04-11-2016, 11:16 AM
A survey on self-medication versus prescribed medication causing benefits and adverse effects and creating awareness among population
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ABSTRACT
Aim:
Main purpose of this study was to compare the pattern of self-medication and prescribed medication in common population in Chennai, India and to tabulate results and there by creating awareness on all population & elderly patients which would have great impact on patient safety.
Methods:
A questionnaire consisting of 15 questions were framed based on knowledge and usage of self administrated drugs as well as prescribed drugs and were given to 100 people of Chennai population. This was a cross-sectional study, hence it has self-developed questionnaire, consisting of both open and close-ended questions related to various aspects of self-medication and prescribed medication were used. Study population consisted of common population of Chennai, between age group 20-50.
Results:
Among 100 respondents, 72% respondents practice self medication, while only 28 % go for prescribed medication. Adverse reactions, lack of knowledge about dose, frequency of administration and chances of taking the wrong medicine were the major drawbacks of self-medication reported. The frequently reported illness that prompted self-medication included Headache, Cough, Fever, Diarrhoea, and Acidity. Majority of them obtained OTC by mentioning name of drug or by telling symptom or by showing old prescription. Drugs most commonly used by self-medication were analgesics, anti pyretic and anti-diarrhoeal.
Conclusions:
Usage of OTC was highest amongst common population. Time consumption for consultation, the Financial crisis, availability of OTC drugs, predictability of doctors general prescription were the commonly mentioned reasons for self medication. It was analyzed that most of them were not aware of the drug, dosage, frequency of administration and adverse reactions. While, very little people were aware of these medications. Drugs, especially antimicrobials, which were not taken for the proper duration, can leads to serious resistance. Hence, proper Education and awareness must be created to help patients decide on proper medications.
Key words; Self medication, Over the counter (OTC), Anti-biotic, Awareness.
INTRODUCTION;
Self-medication is the use of drugs with therapeutic intent but without professional advice or prescription. It has also been defined as the use of non-prescription medicines by people on their own initiative [1]. While, on the other hand prescribed medication is the use of drugs with the help of medical supervision and prescription. Drug retail shops frequently serve as the public's first point of contact with the health care system [2]. In India, pharmacists and pharmacy attendants play an important role in fostering self-medication among the public [3]. Self-medication could cause bacteria resistance to such antibiotics and may precipitate the emergence of multiple resistant organisms that would be difficult to treat and this has caused increased morbidity [4-7]. Studies on self-medication patterns and the prevalence on doctor prescribing in the India, shows an increasing number of patients developing resistance to the commonly used antibiotics. The most commonly available over the counter (OTC) medicines in Chennai are analgesics, non-steroidal anti-inflammatory drugs (NSAIDs), anti histaminic, vitamin supplements, tonics, and cough and cold remedies. Although, these medications are considered safe, but their excessive use can lead to serious adverse effects.
In India, the Drugs and Cosmetics Act, 1940 (DCA), the Drugs and Cosmetics Rules, 1945 (DCR) regulates the import, manufacture, distribution and sale of drugs and cosmetics. The “OTC” (over the counter) has no legal implications in India. [8] Hence “OTC Drugs” means drugs legally allowed to be sold “Over the Counter” by pharmacists, i.e. without the prescription of a Registered Medical Practitioner. Prescription-only drugs are listed in Schedules H and X of the Drug and Cosmetics Rules. Drugs listed in Schedule G (mostly antihistamines) do not need prescription to purchase but require the following mandatory text on the label: Caution: It is dangerous to take this preparation except under medical supervision. [9] In several studies it has been found that inappropriate self-medication results in wastage of resources, increases resistance of pathogens and generally entails serious health hazards such as adverse drug reactions, prolonged suffering and drug dependence. [10]
Self-medication is now increasingly being considered as a component of self-care. [11] Unlike other aspects of self-care, self-medication involves the use of drugs and drugs have the potential to do good as well as cause harm. When practiced correctly, self-medication can save the time spent in waiting to see a doctor, may be economical but due to their improper use due to lack of knowledge of correct dose, side-effects and interactions could have serious implications, especially in extremes of ages (children and old age).[12] Therefore the study was taken up to analyze the population at risk, rate of self medication, in compared to doctors prescribed medication and create awareness of the adverse effects among the participants.
