size of 400 was obtained using Rao (1985) determination formula. Data was collected through questionnaires and in-depth interviews. The analysis was accomplished using descriptive and inferential statistics. The findings of the study indicated a high rate of self-medication among undergraduates of the Federal University of Lafia. Both traditional and orthodox medicines were self-medicated among the undergraduates of FULafia. Self-medication was influenced by availability, accessibility, and affordability of drugs by the undergraduates. It was concluded that, self-medication helps as a response to illness, but it has both negative and positive implications on the healthy living of the students of the Federal University of Lafia, therefore, the school management should situate health facilities on the campus so as to enhance students’ free and easy access to healthcare whenever the need arises.
ABSTRACT
Background:
Pharmacists play an essential role in self-medication by providing guidance and counselling services to consumers; hence, it is necessary to assess pharmacists’ awareness and attitude towards self-medication to promote responsible self-medication practices.
Objective:
To develop a valid and reliable instrument to assess the knowledge and attitude of pharmacists towards self-medication practices and their role in promoting responsible self-medication.
Method:
A questionnaire was developed in English after a relevant literature review, which was further administered to a sample of 105 community pharmacists. The reliability of the questionnaire was assessed using the Karl–Pearson correlation and Cronbach alpha statistics. Content validity was evaluated by subject experts. The dimensional structure of items was assessed through exploratory factor analysis and confirmatory factor analysis (CFA).
Key Findings:
The final questionnaire comprises 27 items for knowledge and attitude with a Karl–Pearson correlation value of 0.896 and Cronbach alpha value of 0.814 (24 items), indicating good internal consistency and reproducibility. Factor analysis identified five factors: namely, (i) attitude towards providing guidance and advice to consumers to promote responsible SMP, (ii) attitude towards shared responsibility for promoting rational medicine supply and use, (iii) knowledge of the advantages and disadvantages of SMP, (iv) knowledge of the definition of self-medication, (v) attitude towards professional competency of a pharmacist as a healthcare provider. CFA results demonstrate good model fit with the value of Chi-square (184.56), CFI (0.937), RMSEA (0.054), and SRMR (0.075). Model validity measures ensure satisfactory validity and reliability.
Conclusions:
The findings demonstrate a valid and reliable measure for assessing the knowledge and attitude of pharmacists towards self-medication.
Introduction
Healthcare students are becoming increasingly concerned about self-medication (SM), which can have major health repercussions. It affects how future physicians make professional decisions about medications. Such a mindset has an indirect impact on providing their patients with appropriate counselling. The study was planned to investigate the attitude, determinants and different clinical aspects associated with SM of dental pain amongst medical students in Jeddah, Saudi Arabia.
Materials and Methods
The present descriptive cross-sectional study was conducted exclusively on the 400 medical students from the 1 st year and interns pursuing bachelor’s degrees from various medical colleges in Jeddah, Saudi Arabia. A convenient non-probability sampling technique was employed, and a pre-tested/pre-validated questionnaire was loaded on Google Forms and sent to the medical students of medicine, dentistry, pharmacy and nursing programmes. Qualitative characteristics were assessed using the Chi-square test. The significance level ( P value) chosen for the various comparisons was P < 0.05.
Results
The results of this study show that 65.5% of students self-medicate. It was significantly more common in women (74.9%), pharmacists (76.9%) and dental students (72.7%). Students who self-medicated less often were in the 1 st and 2 nd years (49.2% and 57.1%). Toothache was the most common cause for which they self-medicated (79.8%).
Conclusion
The results of the present study have shed light on the fact that SM was high amongst medical students in Jeddah. The potential problems associated with self-medication should be highlighted to students to reduce the risk of inappropriate SM, which can seriously harm both students and others to whom they prescribe medication.
Recently, self-medication using over-the-counter medicine (OTC) or non-prescription medicine became rapidly popular. Enhancing society's awareness of OTC knowledge and its rational use is greatly significant to promote public health both in adults and children. In the US, a high number of young children are brought to the emergency room due to accidental unsupervised medication each year. Therefore, learning how to self-medicate using OTC at an early age is very critical to improve medication safety in society. This study aims to trained elementary school grades V and IV at the age of 10 to 12 to perceive the basic knowledge of OTC and how to take them safely. This study conducted outreach to students in grades V and VI starting with a pre-test, education dan training, followed by a question-and-answer session, and closed with a post-test. After education and training, the knowledge of the OTC among the students increased, especially significantly in Grade V indicated by post-test score elevating. Thus, this attempt may contribute to increasing the awareness of self-medication using OTC among children.
The purpose of the study was to assess the self- medication practices among healthcare workers in southIndia famous hospital JIPMER, Puducherry. Study had the aim to assess the self- medication practicesamong health care workers , to know the common drugs used for self –medication and potential reasonscontributing to self-medication practices among health care workersThe population included all staff nurses, pharmacists, radiology technicians, anaesthetists, laboratorytechnicians, health assistants and social workers who are working at different units of JIPMER Hospital,Puducherry. Proportionate sampling technique was used to select the sample for the present study. Sampleconsists of 296 health care workers in JIPMER hospital Puducherry. After getting permission from NursingResearch Monitoring Committee (NRMC) and Institute Ethical Committee (IEC), the healthcare workers ofJIPMER were contacted to collect data. They were approached after the working hours, explanation aboutthe study has been given to the healthcare workers and written informed consent has been obtained fromthem. Structured self-report questionnaire has been used to collect data. Each participant approximately took30 minutes to answer the questionnaire. The findings of the study revealed that 88% of healthcare workerspracticing self-medication and 12% were not practicing any form of self-medication. Majority of participanttook medications like analgesics 246 (34.7) antipyretic 146 (20.3) antibiotic 78(10.8) antacid 66 (9.7).
Previous research has demonstrated a link between the administration of analgesic drugs and the reduction of empathy levels in humans. This apparent blunting effect of pain medication has been explained through shared neural mechanisms for the first-hand and the empathic experience of pain (simulation theory). Considering that analgesics are among the most consumed drugs in the world and the ability to empathize with others is fundamental to human social interactions, the aim of the present study was to investigate whether the typical day-to-day analgesic consumption rate in Austria and Germany is associated with a reduction in empathy and prosocial behavior. We therefore collected self-reports of analgesic consumption behavior as well as empathy for pain and prosocial behavior measures in an online survey ( n = 940). Analyses revealed no significant association between the analgesic intake frequency and measures of empathy or prosocial behavior. However, liberal intake of analgesics (i.e. mind-set of “a pill is a quick solution”) was linked to lower empathic concern and helping behavior, which may hint towards a negative effect in people who take pain medication for non-pain related issues or episodes of low pain. Nevertheless, further research is needed to investigate the effects of analgesic drugs in high frequency users.
