Transcript a study of over the counter medication use, among

A STUDY OF OVER THE COUNTER
MEDICATION USE, AMONG PATIENTS
PRESENTING TO FAMILY PHYSICIANS,
AT A TEACHING HOSPITAL IN KARACHI
Dr. Waris, Qidwai
Mr. Syed, Iqbal Azam
Mr. Faisal M Khan
ABSTRACT
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Objective: To study the use of the “Over the Counter”
medications, among patients visiting the Family Physicians, at
a teaching hospital in Karachi.
Design: A Cross-sectional survey
Place and Duration of study: Family Practice Center, the
Aga Khan University Karachi, from
August to October, 2001
Subjects and Methods: A total of 393 patients were surveyed
against a sample size estimated at 347. A questionnaire was
developed and administered to collect information on the
demographic profile and the “Over the Counter” medications
use, among the respondents.
Results: The demographic profile showed that the
respondents were young and well educated and better placed
socio-economically. Over the Counter medication use within
the previous 6 months, was found in 153 (39%) respondents.
“Analgesics” were the most commonly used Over the Counter
medication group among the respondents. “Cousins/neighbor”
were the group most commonly advised to use Over the
Counter medications by the respondents. Awareness
regarding “misuse/abuse of OTC medications” was found in
167 (42.49%) of the respondents. Reasons for abuse as
quoted by the respondents were, “the need to save money by
avoiding doctor’s consultation”, “addiction potential” and “easy
availability of medications in the open market”. With regards to
the “Over the Counter” use of medications in future, 250
(63.61%) of the respondents said they would like to see a
doctor before taking any medicines.
Conclusions: We have found substantial use of over the
counter medications in our study. We recommend a strong
patient education program and government legislative control
over the sale of medications in the country.
Key-words: OTC MEDICATION SELF-MEDICATION
SELF-CARE
INTRODUCTION
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Safe care and the “Over the counter” (OTC) medication
use, is the use of medications largely outside the
control of licensed medical practitioners.
Diabetic patient spends almost as much money on
OTC medications and alternative medications together,
as they do on their diabetic medications1.
In the United States of America alone, non-steroidal
anti-inflammatory drugs (NSAIDs), account for 30 billion
OTC medications sold2. Significant concerns are
expressed regarding the use of OTC medications. The
use of NSAIDs is associated with significant
gastrointestinal complications3,4. Migraine is a
common condition in which most patients never seek
medical advice, and one assumes that their headaches
are under control with simple OTC analgesics5,6. Also
the use of OTC medications is associated with liver
toxicity7, as well as fatal civil aviation accidents8.
It has been argued that resistance takes place if OTC’s
medications are used without proper control9. Also,
secondary haemochromatosis is reported from the use
of OTC preparations containing iron 10. Recently, the
safety and effectiveness of the OTC antidepressants
available in the market has been questioned11.
Physicians are advised to inquire about all medications
their patients are taking on account of the likelihood of
drug interactions12. A new range of “OTC” medications,
continue to flood the markets with the passage of every
day, further complicating the situation13.
OBJECTIVES
• To study the use of over the
counter medications, among
patients visiting the Family
Physicians at the Aga Khan
University, Karachi.
PATIENTS AND METHODS
• It was a cross sectional survey,
conducted from August to October, 2001,
at the Family Practice Center, the Aga
Khan University Hospital, Karachi. On an
average 150 patients are seen daily at
the center by 10 Family Physicians.
• After extensive literature search and
feedback from colleagues, a
questionnaire was developed to collect
information on the demographic
parameters of the respondents and the
“OTC” medication use, among the
respondents. The questionnaire was
administered by convenience sampling,
in the waiting area of the clinic. The
ethical requirements for the study were
met, including the signing of the
“informed consent form” by the
participants after assurance of
maintaining “confidentiality” was
provided.
Sample size estimation
• Sample size estimated based
on following assumptions for
cross-sectional surveys14
• Population size: 3600
• Estimated prevalence: 50%
• +/-Maximum error: 5%
• Sample size: 347
RESULTS
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The cross sectional survey covered 393 respondents.
There were 08 non-responders.
The mean age of the respondents was 29.4 years, 165
(42%) were men and 228 (58%) women. The majority
was married, with over matriculate education and in
private or government service or housewives (Table-I)
The use of “OTC” medications in the previous six
months was found in I53 (39%) of the respondents.