METHODS;
A questionnaire consisting of 15 questions were framed based on knowledge and usage of self administrated drugs as well as prescribed drugs and they were given to 100 people of Chennai population. This was a cross-sectional study, hence it has self-developed questionnaire, consisting of both open and close-ended questions related to various aspects of self-medication and prescribed medication which were most commonly employed. Study population consisted of common population of Chennai, between age group 20-50. People were explained about the aim and purpose of the study and the concept of self-medication and prescribed medication were clearly explained and discussed with the population of Chennai. The respondents were interviewed with the questions and corresponding answers were marked.
The questionnaire was in two parts. The first part contained questions on demographic information of the respondents such as Name, age, gender, etc. The second part contained questions on core issues which delt on direct questions such as reasons for self medication, most common drugs used for self-medication, type of ailment treated through self-medication, factors influencing discomforts of self-medication practices and also knowledge about drug resistance. The questionnaire, consisted of close- and open-ended questions, and they were framed in such a way for easy understanding and filling by respondents. The questionnaire was also backed with amoral interview. Some of the questions asked during the interview section were: do you think self-medication is a good practice? Do you think education will help reduce the incidence of self-medication?
The aims of our study were to:
1) Obtain baseline data on self and non-doctor prescribing in Chennai city.
2) Obtain information on the factors influencing self medication and Doctor prescribing medication, and
3) To create awareness about the drug interactions, that can lead to serious implications and adverse effects, due to self-medication.
Data obtained from the questionnaire were coded, given sequential numbers and entered into the Statistical Package for Social Sciences (SPSS), version 16, software. Analysis was carried out using descriptive statistics and Prevalence of self-medication along with prescribed medication, among population were measured in percentages. Descriptive analysis was employed to present bar charts for appropriate results.
RESULTS:
One hundred respondents were covered during this entire study. The age distributions of the responders [Table 1] were between the ages of 20 to 50 years. Out of one hundred responders (59%) were male and the rest (41%) were females. [Table 2] These 100 responders were from various professions from Chennai district selected randomly for this survey. Coming to the results of administrating self medication drugs in comparison to doctors prescribed drugs, when enquired about whether self medication is good practice or not, (68%) responders accepted it’s not good, while remaining (30%) responders said it’s not bad, followed by 2% who doesn’t know about it. [Table 3] According to the (28%) responders fever and cold are major reasons that demands them visiting doctors, followed by continuous headache (27%), and diarrhea (24%). [Table 4] When they are enquired about completing the course of drugs that doctors prescribed (63%) responders said yes, while remaining (35%) does not finish the course of drugs which doctors prescribe is noted. [Table 5] (62%) responders said that they will visit doctor for second time, if problem persists, while (38%) responded that, they will buy the same drugs over the counter, which was earlier prescribed by the doctors. [Table 6)] From this survey we identified that confidence in self-medication (41%) was the main reason for administrating self medication followed by, financial crisis (35%), and time consumption (15%). [Table 7] We noticed (66%) responders were aware that drugs taken through self-medication has many disadvantages, while (33%) came up with a taught ,it doesn’t have any sort of adverse effects, while remaining (1%) doesn’t have any idea about it. [Table 8] According to the responders, the most commonly used over the counter drugs were Antibiotics (21%), Analgesics (21%), Anti-diarrheal (17%) followed by Anti-histamines (12%). [Table 9] we also founded that (63%) responders does not aware that Anti-biotic must be taken for complete, dose due to its resistance, while just (32%) responders know about it, followed by (5%) individuals who doesn’t even have any clue about it. [Table 10] Even tough self medication have many side effects (54%) responders does not experienced any side effects , while (31%) had severe side effects due to wrong self-medication, remaining (15%) were not sure about it. [Table 11] when enquired about the safety of physician prescribed medication in compared to self medicated ones, (93%) responders were absolutely sure that prescribed drugs are safe, while (7%) individuals said even prescribed drugs may not be safe always. [Table 12] Interestingly (79%) responders said that they didn’t experienced any hospitalization due to adverse effects of self medication , while (14%) went on hospitalization for further treatment due to its side effects , while (7%) individuals were not sure about it. [ Table 13] we also identified the most common discomforts that people experienced while administrating self medication they are Diarrhea (32%), Allergies and rashes (21%), Constipation (18%), Nausea /Vomiting (14%), Head ache (12%), and remaining (3%) doesn’t had any discomforts. [ Table 14] when we enquired about their knowledge about drugs used for common problem , (47%) people responded that they have good knowledge , (36%) responded they have average knowledge , while remaining (17%) have no idea about any drugs or drug names. [Table 15]Even after (47%) individuals said they have good knowledge about drugs still (89%) individuals have no clue about combination drugs like H2 Blockers for NSAIDs, while only (11%) people knew about it and responded it’s to neutralizing gastric irritation. [Table 16] finally after hearing all these , we enquired them about Source of drug information, they responded that they gained knowledge from Doctors(48%), Internet (24%), friends (14%), Media (7%), Relatives ( 4%), while remaining (3%) learned from academic knowledge. [Table 17]