Background: The rise in trends of self-medication, particularly among medical students without being aware of its consequences, especially during the COVID pandemic, has raised a major concern. Self-medication may lead to unintended consequences, such as adverse events, unnecessary expenses, delay in attending professional evaluation, masking of symptoms, and drug interactions. Aims and Objectives: The aim of the study was to analyze the prevalence, practice, and pattern of self-medication during the COVID-19 pandemic among medical students. Materials and Methods: In October 2022, a cross-sectional questionnaire-based study was conducted using a validated, pretested questionnaire. Information regarding the demographic details, symptoms that led to self-medication, various drugs used, source of drug information, drug used/drug groups used, and reasons for self-medication during COVID-19 were all described in terms of frequency and percentage. Results: In the present study, 80% of the students practiced self-medication. Fever and headache were the most common symptoms for which self-medication was taken. Paracetamol and azithromycin were the most common drugs used for self-medication. Forty-four percent of the students used medical formulas from the previous consultation as the source of drug information, and 16% from the Internet. About 85% of students obtained the drug from a pharmacy. Thirty-two percent of the students self-medicated because they had symptoms of COVID-19 and 29% as a preventive measure. Conclusion: Self-medication was widely practiced by medical students during the COVID-19 pandemic. There is a need to educate medical students through various measures about the rational use of self-medication.
Introduction: The prevalence of self -medication with antibiotics is quite high in Pakistan as compared to developed countries. Antibiotics are often taken erroneously for certain ailments, without having the appropriate and sufficient knowledge of their use. As a result, this carries potential risks for the individual as well as the community, in form of several side effects such as antibiotic resistance. Therefore, the prevalence of self-medicated antibiotics in COVID-19 Omicron Pakistan needs to be studied and evaluated. Methods: An online based cross-sectional survey was conducted using a self-administered, self-made and validated questionnaire to address this key issue in Pakistan. This questionnaire was delivered country wide and making it sure that it would reach all the provinces including the capital of Pakistan. The questionnaire included general as well as specific questions in such a way that it targeted almost every single person having at least certain knowledge about medicines especially antibiotics. Data was collected using self-administered questionnaires and analyzed using SPSS version 21. Results: A total of 390 respondents were included in the final analysis. In this study men made up the majority of respondents, 240 (61.5%), and females made up about 150 (38.5%). Self-medication was quite prevalent in our study population with 125 (32.1%) out of 390 (100%) individuals were using any of the drugs since the start of pandemic. The most commonly utilized medications were cephalosporin, ceftriaxone (32.1%). Followed by macrolides, azithromycin, clarithromycin which was used by 119 (30.5%) participants. And penicillin, amoxicillin with clavulanic acid (17.4%) and fluoroquinolones, ciprofloxacin (7.2%) while the percentage of use of other antibiotics is 12.8%. The most common reasons reported for the usage of these medications included fatigue, cough, sore throat and runny nose which was about (48.7%). Conclusion: Our study revealed common self-medication practices among General population. It is a significant health issue especially during the pandemic times, with high consumption reported as a prevention or treating symptoms of Omicron.
Adverse Drug Reactions (ADRs) have a direct impact on human health. As continuous pharmacovigilance and drug monitoring prove to be costly and time-consuming, computational methods have emerged as promising alternatives. However, most existing computational methods primarily focus on predicting whether or not the drug is associated with an adverse reaction and do not consider the core issue of drug benefit-risk assessment—whether the treatment outcome is serious when adverse drug reactions occur. To this end, we categorize serious clinical outcomes caused by adverse reactions to drugs into seven distinct classes and present a deep learning framework, so-called GCAP, for predicting the seriousness of clinical outcomes of adverse reactions to drugs. GCAP has two tasks: one is to predict whether adverse reactions to drugs cause serious clinical outcomes, and the other is to infer the corresponding classes of serious clinical outcomes. Experimental results demonstrate that our method is a powerful and robust framework with high extendibility. GCAP can serve as a useful tool to successfully address the challenge of predicting the seriousness of clinical outcomes stemming from adverse reactions to drugs.
Imagine you are a general practitioner. A middle aged male patient of yours has taken a cholesterol test at a pharmacy which showed raised concentrations and wants to discuss his treatment options. Following sound evidence1 and national guidelines,2 you tell him that, because he has no other risk factors, medical intervention is not warranted. However, the patient knows that recent trial evidence shows that statins can reduce cardiac events even in populations with mildly raised total cholesterol concentrations.3 You know that such use could greatly increase the cost of such drugs—to as much as £3.5bn in England,4 from £113m in 1997.1You support shared decision making with patients,5 6 but you recognise the dilemma here: should you see yourself as the agent of the patient, focusing on the effectiveness of treatments, or of the healthcare system and the population it serves, focusing on affordability?If you choose the system perspective there is more scope for conflict between you and the patient about the treatment of choice. In some cases conflict can arise because the patient's choice is likely to affect negatively the health of others. For example, the efficacy of some forms of immunisation requires high utilisation to ensure herd immunity, but individuals focusing on its costs and benefits to them may decide not to have immunisation. Similarly, a patient requesting antibiotics for a simple viral infection may be reluctant to recognise the dangers to population health of inappropriate antibiotic use.In most cases the treatment chosen by the individual patient does not so directly impact on the health of others, yet it will still have an opportunity cost. Resources used to treat one individual will be unavailable for other patients covered by the same health system This situation applies to all collectively funded systems, including those based on private insurance.7 Moreover, when patients do not personally bear the costs of treatment there is little incentive for them to constrain their pursuit of maximum health gain. If, together with the patient, you decide to prescribe statins because it will slightly reduce his risk of a cardiac event, regardless of the cost of this form of management, the patient's extra benefit will be at the expense of others in the system who are unable to have their preferred—and possibly more effective—treatment. If the objective of the system is to maximise total health benefits from available resources then, within a collectively funded system, the individual doctor-patient partnership may not be able to make an unconstrained choice.If shared decision making is an important policy objective how can the risk of conflict be reduced? One approach is to augment the clinical evidence with information about costs of treatment.8 You and your patient would then be expected to weigh up all the attributes of treatment, including costs. To be consistent with the system's goal, the final decision needs to strike a balance between the likely benefits to your patient and the benefits forgone to other patients. Healthy individuals may behave altruistically in health care—blood donation is one example. Nevertheless, it is an important research question whether, when the implications of limited resources are explained to them, ill patients are willing to agree to decisions which result in less chance of health gain for themselves but improved aggregate outcomes.An alternative to relying on the individual patient's altruism is for the doctor to filter the information and tell patients only about treatments the health system is willing to fund. However, as more sources of information become available to the patient, for doctors to discuss only cost effective treatment options would threaten the trust that has to underlie a successful partnership.A more promising approach to lessening the conflict between the doctor and patient is to make a clear distinction between clinical guidelines, which inform doctors (and, through them, their patients) about the health related attributes of treatments, and system guidelines, which indicate which treatments the system will fund.9 Telling the patient about all available treatments while also indicating which ones the system will fund will not, of course, remove the conflict. Rather, it shifts it away from the consulting room towards the policymakers who decide what the system will fund But this is