SelfCare Focus 8.3

A selection of newly published papers on self-care from the worldwide literature

Every week, we will provide a brief summary and a link to the published abstract of newly published papers selected from the worldwide literature as being of particular interest to the SelfCare community.

Patients’ valuation of the prescribing nurse in primary care: a discrete choice experiment.

By: Gerard K, Tinelli M, Latter S, Smith A, Blenkinsopp A.

Health expectations. 2015 Dec;18(6):2223-35.

Summary: There is little evidence about value-based patient preferences for a prescribing nurse in a general practice setting. The study therefore sought to quantify value-based patient preferences that influence choice of consultation for managing a minor illness. There was a strong preference for consulting one’s own doctor for minor illness. However, a consultation with a nurse prescriber with positive patient-focused attributes can be more acceptable to patients than a consultation provided by a doctor. The attributes of ‘professional’s attention to patient views’ and extent of ‘help offered’ were pivotal. Past experience influenced preference.



Actual use of and adherence to ibuprofen 400 mg tablet dosing instructions in a simulated OTC environment.

By: Meeves S, Leyva R, Richardson C, Wilson B, Savastano DM.

International Journal of Clinical Pharmacology and Therapeutics 2017 Jul;55(7):547-557

Summary: In a 30-day study simulating an OTC-like environment, American analgesic consumers reviewed proposed product packaging for a new 400 mg ibuprofen formulation and made a purchase decision. Purchasers used the product as needed and recorded use over 30 days. Outcomes included the percentage of participants who exhibited correct or acceptable product use. Of 685 purchasers providing use data, correct or acceptable use behavior occurred in 95.2% relative to total daily dose and in 84.4% regarding the number of tablets taken per dosing occasion. Most participants (87.3%) never used > 1,200 mg/day or took > 1 tablet/ dose (78.1%). Nearly 43% of subjects re-dosed within 6 hours of the previous dose. Adverse events were consistent with prior ibuprofen 200 mg experience. The authors concluded the study provided evidence that a majority of US consumers would be able to use OTC ibuprofen 400 mg tablets in a manner consistent with product labeling.



Switching, Adverse Effects and Use of Over-the-Counter Analgesics among Users of Oral Anticoagulants: A Pharmacy-based Survey.

By: Hellfritzsch M, Hyllested LMR, Meegaard L, Wiberg-Hansen A, Grove EL, Pottegard A.

Basic and Clinical Pharmacology and Toxicology 2017 Jul;121(1):37-43.

Summary: Researchers conducted a survey of patients filling a prescription for oral anticoagulants at two large Danish community pharmacies. They collected information on patient knowledge of their anticoagulant treatment. Patients were also asked about use of OTC analgesics. Among 335 eligible patients, 301 agreed to participate. Although half of all patients had recently bought OTC analgesics, the purchase of ibuprofen and aspirin was 6%, leading to a conclusion that use of OTC NSAIDs was rare.



Management of respiratory tract infections in young children – A qualitative study of primary care providers’ perspectives.

By: Biezen R, Brijnath B, Grando D, Mazza D.

Primary Care Respiratory Medicine 2017; 27 (1): Article Number: 41533.

Summary: Respiratory tract infections in young children are the most common cause of general practice visits in Australia. Despite the availability of clinical practice guidelines, the treatment and management of respiratory tract infections in young children is inconsistent. The aim of the study was to explore the management of respiratory tract infections in young children from a multi-disciplinary perspective.
The findings indicate that factors such as primary care provider time constraints, parental anxiety, general practitioner perception of what parents want, perceived parental pressure, and fear of losing patients were some of the reasons why primary care providers did not always adhere to guideline recommendations. Primary care providers also provided conflicting advice to parents concerning OTC medications and when children should resume normal activities.



International variability in the prevalence of insomnia and use of sleep-promoting medications, supplements, and other substances.

By: Havens CM, Grandner MA, Youngstedt SD, Pandey A, Parthasarathy S.

31st Anniversary Meeting of the Associated Professional Sleep Societies — SLEEP 2017. United States. pp A117-A118.

Summary: Few studies have compared insomnia prevalence across multiple countries using standardized measures. An international web-based survey was conducted across 10 countries with 7817 respondents. The prevalence of insomnia ranged from 5.4% (Netherlands) to 30.5% (Brazil). Use of over-the-counter medications and supplements was consistently more common in the US.


Misuse of over the counter medicines in community pharmacies in Scotland.

By: Hill D, McCabe A, Paterson K, Stuart J, Campbell D.

Journal of Substance Use 2017; May: pp 1-7.

Summary: This article examined the self-reported use of medication from a small sample of community pharmacies in Scotland. Data were collected over a short time period in 2015 from 15 community pharmacies. The data demonstrate the widespread misuse of OTC. The most prevalent group identified as females, between 41 and 60 years of age. It was most commonly reported that the recommended treatment duration is exceeded rather than the maximum recommended daily dose.