DISCUSSION;
Self-medication is defined as the use of medication, whether modern or traditional, for self-treatment without advice of physician (expert in medical profession) either for diagnosis, prescription or surveillance of treatment. Experience from prior illness; advice from pharmacist, relatives and friends play major role in the self-medication. Out of total 100 participants, 59 were male and 41 were female. There was no statistically significant difference between males and females in regards to self-medication. Similar result was noted by Shahbaz Baig. [13] A questionnaire based cross-sectional study shows that prevalence of self-medication was 88% among study participants. Frequency of self reported medication is highly variable in different parts of the world; as low as 45% in Turkey to as high as 94% in Hong Kong. [16] In Spain and Turkey, the ratio of self-medication was 12.7 and 45% (Figueiras et al., 2000). In Hong Kong, it was 94% (Chang and Trivedi, 2003). This indicates that self-medication is not only practiced in under developing countries, but also in developed countries despite knowing the harmful effects of medicines.
Some authors reported that previous experience was one of the major reason for self medication besides non availability of doctors and transport, ability to self manage, urgency to treat, assumption of better knowledge, lack of time and cost of treatment were the other contributing factors. But our study proves that they are not only the reason, but also, the confidence in self-medication drugs (41%), financial crisis (35%), and time consumption (15%), were also main reason for administrating self medication.
In our study we enquired them about Source of drug information; they responded that they gained knowledge from Doctors prescription (48%), Internet (24%), friends (14%), Media (7%), Relatives (4%), while remaining (3%) learned from academic knowledge. Similarly V D Phalke et al reported Advertisement in newspaper, media as main sources followed by chemist shops. Therefore it is necessary that pharmacist should take responsibility to avoid selling drugs without prescriptions
Doctors and pharmacists play a very important role in creating awareness about self-medication by educating the patients. Hence it is suggested that the public education is mandatory on the type of illnesses for self-diagnosis and its medication, along with implementation of stringent rules and regulations on their use. It is also essential to highlight the dangers of OTCs on their misuse.
Prior to suggesting any OTC medications, pharmacists should thoroughly assess the nature and extent of the patient's condition and recommend that they seek expert care when needed. The motivating factors for self medication could be; easy availability of prescription drugs across the counter without a valid prescription, lack of stringent controls over medical advertising, low medical literacy among the population and the compulsion to reduce health-care costs. For this purpose, prescription system should be more strengthened by provided support by the government.
Drugs such as antibiotics and others which may be very harmful if not taken properly and it should not be available to the patients without prescription. These practices may lead to drug abuses and addiction and may alter the effects of other drugs. The attitude of self medication among pharmacist was also observed mostly in India where antibiotics were among the most commonly used drug for self medication. Though self-medication is widely practiced throughout the world and may be helpful in treating minor common ailments, but this practice should be based on proper medical information, otherwise irrationally using drugs may lead to serious health hazards, adverse drug reaction and even death. Hence proper awareness must be taken to educate the people of our country.
Conclusions
Our study shows that majority of the participants were aware of OTC drugs and self-medication is widely practiced among them when compared to prescribed medication. Confidence in self-medication, financial crisis where the some of the reasons for using OTC drugs. Anti-Biotics and Analgesics were the drugs most commonly used for self-medication. Male sex and age between 25- 40 years were associated with increased self-medication. Time consumption for consultation, the Financial crisis, availability of OTC drugs, predictability of doctors general prescription were the commonly mentioned reasons for self medication. Diarrhoea and headache were the most common reasons for self medication. We founded Drugs especially anti-biotics were not taken for the proper length of time, which can leads to serious resistance in future. Education to help patients decide on the appropriateness of self-medication is required. Self-medication is an alarming sign for society. It was analyzed that most of them were not aware of the drug, dosage, frequency of administration and adverse reactions. While very little people were aware of these medications. Drugs, especially antimicrobials, which were not taken for the proper duration, can leads to serious resistance. Hence, proper Education and awareness must be created to help patients decide on proper medications, which can save the lives of most valuable human creature.