the most appropriate place for systemwide funding decisions if the process is transparent, based on good analytical methods and explicit system objectives, and, ideally, has high levels of political accountability. In some countries systemwide statements are provided about whether particular healthcare interventions will be funded from public resources—for example, in the case of new pharmaceutical products in Australia10 and Ontario.11 The National Institute for Clinical Excellence in England represents an opportunity for the NHS to provide clear statements about whether or not it will fund particular interventions and, if so, for which patients.Thus you would be able to share all relevant information with your patient about the clinical implications of statins, perhaps emphasising the very small changes in cardiac risk they would generate, but you could also tell him that the health service had ruled out funding these drugs for people like him.But what if your patient continues to want statins? In many countries he could fund the treatment himself. The extent to which private funding is permitted, either through private insurance or payments at the point of consumption, is ultimately a political decision, reflecting, among other things, society's beliefs about equity in and access to health care. Therefore the conflict between the individual and society reaches its ultimate manifestation in political choices about a preferred healthcare system.References1.↵NHS Centre for Reviews and Dissemination. Cholesterol and coronary heart disease: screening and treatment. Effective Health Care 1998; 4.2.↵Standing Medical Advisory Committee. The use of statins. London: Department of Health, 1997.3.↵Downs JR, Clearfield , Weis S, Whitney E, Shapiro DR, Beere PA, et al. Primary prevention of acute coronary events with Lovastatin in men and women with average cholesterol levels. JAMA 1998; 279: 1615–1622.OpenUrlFREE Full Text4.↵Pickin DM, Payne JN, Haq IU, McCabe CJ, Ward SE, Jackson PR, et al. Statin therapy/HMG Co-A recuctase inhibitor treatment in the prevention of coronary heart disease. Sheffield: Trent Institute for Health Servies Research, 1996.5.↵Charles C, Gafni A, Whelan T. Shared decision-making in the medical encounter: what does it mean? (or it takes at least two to tango). Soc Sci Med 1997; 44: 681–692.6.↵Charles C, Gafni A, Whelan T. Decision making in the physician-patient encounter: re-visiting the shared treatment decision model. Soc Sci Med 1999; 49: 651–661.7.↵Eddy DM. The individual v society. Is there a conflict? JAMA 1991; 265: 1446–1450.OpenUrlFREE Full Text8.↵Freemantle N, Mason J. Not playing with a full DEC: why development and evaluation committee methods for appraising new drugs may be inadequate. BMJ 1999; 318: 1480–1482.OpenUrlFREE Full Text9.↵Browman GP, Levine MN, Mohide EA, Hayward RSA, Pritchard KI, Gafni A, et al. The practice guidelines development cycle: a conceptual tool for practice guidelines development and implementation. J Clin Oncol 1995; 13: 502–512.OpenUrlFREE Full Text10.↵Commonwealth of Australia. Guidelines for the pharmaceutical industry on preparation of submissions to the Pharmaceutical Benefits Advisory Committee: including major submissions involving economic analyses. Canberra: AGPS, 1995.11.↵Ministry of Health. Ontario guidelines for economic analysis of pharmaceutical products. Ontario: Ministry of Health, 1994.
Self medication with over the counter medicines has long been a feature of the lay health system. With the reclassification of certain drugs, the public can buy preparations that were previously available only on prescription. Sales of over the counter medicines are now equivalent to a third of the NHS drugs bill; governments throughout the world see self medication as a way of shifting some of the cost of health care onto consumers. The trend towards increased self care and with it the increasing empowerment of patients has many potential benefits; collaboration between doctors and pharmacists will be critical.
There is a paucity of research about patients' attitudes towards their doctor's recommending over-the-counter (OTC) remedies or about how patients respond to the doctor's suggestion to try an OTC remedy.
The aim of this study was to ascertain the attitudes of patients to OTC drugs.
505 consecutive patients from each of six participating practices filled in a questionnaire.
A total of 2765 (91.3%) patients responded. The responses from 2624 patients were from adults and are presented here. Based on the number of valid responses to each question, 53.8% of these patients were exempt from prescription charges, 55.1% took regular prescribed medication and 24.6% stated that they used OTC remedies regularly. There were generally positive attitudes to doctors enquiring about prior OTC use as well as to doctors making OTC recommendations in the consultation. However, patients expressed fairly negative attitudes towards pharmacists making generic substitutions and were even more hostile to the idea that pharmacists should make therapeutic substitutions.
In conclusion, GPs should consider asking their patients regularly about their use of OTC medicines and also consider recommending OTC use if this is cheaper than FP10s. However, the public at present do not appear to be prepared for interventions by the pharmacist.
The high number of unintended pregnancies and terminations in Britain indicates that women who could use emergency contraception do not. Knowledge of access to sources of emergency contraception is limited. Oral administration of combined oestrogen-progestogen is safe and does not require routine physical administration, and there are proposals to re-regulate this from a prescription-only medicine to a pharmacy medicine, available over the counter in community pharmacies under the supervision of a pharmacist.
We aimed to demonstrate that the availability of combined, oral oestrogen-progestogen under the supervision of the community pharmacist would be safe and effective.
Guidelines were developed by a multidisciplinary group incorporating pharmacists, GPs, a pharmacologist and a consultant in family planning. The guidelines were based on published evidence, where possible.
Guidelines have been developed to accompany the provision of combined, oral oestrogen-progestogen which demonstrate that over-the-counter availability could be a safe and effective method of reducing the number of unwanted pregnancies in Britain.
Many drugs previously restricted to prescription only status are being reclassified as pharmacy only status and hence are becoming available over the counter to patients. A general practitioner should make enquiries about a patient's self-medication practices before deciding on treatment for the patient. Over-the-counter medicines are considered safe and their increased use indicates that patients are taking greater responsibility for their own health and possibly taking some of the financial burden of drug treatment from the National Health Service. The retention of their restriction to pharmacy only sale provides some additional protection for patients and promotes the role of pharmacists in the care of patients. However, having more drugs available for self-treatment may encourage patients to believe that there is a drug treatment for every ailment. Increasing the range of drugs available over the counter increases the risks of interactions and adverse reactions and of self-treatment being undertaken when medical aid should have been sought. For general practitioners to recommend positively use of over-the-counter preparations may involve some medicolegal risks, and the potential savings to the NHS may prove illusory. Education for patients and better communication between general practitioners and community pharmacists are required to allow easier availability of modern medicines to patients in order to bring the benefits anticipated.
Pharmaceutical products are licensed as prescription only medicines; non -prescription medicines available only from a pharmacy; or products on the general sales list, which can be sold in any shop. The licences of several medicines have recently been switched from prescription only to pharmacy only, and all prescription only medicines will now be reviewed every few years to see whether restriction on their sale remains justified. From 1983 to 1992, 11 products made the transition; by the end of 1994, 26 will have done so. The categories of drugs that can now be bought without prescription include non -sedating antihistamines, corticosteroids for topical use in hayfever, oral and topical non-steroidal anti-inflammatory drugs, nicotine patches, and H2 antagonists.
The change of status brings several advantages. Patients can benefit from more effective treatments for a wider range of minor ailments without needing to see their doctor. Similarly, general practitioners will be pleased that …
Self medication with over the counter medicines has long been a feature of the lay health system. With the reclassification of certain drugs, the public can buy preparations that were previously available only prescription. Sales of over the counter medicines are now equivalent to a third of the NHS drugs bill; governments throughout the world see self medication as a way of shifting some of the cost of health care onto consumers. The trend towards increased self care and with it the increasing empowerment of patients has many potential benefits; collaboration between doctors and pharmacists will be critical.