Analgesics and antibiotics were found to be the most
commonly used “OTC” medications (Table-II)
Cousins, neighbors, friends and immediate family
members were the categories of people advised to use
“OTC” medications (Table-III)
Central nervous system symptoms, addiction,
drowsiness, cardiovascular system symptoms,
behavioral problems, disturbance in thinking, suicide,
coma and death were quoted as side effects of sleep
inducing medications
(Table-IV)
Awareness about the misuse/abuse potential of “OTC”
medications was found in 167 (42.49%) of the
respondents. Potential reasons for misuse/abuse were
quoted as, “the need to save money by avoiding a
doctor’s consultation”, “addiction potential” and “easy
availability of medications in the open market without a
doctor’s prescription”.
With regard to future use of OTC medication, 250
(63.61%) of the respondents said they would like to see
a doctor before taking any medicines.
TABLE-I
Demographic Profile of
the Study Population
S.NO
PARAMETER
NUMBER ( PERCENT )
1.
SEX:
Males
Females
2.
Mean Age (SD*) (In years)
29.4 (7.89)
3.
Marital Status:
Single
Married
Others
137 (34.9)
255 (64.9)
01 (0.2)
4.
Educational Status:
Illiterate
Primary
Secondary
Matriculation
Intermediate
Graduate
Post-graduate
Diploma
Not known
5.
Occupational status:
Private service
Government service
Self employed
Student
Laborer
Unemployed
* Others
Standard
deviation
including
housewives
n
165 (42)
228 (58)
23 (5.9)
29 (7.4)
27 (6.9)
47 (12)
76 (19.3)
106 (27)
27 (6.9)
4 (1.0)
54 (13.7)
51 (13)
19 (4.8)
34 (8.7)
77 (19.6)
6 (1.5)
16 (4.1)
190 (48.3)
393
TABLE-II
GROUPS OF “OTC”
MEDICATIONS USED BY
THE RESPONDENTS
S.NO
GROUP OF MEDICATION
NUMBER (PERCENT)
1.
Analgesics
109 (71.24)
2.
Antibiotics
26 (16.99)
3.
Tranquilizers
9 (5.88)
4.
Others: Antihistamines
5 (3.26)
Antipyretics
2 (1.3)
Vitamins
1 (0.65)
Herbal medicines
1 (0.65)
n
153
TABLE-III
GROUPS OF PEOPLE ADVISED
TO USE “OVER THE COUNTER” MEDICATIONS*
S.N
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RELATIONSHIP
NUMBER (PERCENT)
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Cousin/Neighbor
67 (60.90)
2
Friends
30 (27.27)
3
Immediate family
13 (11.81)
n
* Advised by the respondents
110
DISCUSSION
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We have documented the use of “OTC” medications among
our study population. Respondents in our study were young,
therefore in better health and with less number of co-morbid
conditions. Since they were visiting a family physician with a
medical problem, one can argue that these patients probably
are the ones who prefer to seek medical advice, rather then
take an “OTC” medication.
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Self-medication has been found to increase with improvement
in socio-economic status15. Since respondents in our study
were better placed socio-economically, therefore the use of
“OTC” medication may be more among them.
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An earlier study on the use of anti-microbial agents, conducted
in Karachi, showed that 6.3% of the patients used them as
self-medication, over a four weeks period. We have found a
much higher 17% use of antibiotics in our study, but over a 6
month period. Antibiotic resistance can be an outcome of such
antibiotic misuse.
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In another study conducted in Karachi, self- medication was
found in 51.3% of the households with a sick child, over a
period of four weeks16. This reported use of “OTC” medication
is significantly higher than the finding among our respondents.
DISCUSSION
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We have found “analgesics” to be the most commonly used
“OTC” medication group, which is similar to the findings of an
earlier study conducted in the west17. Analgesics use can
have serious side effects2, and can lead to serious
consequences for the patients.
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“Benzodiazepines” are available over the counter in Pakistan.
It is because of this reason that their use has been reported in
84% cases of self-poisoning in Pakistan18. Their use is
known to cause increased sedation, decreased attention and
amnesia19. We need strict control over the sale of
tranquilizers in the country.
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The assumption that increased access leads to irrational use
of over-the-counter medicines has not been substantiated20.
This shows that the availability of medicines over the counter
but with proper safeguards and regulations is required.
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It is expected that patients will continue to place an increasing
emphasis on “selfcare”, and we have to remain up-to-date in
our knowledge, in order to make such practice is safe and
useful21.
CONCLUSION
• The use of “OTC” medication
among our respondents is
found to be substantial. The
medical community must
ensure that the practice is safe
and useful for our patients.
Education of patients on this
issue and effective government
control over the sale of
medications are strongly
recommended.