Decision-making in men considering use of non-prescription tamsulosin for lower urinary tract symptoms.

By: Cohn J, Dmochowski R, Kowalik C, Roehrborn C, Bierer D, Verbeek A, Wruck J.

112th Annual Meeting of the American Urological Association, 2017. J Urol 2017; 197 (4 Supplement 1): e104.

Summary: The researchers aim was to assess appropriate decision-making in men choosing to use tamsulosin in a simulated OTC setting for lower urinary tract symptoms. Adult men not taking a prescription medication for benign prostatic hyperplasia (BPH) were shown a mock-up of the drug packaging and asked if the medication would be appropriate for their personal use. Three urologists reviewed the data of men reporting the product to be appropriate for their use who did not meet appropriate self-selection criteria. 470/619 (75.9%) eligible men self-selected use. The proportion of men meeting appropriate self-selection criteria on unmitigated and mitigated analyses was 92.8% and 97.9%.


Management of allergic rhinitis in the era of effective over-the-counter treatments.

By: Carr WW and Yawn BP.

Postgraduate Medicine 2017; Jun 9: pp 1-9.

Summary: Up to two thirds of patients self-manage AR before seeking medical care. For many patients, the impact on quality of life is greater than suggested by reported symptoms and should also be a focus of treatment. The authors feel that while many patients can effectively manage AR symptoms independently, a significant percentage will need direction from a physician to obtain optimal results. The availability of several different classes of treatment (decongestants, antihistamines, intranasal corticosteroids (INS)) has increased the complexity of self-management, leaving patients confused about the best approach to treatment. Treatment guidelines universally classify INS as the most effective medical agents available for use in the OTC and primary care settings. But, patients may have negative perceptions about their safety and may have experienced unpleasant taste, scent, and feel with nasal sprays. This article reviews the primary care management of AR in the context of the availability of effective OTC medicines.



Implications of dispensing self-administered hormonal contraceptives in a 1-year supply: a California case study.

By: McMenamin SB, Charles SA, Tabatabaeepour N, Shigekawa E, Corbett G.

Contraception 2017; 95: 449-451.

Summary: As of September 2016, California became the sixth state to pass legislation requiring health plans and insurers to cover a year supply of self-administered hormonal contraceptives such as contraceptive pills, patches and vaginal rings. This legislation is estimated to result in 38% of current contraceptive pill, patch, and ring users receiving a 12-month supply dispensed at one time. This shift in dispensing patterns was estimated to result in a reduction of 15,000 unintended pregnancies, 2000 fewer miscarriages, and 7000 fewer abortions in California decreasing total net health care expenditures by 0.03%.



A population-based study of risk perceptions of paracetamol use among Swedes-with a special focus on young adults.

By: Håkonsen H, Hedenrud T.

Pharmacoepidemiol Drug Saf. 2017 Jun 5. doi: 10.1002/pds.4238.

Summary: The purpose was to investigate risk perceptions of paracetamol use with a special focus on young adults. A web survey was sent to a representative sample (n = 5838) of the Swedish adult population. Altogether, 3120 persons answered the full questionnaire. Most respondents (70.5%) reported use of paracetamol in the 3 months prior to the study. The highest proportion was found among those aged 18 to 25 years (75.8%). Nine in 10 were OTC paracetamol users. A total of 14.2% thought paracetamol was completely harmless to use, while 54.3% indicated risks associated with use even when following the dosing instructions. One third disagreed that it is less risky to use paracetamol compared with NSAIDs. Three-quarters identified liver damage as a potential consequence of exceeding the recommended maximum daily dose.



Rates of Nonsteroidal Anti-Inflammatory Drug Use in Patients with Established Cardiovascular Disease: A Retrospective, Cross-Sectional Study from NHANES 2009-2010.

By: Castelli G, Petrone A, Xiang J, Shrader C, King D.

American Journal of Cardiovascular Drugs 2017; 17: 243-49.

Summary: The purpose of this study is to evaluate the rates of NSAID use among patients with CVD following the 2005 FDA warning regarding NSAID use and increased CVD risk. This was a retrospective, cross-sectional study of participants from the National Health and Nutrition Examination Survey 2009-2010. Respondents with CVD were 2.1 times more likely to use OTC NSAIDs or prescription NSAIDs than respondents without CVD.



Are antihistamines effective in children? A review of the evidence.

By: De Bruyne , Christiaens T, Boussery K, Mehuys E, Van Winckel M.

Archives of Disease in Childhood 2017; 102:56-60.

Summary: In this paper, the case of first-generation H1-antihistamines is investigated, notably the range of indications for which products are licensed in different European countries and the evidence base (or lack thereof) for each indication, as well as reported adverse drug reactions. The authors concluded that many of the licensed indications of first-generation antihistamines do not appear to be evidence based.