The increasing trend towards deregulation of more medicines to over the counter status has implications for the primary health care team as well as for consumers and patients. Better information for patients could improve the safety of over the counter medicines, but better systems need to be devised for reporting adverse reactions. "Collaborative care" could bring financial benefits. Doctors, nurses, and pharmacists need to discuss how they will respond to self medication practices, and ways of rewarding pharmacists for advising patients need to be found. Improved communication between doctors and pharmacists and the involvement of nurses could bring health care professionals into a new and more constructive interaction with each other and with the patient--or the changes required could split the professions as they each try to keep control of medicines.
The first reclassification in the United Kingdom (UK) of a prescription only medicine (POM) to a pharmacy medicine (P) occurred in 1983. Recently, the Government has accelerated this process. Given the increased number of products that are now available without prescription, it is appropriate that current views on POM-to-P switches should be sought. All 167 pharmacists in charge of registered pharmacies in the English counties of Cornwall and Somerset were sent a postal questionnaire during February 1996. The statistics package SPSS for Windows was used to enter coded questionnaire responses and to perform chi-squared and non-parametic analyses of cross-tabulated responses. Completed questionnaires were returned by 141 pharmacists, which represented an overall response rate of 84.4%. The survey found that pharmacists agreed that POM-to-P switches enabled them to fulfil a more clinical role (91%); their professional status was enhanced (85%); the range of therapeutic options was increased (99%) and that more customer counselling was involved (99%). Respondents were asked for their opinions on six products that have recently switched from POM to P. Pharmacists generally supported the POM-to-P concept, but support for individual products varied. It was highly significant that male pharmacists were more likely to recommend Regaine (minoxidil lotion 2%) than their female colleagues.
Interviews were carried out amongst community pharmacists and General Practitioners (GPs) in England to examine attitudes towards the deregulation of emergency contraception. Currently, emergency contraception is only available on prescription but there is debate about changing its prescription status to enable community pharmacists to sell it. Respondents were asked to discuss whether they felt it should be deregulated and factors relating to this. This study found little support for the reclassification of emergency contraception. Specific reservations identified were: concern about irresponsible use of emergency contraception by women; the need to regulate supply; fear about the therapeutic safety of increasing availability; and the need for adequate training for pharmacists. Religious and moral objections, which have often been used in arguments against deregulation, did not emerge as strong themes in this study. Community pharmacists can potentially make a significant contribution to the safe and effective provision of emergency contraception, however, our study raises a number of concerns about the feasibility of deregulation. If deregulation were to be a success these concerns would have to be addressed before the start of the deregulation process.
A postal survey has been conducted to investigate developments in the use of patient medication records (PMRs) by community pharmacists in England and Wales since 1991. Of a sample of 823 pharmacies, 95.5 per cent were maintaining PMRs in March/April, 1995, compared with 61.5 per cent in 1991. PMR use in 1995 continued to be influenced by the year of registration of the pharmacist in charge of the pharmacy, with 99 per cent of those who registered since 1985 now using a PMR system. Almost 95 per cent of the PMR users, that is almost 91 per cent of the respondents, either were using a system supplied by one of seven providers, or were using a Boots APECS system. The market share held by other PMR system suppliers has decreased. Independent, small multiple and large multiple pharmacies were found to differ as to whether National Health Service fees were claimed for setting up and maintaining PMRs, with independent pharmacies being least likely to have claimed. There was no change in the percentage (21 per cent) of respondents who kept some records of non-prescription medicines (NPMs) in their PMR system. However, given the markedly increased usage of PMRs, the percentage of PMR users who made no entries of NPMs in the PMRs was shown to have increased from 65 per cent to 77 per cent. Pharmacists who had been registered for more than 10 years, and those who had graduated from the former polytechnic schools of pharmacy were more likely to record the supply of counter-prescribed NPMs.
Using a structured interview technique, the perceptions of 1,000 members of the general public towards current activities and future roles of community pharmacists were investigated. The majority of participants (73.2%) visited a community pharmacy at least once per month and 76.7% of respondents perceived pharmacists as caring healthcare professionals. Over 80% of participants were in favour of pharmacists extending the range of services provided and almost 30% would like to see pharmacists offering more advice on minor ailments, a service which pharmacists presently provide. From answers given by those patients who were receiving prescriptions for repeat medication, it would appear that pharmacists are focused on providing a quick and efficient dispensary service with little attempt to provide pharmaceutical care. Determined efforts must be made to market the services presently provided by community pharmacists to the general public and to further developing the range of services provided.
Objective.
—To estimate the prevalence of recent over-the-counter (OTC) medication use in a national sample of preschool-age children.Design.
—Follow-up survey of a nationally representative sample of 3-year-old children in the US population by telephone or personal interview.Participants.
—A total of 8145 children whose mothers were interviewed for the 1991 Longitudinal Follow-up to the National Maternal and Infant Health Survey.Main Outcome Measures.
—Report of any OTC medications given in the past 30 days and the type of medications that the child received.Results.
—During the past 30 days, 53.7% of all 3-year-old children in the United States were given some OTC medications. Among OTC medication users, the most common medications reported were Tylenol (66.7%) and cough or cold medicine (66.7%). Most respondents reported that recent child illness episodes (70%) were treated with OTC medications. After adjustment for recent child illness, women who were white (odds ratio [OR], 1.32; 95% confidence interval [CI], 1.13 to 1.55), were more educated (OR, 1.58; 95% CI, 1.24 to 2.00), and had higher incomes (OR, 1.75; 95% CI, 1.33 to 2.30) were more likely to have given their child OTC medications. Women without health insurance were also more likely to have given OTC medications (OR, 1.27; 95% CI, 1.04 to 1.55). Provider visits, but not telephone calls, were associated with a reduction in OTC medication usage.Conclusions.
—Over-the-counter medications are an important component of health care for treating illness in US preschool-age children. The high prevalence of use has occurred despite the dearth of scientific proof for the effectiveness of certain classes of OTC medications and the risks associated with improper use.(JAMA. 1994;272:1025-1030)
Objective.
—To determine whether over-the-counter cold medications have been shown to be effective in relieving symptoms in children, adolescents, and adults.Data Sources.
—The MEDLINE database using the key words combined with medications and research and review articles. Articles were retrieved if they were written in English and published between January 1950 and January 1991.Study Selection.
—Articles were selected if they described a controlled clinical trial on the treatment of the common cold. Forty-eight percent of 106 articles met the selection criteria, and these were grouped by age into child studies (<5 years old and <12 years old) and adolescent (aged 12 years and older)/adult studies.Data Extraction.
—Each article was scored on 11 criteria to determine scientific validity. Those articles scoring above 70% were included in the final analysis. Two authors independently scored a sample of articles to determine interrater reliability.Data Synthesis.
—Very few studies have been performed on children. Of those, two done on preschool children demonstrated no symptom relief, whereas two done on older children showed some benefit. In the adolescent/adult studies, chlorpheniramine maleate, pseudoephedrine hydrochloride, oxymetazoline hydrochloride, phenylpropanolamine hydrochloride, ipratropium bromide, and atropine methonitrate all improved nasal symptoms. Combination therapy (using an antihistamine-decongestant mix) was shown to relieve a variety of symptoms.Conclusions.
—No good evidence has demonstrated the effectiveness of over-the-counter cold medications in preschool children. Furthur studies are required to clarify the role of these medications in children. Certain single over-the-counter medications and combinations have been shown to reduce cold symptoms in adolescents and adults.(JAMA. 1993;269:2258-2263)
AIM • To determine the attitudes, hopes and concerns of community pharmacists in Great Britain about the proposed deregulation of emergency hormonal contraception (EHC) at a time when the change was becoming increasingly likely. DESIGN • Postal questionnaire survey with two mailings. SUBJECTS AND SETTING 1,827 community pharmacists in community pharmacies in Great Britain (691 independents, 464 owners, but supported as part of an alliance, and 672 working for pharmacy multiples). OUTCOME MEASURES • Self-reported Likert-scale for 31 attitudinal statements and thematic analysis of qualitative data from open responses. RESULTS • The response rate was 66 per cent (1,205/1,827). Pharmacists were in broad agreement with EHC deregulation as indicated by the responses to the statements. Most pharmacists (96 per cent) wanted to be paid a fee for providing this service although opinion was divided on whether women should pay for this product themselves. Pharmacists also felt that the provision of this product would increase their role within the wider primary care team, something which many of them actively sought. A number of important practical and service issues were raised. CONCLUSION • The majority view was that EHC is suitable for over-the-counter sale and pharmacists seem ready to take on this task. What will be needed is comprehensive organisation and evaluation of the service in terms of providers, users and stakeholders.
A survey was conducted among a sample of those pharmacists in Britain who installed a patient medication record (PMR) system during 1990 to gauge the importance of various factors that might have influenced the pharmacist's decision to acquire the system. The responses indicate that government funding influenced the developing utilisation of PMRs, but to a lesser extent than anticipated. PMRs have been installed primarily for clinical and professional reasons. Of the reasons for installing a PMR system, competition from other pharmacies was more likely to be considered important by female pharmacists, and by pharmacists working for large multiple companies, than by their male counterparts or independent contractors. The need to upgrade equipment at the end of its life span was cited as a reason for purchasing a PMR system. Future progress is likely to be very dependent on such upgrades at periodic intervals to introduce new technology into pharmacy practice.
The last 30 years has brought significant changes to self care through responsible self medication. From being essentially unregulated in the 1960s, over-the-counter (OTC) medicines have been transformed by the evolving statutory and regulatory initiatives into a mature market with a high level of consumer confidence in their safety and expected benefits. This paper reviews the legislative/regulatory achievements that have modernized self care with OTCs, including the statutory and regulatory basis for OTCness, the criteria and studies used as a basis for permitting OTC availability, and the paradigm for interaction between regulators and sponsors, as well as the challenges still facing the industry.
The developing organism is unique in its responsiveness to drugs. The predictability of therapeutic effectiveness and safety of drugs in pregnancy using the adult as a model for pharmacokinetics and pharmacodynamics can result in grave consequences in the fetus. There exists a general misconception that since over-the-counter (OTC) drugs are readily available, these pharmaceutical agents can be viewed as safe to use by adults. Ingestion of OTC preparations during pregnancy results in placental transfer and accumulation of these drugs in the fetus. As the fetus lacks the ability to handle pharmaceutical agents, since renal function, metabolic pathways, etc. are not fully developed, drug exposure in utero may produce deleterious effects in the fetus but not the mother. Clinicians are aware of drug-induced effects on the fetus and have dramatically reduced the use of prescription drugs during pregnancy. However, the use of self-medication (OTC) has significantly increased during pregnancy through extensive, effective advertising by the pharmaceutical industry and lack of sufficient data indicating an OTC effect on the fetus. However, the consequences of OTC drug use need to be established, since these compounds continue to be used extensively, especially during pregnancy.
Paternalism is endemic in the NHS. Benign and well intentioned it may be, but it has the effect of creating and maintaining an unhealthy dependency which is out of step with other currents in society. Assumptions that doctor (or nurse) knows best, making decisions on behalf of patients without involving them and feeling threatened when patients have access to alternative sources of medical information—these signs of paternalism should have no place in modern health care. The articles assembled in this issue of the BMJ consider the scope for creating meaningful partnerships between doctors and patients and between health policymakers and local communities.Partners work together to achieve common goals. Their relationship is based on mutual respect for each other's skills and competencies and recognition of the advantages of combining these resources to achieve beneficial outcomes. Successful partnerships are non-hierarchical and the partners share decision making and responsibility. The key to successful doctor-patient partnerships is therefore to recognise that patients are experts too.1–3 The doctor is, or should be, well informed about diagnostic techniques, the causes of disease, prognosis, …
Even if a specific directive has been approved many years ago, the situation of self-medication products (OTC) in EU countries is still far from being harmonized. In Italy the market is lower than that of most other countries; in order to solve some of the major problems that led to this situation a guideline, concerning the criteria for the definition of an OTC product, and the characteristics of the label and the package leaflet, was recently published. In this document the characteristics of OTC, such as composition, indications and duration of the treatment are assessed. The European Commission has recently published a guideline on the readability of labels and package leaflets of medicinal products for human use. The two documents stated the same principles and the Italian document is in agreement with the European guidelines. In this paper the Italian situation of OTC products (definition and presentation) is presented and discussed.
Thesis (Ph. D.)--University of Bath, 1993.
A questionnaire was completed by 103 symptomatic women attending a busy, walk-in genitourinary medicine clinic in London before seeing a doctor. This questionnaire asked about the patients' own diagnosis of symptoms, previous remedies and their source. The answers were compared to their past history and current diagnosis.
Of symptomatic women 56% had used a self-administered remedy prior to attending the clinic. This was significantly associated with a history of a previous episode of genital infection which had produced similar symptoms to the current problem. Forty-three percent of those who used self-medication reported some improvement in symptoms and more than 50% tolerated longer than 10 days of symptoms before attending the clinic.
With few exceptions, use of multiple analgesic drugs achieves dubious increases in analgesia while placing elders at increased risk of the many potential adverse effects of analgesic drugs. The potential for duplication of analgesic therapy among the elderly is great due to prevalent painful chronic conditions and the variety of prescription and nonprescription analgesic remedies available. The prevalence of multiple analgesic product use and patterns of concurrent use of different analgesic categories was investigated in a geographically defined population of persons 65 years of age and older. The demographic characteristics of users of multiple analgesic drug products were examined, as were their smoking status, alcohol use, lifetime history rates of major illnesses, physical functioning, pain experiences, memory performance, and depressive symptoms. A substantial proportion of analgesic users reported taking multiple products in the preceding 2 weeks (14.4% of female and 10.5% of male analgesic users). Men who reported pain in the preceding year were more likely to use multiple analgesic products. Women who experienced pain or limited physical functioning, or who had higher depressive symptom scores or a life-time history of ulcers were most likely to use multiple analgesic products. Thus, although some users of multiple analgesic products reported significant pain, several other factors were shown to be related to the phenomenon of multiple use.
Many elderly people in the United States take vitamin/mineral supplements, but little is known about supplement use by the elderly in the United Kingdom. Among 203 patients referred to a geriatric outpatient clinic in Britain, 28% used supplements during the last year. Most supplement users consumed them daily and had used them for over a year. Multivitamins were the most frequent type of supplement taken, followed by Iron, B Vitamins, Vitamin C, and Vitamin E. The primary reasons for supplement use were for more energy, treating illness, and feeling stronger.
The objectives of this research were to explore lay medication activities as an aspect of self-managed health care in the Canadian context and to identify the sociodemographic and sociomedical characteristics of those who engage in self-medication. Interview data were collected in 1983 from a random cross-sectional sample of 524 adult residents living in Winnipeg, Canada. Respondents were questioned about the types of medicines they keep in their home (both prescribed and nonprescribed), self-treated symptomatic conditions; recent medication activities, the use of prescribed medicine in self-treated illness episodes, and the use of home remedies. This study contributes to a growing body of international evidence that has demonstrated that self-medication is a vital part of daily self-care behavior. For the most part, the results are comparable to those reported by previous British and U.S. studies of self-medication. Winnipeg residents were found to be active self-care providers who engage in a variety of self-medication practices. The study also illustrates the fact that the altered use of prescribed drugs (particularly by those with higher levels of formal education) is an important aspect of self-medication behavior. These findings have clear implications for health care practitioners.
This study has identified some potentially important characteristics of elderly women who overuse vitamin and mineral supplements. These women tended to live alone and to have medical problems. The supplements were usually self-prescribed and purchased in a drugstore. The sources of information that supported supplement use were primarily the print media and family and friends rather than health professionals. Other studies have made similar findings. The degree of IHLC orientation failed to predict the amount of supplement use, although IHLC was shown to be useful in a recent study that included both young and elderly women. Thus, from our perspective, the identification of possible overusers of supplements should begin with elderly women who have health problems and live alone; point-of-purchase information should be targeted to drugstores. In this study and in other, either the actual reasons for supplement use were often inappropriate or the diets were adequate in many of the vitamins taken by supplements, such as vitamins A and C. Thus, education for elderly women that stresses the appropriate reasons for nutrient supplement use is clearly needed so that a correct link between nutrition need and use always is maintained. The high IHLC scores suggest that the majority of women in this study want to make their own decisions about their health. Given better information, overusers of supplements might instead choose a more reasonable approach for improving their diets. Dietitians/nutritionists were not usually used as a source of nutrition information by the elderly women in this study.(ABSTRACT TRUNCATED AT 250 WORDS)
Four patients with mild, asymptomatic chronic renal failure became severely hypercalcaemic while taking over-the-counter antacids with daily calcium loads of only 4-8 g. Renal impairment carries an increased liability to this syndrome. Persistent elevation of serum parathyroid hormone levels led to parathyroid exploration in two of the cases, and normal glands were found. In retrospect the hormone levels were appropriate to the degree of renal impairment. Over-the-counter antacid preparations should carry dosage warnings to avoid the possibility of hypercalcaemia.
To estimate the prevalence of recent over-the-counter (OTC) medication use in a national sample of preschool-age children.
Follow-up survey of a nationally representative sample of 3-year-old children in the US population by telephone or personal interview.
A total of 8145 children whose mothers were interviewed for the 1991 Longitudinal Follow-up to the National Maternal and Infant Health Survey.
Report of any OTC medications given in the past 30 days and the type of medications that the child received.
During the past 30 days, 53.7% of all 3-year-old children in the United States were given some OTC medications. Among OTC medication users, the most common medications reported were Tylenol (66.7%) and cough or cold medicine (66.7%). Most respondents reported that recent child illness episodes (70%) were treated with OTC medications. After adjustment for recent child illness, women who were white (odds ratio [OR], 1.32; 95% confidence interval [CI], 1.13 to 1.55), were more educated (OR, 1.58; 95% CI, 1.24 to 2.00), and had higher incomes (OR, 1.75; 95% CI, 1.33 to 2.30) were more likely to have given their child OTC medications. Women without health insurance were also more likely to have given OTC medications (OR, 1.27; 95% CI, 1.04 to 1.55). Provider visits, but not telephone calls, were associated with a reduction in OTC medication usage.
Over-the-counter medications are an important component of health care for treating illness in US preschool-age children. The high prevalence of use has occurred despite the dearth of scientific proof for the effectiveness of certain classes of OTC medications and the risks associated with improper use.
To determine whether over-the-counter cold medications have been shown to be effective in relieving symptoms in children, adolescents, and adults.
The MEDLINE database using the key words combined with medications and research and review articles. Articles were retrieved if they were written in English and published between January 1950 and January 1991.
Articles were selected if they described a controlled clinical trial on the treatment of the common cold. Forty-eight percent of 106 articles met the selection criteria, and these were grouped by age into child studies (< 5 years old and < 12 years old) and adolescent (aged 12 years and older)/adult studies.
Each article was scored on 11 criteria to determine scientific validity. Those articles scoring above 70% were included in the final analysis. Two authors independently scored a sample of articles to determine interrater reliability.
Very few studies have been performed on children. Of those, two done on preschool children demonstrated no symptom relief, whereas two done on older children showed some benefit. In the adolescent/adult studies, chlorpheniramine maleate, pseudoephedrine hydrochloride, oxymetazoline hydrochloride, phenylpropanolamine hydrochloride, ipratropium bromide, and atropine methonitrate all improved nasal symptoms. Combination therapy (using an antihistamine-decongestant mix) was shown to relieve a variety of symptoms.
No good evidence has demonstrated the effectiveness of over-the-counter cold medications in preschool children. Further studies are required to clarify the role of these medications in children. Certain single over-the-counter medications and combinations have been shown to reduce cold symptoms in adolescents and adults.
In January 1991, miconazole and clotrimazole were released as nonprescription therapy for vaginal candidiasis. Considering the number of women suffering from vaginal symptoms annually, these new over-the-counter (OTC) products may have a considerable impact on women's health care.
All 191 family physicians and obstetrician and gynecologist members of the Toledo and Lucas County Academy of Medicine were surveyed in June 1992. The survey instrument was constructed to include questions regarding physician perceptions of the impact of OTC antifungal agents on preventive care; the type of advice they currently give patients concerning the use of OTC antifungal agents; and their estimates of the incidence of misdiagnosis and reported side effects resulting from use of OTC antifungal agents.
Of the surveyed physicians, 24% concluded that the reclassification of antifungal agents was a positive change for their female patients, 19% believed it was a negative change, and the remaining 57% noted no impact on their patients' well-being. Over 40% of the physicians indicated that four to six of their patients had delayed treatment for other vaginal conditions because of inappropriate use of an OTC antifungal preparation within the last year. On a positive note, the physicians in favor of the OTC preparations believed their patients were getting faster and more economical care and were in "control of their health care."
Physicians participating in this study reported mixed opinions concerning the reclassification of vaginal antifungal agents and raised several pertinent questions that require further examination.
More over the counter medications have been made available recently. We carried out a survey of general practitioners' views on various drugs being dispensed by community pharmacists without a prescription to determine whether these views have changed since 1990.1
Details of 1301 general practices were obtained from eight family health service authorities throughout England. All 250 fundholding practices were included in the study together with a random sample of 250 urban and 350 rural non-fundholding practices to permit comparisons between fundholding (mainly rural) and rural non-fundholding general practices and between urban and rural non-fundholding practices. The larger number of rural non-fundholding practices were included so as to increase the statistical power of the study.
In November 1994 a questionnaire was dispatched to one randomly selected doctor from each practice. It sought information on basic characteristics of the practice and the responding general practitioner. The section …
People are buying more medications for themselves,1 and increasingly powerful drugs are obtainable without prescription.2 In view of these trends, it is timely to examine their implications for patients and health care professionals. A series of articles starting in this issue of the BMJ (p 629) examines the move towards greater over the counter access to drugs and its relation to increasing public awareness of health and medicines, the changing roles of doctors and pharmacists, pharmaceutical industry strategies, and the question of safety and abuse of drugs.2
Over the counter (OTC) drugs are available to the public without prescription. They include traditional pharmacy preparations and drugs that have more recently been deregulated from their previous status as “prescription only medicines.” Policies on over the counter drugs vary around the world. In many European countries, over the counter drugs are available only through pharmacies,3 but in the United States, all over the counter drugs can be sold in general retail outlets. In Australia, pharmacists are required to personally advise purchasers of specific over the counter drugs.
Britain and Ireland have two categories for over the counter drugs: drugs on the general sales list may be sold in general retail premises, while drugs in the pharmacy category are restricted to sale by registered pharmacies.2 This is supposed to ensure that pharmacists monitor patients and give advice on correct usage. However, this responsibility is frequently …
Over-the-counter (OTC) antifungal products for vulvovaginal candidiasis (VVC) have gained tremendous popularity, as evidenced by staggering increases in sales since the products were switched from prescription-only to OTC status. The rapid escalation in the sale of these products may imply that women are using them inappropriately. The purposes of this study were to determine (1) whether women could correctly diagnose VVC and common genitourinary tract problems after reading classic case scenarios, (2) whether women could correctly select the appropriate treatment for these cases, and (3) whether a previous diagnosis of VVC by a clinician had any effect on a woman's ability to self-diagnose and self-treat VVC.
Women 16 years of age and older were recruited from medical and community sites to complete a 63-question survey instrument designed to assess their knowledge of the symptoms and signs of pelvic inflammatory disease, bacterial vaginosis, acute cystitis, vaginal trichomoniasis, and vulvovaginal candidiasis after reading classic case scenarios.
A total of 601 women completed the questionnaire, 552 subjects and 49 medically trained women who served as a criterion standard for comparison. Of the 552 subjects, 365 reported a prior diagnosis of VCC and 154 reported no such prior diagnosis. The medically trained cohort was more accurate in diagnosing VVC (83.7% correct) than were subjects who had received a prior diagnosis of VVC (34.5% correct), and more accurate than subjects without a previous diagnosis of VVC (11.0% correct, P < .001). A greater percentage of subjects in whom VVC had been previously diagnosed, as compared with the medically trained cohort, would use OTC agents inappropriately for pelvic inflammatory disease (6.7% vs 4.3%, respectively; P = NS), bacterial vaginosis (14.6% vs 6.4%, respectively; P = .028), urinary tract infection (2.0% vs 0%, respectively; P < .001), and vaginal trichomoniasis (11.8% vs 6.6%, respectively; P = .048).
A minority of women were able to correctly diagnose VVC from a classic case scenario. A prior clinical diagnosis of VVC had only a moderate positive effect on subjects' ability to correctly diagnose a classic case. Based on our findings, women likely use OTC antifungals inappropriately to treat gynecologic conditions that are similar but potentially more severe. Numerous adverse consequences may result from misdiagnosis. Improved patient education by health care providers and the manufacturers of OTC antifungal drugs might improve this diagnostic problem.
The scope of self-medication is increasing in many countries, and drugs for dyspepsia are a popular group for deregulative activities. This study investigated what kind of upper gastrointestinal symptoms people self-medicate and how appropriate this self-medication is.
An anonymous questionnaire was give to 50 consecutive customers buying antacids, alginates, or sucralfates in 10 pharmacies in the capital area in Finland in 1995. In half of the pharmacies the questionnaire was returned by mail, and in the other half the questionnaire was filled out at the pharmacy. The response rate was 53% (n = 292).
The commonest reasons for self-medication were heartburn (88%), gastrointestinal pain (31%), and acid regurgitation (32%). Seventy-five per cent of respondents had used dyspepsia drugs for more than a year. The commonest way to self-medicate was to interchange regular and occasional use. Knowledge about the proper use of dyspepsia drugs was poor, and 6% of respondents had symptoms contraindicating self-medication but had not visited a physician during the past year. Patients more than 60 years old were especially at risk of potential inappropriate use.
Over-the-counter (OTC) drugs for dyspepsia are likely to be used improperly. A physician's advice on the use of OTC dyspepsia drugs, in addition to detailed printed information about drug action and proper administration, would be important means to guarantee appropriate use of these drugs.
The most frequent medical intervention performed by a doctor is the writing of a prescription. Because chronic illness increases with advancing age, older people are more likely to have conditions that require drug treatment. Advanced age, frailty, and increased use of drugs are all factors that contribute to a patient's risk of developing a drug related problem. As many as 28% of hospital admissions in the United States of older people are as a result of drug related problems,1 up to 70% of which are attributed to adverse reactions to drugs.1 Creating optimal drug regimens that meet the complex needs of elderly people requires thought and careful planning.
Inappropriate prescribing is expensive. In a recent study the costs of preventable adverse drug events—namely, injury resulting from a drug related medical intervention—occurring during a stay in hospital were estimated to be $2.8m (£1.75) annually in two large American teaching hospitals.2 The national cost of managing the consequences of inappropriate prescribing remains uncertain. One estimate has put the annual cost of drug related morbidity and mortality in outpatient clinics at $76.6bn.3 Drug related morbidity and mortality is an important area to target both to improve the quality of medical care for elderly people and to reduce the costs of health care for this population.
A prescriber can do little to modify age related physiological changes in trying to minimise the likelihood that an older person will develop an adverse drug reaction. However, when assessing a patient who is already taking drugs, a doctor should always consider the development of any new signs and symptoms as a possible consequence of the patient's drug treatment. This article will focus on an under-recognised, and largely preventable drug related problem that we have termed the “prescribing cascade.” 4 The prescribing cascade begins …
Use of over-the-counter (OTC) medications by elderly patients is often not identified. This survey was performed to study the use of OTCs by medical in-patients aged 65 and over. Data on the use of OTC medications before and during hospital admission were collected by questioning patients and case notes were examined for documentation of their use of OTC medications. OTC medications were used by 44 of 138 (32%) patients interviewed. Patients used a total of 70 OTC medications before admission and six OTC medications were being used during hospital admission. There was no documentation of pre-admission and in-hospital OTC medicine use in the clinical notes and patients had little knowledge of the potential harm some products can cause. As more products become available over the counter, doctors should record their use in patients' notes and patients should be encouraged to seek professional advice before purchasing OTC medicines and to read the product information leaflets.
The aim of this study was to compare the direct medical costs associated with the treatment of patients with heartburn/nonulcer dyspepsia under 2 scenarios: (i) no nonprescription histamine H2 receptor antagonist (H2RA) is available (the 'status quo scenario'); and (ii) the H2RA famotidine (at a daily dosage of 10mg) is available over-the-counter (OTC) at retail pharmacies (the 'OTC scenario'). We employed a decision analysis model over a 16-week period that considered direct medical costs from 2 alternative perspectives: (i) society, including the cost of self-medication borne by patients; and (ii) a provincial third-party payer for healthcare. Data concerning direct medical costs associated with consumer self-medication and physician prescription of medication (including pharmacist dispensing fees), tests and procedures, and consultations with general practitioners and specialists were drawn from a clinician panel, published unit costs, and special surveys of institutional databases. All costs are reported in 1993 Canadian dollars ($Can; $Can1 = $US0.72, October 1995). From a societal perspective, the expected cost per patient over a 16-week period is not substantially different between the status quo and the OTC scenarios ($Can98 and $Can96, respectively). From a provincial third-party payer perspective, the expected costs per patient for the same scenarios are $Can95 and $Can89, a saving of $Can6 per patient. These results are sensitive to the proportion of patients who initially choose to see their physician rather than self-medicate, and the percentage of patients achieving successful treatment of symptoms. Changes in the rate or the cost of nonprescription medication, tests/procedures and physician visits do not affect the relative cost rankings. The total number of physician visits remained constant in both scenarios. From the societal cost perspective, the availability of famotidine in nonprescription form yields total costs that are similar to the status quo. However, from the perspective of the provincial payer, the expected costs per patient are likely to be slightly lower than the status quo if famotidine is available in unrestricted OTC scenario use. To generate significant savings to provincial payers, the number of people choosing immediate physician contact would have to be reduced, although not substantially, in the OTC scenario.
Prescription and over-the-counter medications are an important and widely used part of healthcare in Canada. Such drugs represent an increasing proportion of total healthcare expenditures. The objectives of the paper are to examine pharmaceutical expenditures and utilisation in Canada, review the major cost control strategies for pharmaceuticals, and discuss the future issues and challenges for pharmaceutical policy in Canada. Compared with other Organisation for Economic Cooperation and Development (OECD) countries, Canada (until recently) has not been successful in controlling the rate of increase of healthcare expenditures and, more specifically, pharmaceutical costs. The key variables associated with high rates of increase in drug costs relate to increased per capita use of drugs, use of more expensive drugs, and rising prices of existing drugs. If policies are going to address the fundamental societal issues behind both the price and utilisation elements of pharmaceuticals, policy makers and third-party payers in Canada will probably have to focus, primarily, on manufacturers and major healthcare providers and, secondarily, on consumers. They will need to develop an internally valid package of consistent policies.
Releasing prescription drugs over-the-counter (OTC) has been a trend in many Western countries. The purpose of this study was to find out about Finnish physicians' attitudes towards OTC switches and to find out whether transfer of drugs that are used in a doctor's own area of specialty increases negative attitudes toward release. For the latter purpose, gynecologists' perceptions about the availability of vaginal antifungal OTC drugs was studied.
Postal questionnaire to a representative random sample of gynecologists (n = 169) and general practitioners (GPs) (n = 288) in six counties in Finland in 1996. After a reminder, the response rate was 77% (n = 341). Multivariate logistic regression models were used to explore the relationship of factors to attitudes toward OTC drugs.
The overall attitude toward the availability of OTC drugs was moderately positive but was more reserved toward those drugs only recently given OTC status. However, physicians were judged in many cases to be the most suitable source of information on OTC drugs. GPs working in health centers, more often than other physicians, found drugs suitable for self medication. Our hypothesis about gynecologists being against the release of vaginal antifungal drugs was not supported.
Physicians' views about OTC drugs are influenced by the current OTC status of the drug and by public discussion. The place of work has an important influence on these opinions, most likely reflecting the effect of case mix and patient load.
Patients require access to good quality, evidence based information so they can take an active part in decisions about their health care. The amount of information available to patients is increasing, particularly through the internet. The quality of this information remains variable. Health professionals need to be able to direct patients to sources of good quality consumer health information, including health related websites.
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.
To investigate the abuse of non-prescription (over-the-counter; OTC) products in Northern Ireland.
A structured questionnaire covering various aspects of OTC drug abuse was mailed to all 509 community pharmacies in Northern Ireland.
253 responses were received (response rate 49.7%) after two mailings. Pharmacists named 112 OTC products they perceived were being abused in Northern Ireland. These were classified into 8 groups, with opioids, antihistamines and laxatives the most frequently reported. The frequency of abuse of all product groups was perceived to be either increasing or static. The number of clients suspected of abuse over a three-month period ranged from 0 to 700 (median = 10, mode = 6) with 55% being regular customers. Pharmacists employed several methods to limit patient access to products of abuse. The most common technique was to keep the product out of sight. Others included additional client questioning, providing advice and limiting the quantity of product sold. The majority of respondents agreed their role could be extended to include other methods of dealing with abusers, including participation in harm-reduction programmes to wean abusers off products. Geographical region and location of pharmacy were not significant factors in the abuse of OTC products.
Pharmacists in Northern Ireland perceive abuse and misuse of OTC products to be occurring in practice. Current methods employed for dealing with it are inadequate. Research into methods of effectively dealing with OTC abuse/misuse is required and has commenced on the basis of these findings.
While it is generally accepted that the decision to switch a drug from the prescription market to the over-the-counter (OTC) market is based on an optimization problem that firms are solving, no attempts have been made to formalize the problem. The purpose of this article is to present a model of prescription to OTC switching that helps explain the role of potential generic competition in a firm's decision to switch. In particular, we examine what market conditions are necessary for the threat of generic competition to induce switching.
The model is game-theoretic, played between an incumbent firm and a potential generic entrant, and is solved for its subgame perfect equilibrium. The incumbent first decides whether to apply to the FDA to switch to the OTC market. If the incumbent declines, then the potential generic entrant has the opportunity to apply for the switch. The FDA then accepts or rejects the application, and the generic chooses whether to enter the market.
In equilibrium, when applying to switch is costless, switching occurs if the probability that the application will be approved by the FDA is strictly positive and the OTC market is characterized by first-mover advantages. Adding a cost to the application process places restrictions on the probability of FDA approval to offset the cost of applying. The probability of approval must be sufficiently high to offset the cost of the application.
The model shows that switching from the prescription to OTC market may occur as a response to potential generic competition. Firms switch because they know that if they do not, a generic may initiate a switch and become the first mover in the OTC market.