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.
AN OVER-THE-COUNTER MOISTURIZER IS AS CLINICALLY EFFECTIVE AS, AND MORE COST-EFFECTIVE THAN, PRESCRIPTION BARRIER CREAMS IN THE TREATMENT OF CHILDREN WITH MILD-TO-MODERATE ATOPIC DERMATITIS: A RANDOMIZED, CONTROLLED TRIAL.
By: DW Miller, SB Koch, BA Yentzer et al.
Summary: Atopic dermatitis (AD) is a prevalent skin disorder with significant cost of treatment. Several prescription device moisturizers have been approved by the FDA to treat AD but are significantly more expensive than well-crafted over-the-counter (OTC) moisturizers. The purpose of this study is to compare the clinical efficacy and cost-efficacy of a glycyrrhetinic acid-containing barrier repair cream (BRC-Gly, Atopiclair®), a ceramide-dominant barrier repair cream (BRC-Cer, EpiCeram®) and an OTC petroleum-based skin protectant moisturizer (OTC-Pet, Aquaphor Healing Ointment®) as monotherapy for mild-to-moderate AD in children. OTC-Pet is as effective in treating mild-to-moderate AD as both BRC-Gly and BRC-Cer and is at least 47 times more cost- effective.
NON-PRESCRIPTION ANTIMICROBIAL USE WORLDWIDE: A SYSTEMATIC REVIEW.
By: DJ Morgan, IN Okeke, R Laxminarayan et al.
Summary: In much of the world antimicrobial drugs are sold without prescription or oversight by health-care professionals. The scale and effect of this practice is unknown. This study systematically reviewed published works about non-prescription antimicrobials from 1970-2009, identifying 117 relevant articles. Non-prescription use occurred worldwide and accounted for 19-100% of antimicrobial use outside of northern Europe and North America. Safety issues associated with non-prescription use included adverse drug reactions and masking of underlying infectious processes. Non- prescription use was common for non-bacterial disease, and antituberculosis drugs were available in many areas. Antimicrobial- resistant bacteria are common in communities with frequent non- prescription use. In a few settings, control efforts that included regulation decreased antimicrobial use and resistance. Non- prescription antimicrobial and antituberculosis use is common outside of North America and northern Europe and must be accounted for in public health efforts to reduce antimicrobial resistance.
OVER-THE-COUNTER COUGH AND COLD MEDICINES FOR CHILDREN: A COMPARISON OF UK AND US PARENTS’ PARENTAL USAGE, PERCEPTION AND TRUST IN GOVERNMENTAL HEALTH ORGANISATION.
By: Himmelstein-M, Miron-Shatz-T, Hanoch-Y, Gummerum-M.
Summary: In 2008, the Medicines and Healthcare products Regulatory Agency (MHRA) issued guidelines discouraging use of over-the-counter cough and cold medications in children under six. This study assessed whether parents had heard of and trusted the MHRA recommendations, and examined parental knowledge, perception and behaviours associated with over-the-counter cough and cold medication use in children. One-third (36.5%) of UK parents had not heard about the MHRA recommendations. Half (54.4%) of parents who were aware of the recommendations did not trust them or were unsure what to believe. UK parents with children under six showed widespread (86.9% of sample) use of over-the-counter cough and cold medications with children. Many parents were able to identify one active ingredient in the over-the-counter cough and cold medication they reported using with their children yet few were able to identify all of the active ingredients. Despite ubiquitous use of over-the- counter cough and cold medication with children, only 29.6% of parents rated the medication as very effective, and just half (50.3%) rated the medication as very safe.
PHARMACY ASSISTED PATIENT SELF CARE OF MINOR AILMENTS: A CHRONOLOGICAL REVIEW OF UK HEALTH POLICY DOCUMENTS AND KEY EVENTS 1997-2010.
By: V Paudyal, D Hansford, S Cunningham, D Stewart.
Summary: Substantial focus on pharmacy assisted self care of minor ailments was identified within health policy documents with key drivers being: the need to reduce associated financial burden owing to minor ailments presentation at General Practices (GPs), increasing patient access to services and aiding pharmacists’ professional development through extended role. Two key interventions, directly aimed at shifting this balance of care, were the ongoing legal reclassification of prescription medicines to pharmacy supply and introduction of free minor ailments schemes across the UK. A shift from GP led to community pharmacy led patient self care of minor ailments has been a focus of many UK health policy documents. The existing burden of minor ailments on GP services requires sustained emphasis on community pharmacy, as well as research to reduce gaps between current policy and practice.
HOW MUCH TIME DO ADULTS SPEND ON HEALTH-RELATED SELF-CARE? RESULTS FROM THE AMERICAN TIME USE SURVEY.
By: DE Jonas, Y Ibuka, LB Russell.
Summary: The aim of this study was to describe how much time American adults reported spending on health- related self-care (eg, taking insulin, dressing a wound). Time spent on health-related self-care is disproportionately distributed across the population, with a larger amount of time reported by those in poor health (3.6 hours/week) and the nonworking disabled (3.2 hours/week). To provide patient-centered care and to promote optimal decisions about health-related time management when making recommendations for additional self-care tasks, clinicians need to talk to patients about how much time they are already spending on self-care.
GUIDANCE ON THE USE OF OVER-THE-COUNTER PROTON PUMP INHIBITORS FOR THE TREATMENT OF GERD.
By: G Holtmann, MA Bigard, P Malfertheiner, R Pounder.
Summary: An expert panel group of gastroenterologists convened to develop a consensus-based algorithm for pharmacists for over-the- counter (OTC) treatment with proton pump inhibitors (PPIs). Key considerations were the short-term safety and efficacy of PPIs, and the extent of the risk to the sufferer, owing to the treatment not being controlled by a physician. As defined by the treatment algorithm, the pharmacist should first confirm the diagnosis based on the presence of typical symptoms and secondly, as a result, rule out general practitioner referral. The third step focuses on the nature, severity and frequency of the symptoms – the patients who might have the highest benefit from a short course (14 days) of OTC PPIs are those with less than three episodes of heartburn and/or acid regurgitation per week. Patients who have three or more episodes per week can use the OTC PPIs but should also be encouraged to visit a physician, and those who already have a diagnostic work-up can use proton pump inhibitors as rescue treatment if they are known responders. Owing to their accepted efficacy and safety, PPIs are becoming popular as OTC options for the treatment of gastroesophageal reflux disease symptoms such as heartburn and acid regurgitation. Effective self-management of gastroesophageal reflux disease with OTC PPIs, e.g. omeprazole, could lead to lasting freedom from symptoms and improved quality of life for sufferers.
NEW DEVELOPMENTS IN TRAVELER’S DIARRHEA.
By: BJ de-la-Cabada, HL Dupont.
Summary: Traveler’s diarrhea (TD) affects millions of tourists each year and creates a large economic burden. More than 60% of TD cases are caused by a variety of bacterial enteropathogens: diarrhea-producing Escherichia coli, Shigella, Campylobacter, Salmonella, Aeromonas, Plesiomonas, and noncholera Vibrios. Noroviruses are also an important cause of morbidity among travelers. Prevention strategies should be emphasized, as all individuals with TD experience approximately 24 hours of disability and 5-10% experience chronic functional bowel disease. Poorly absorbed rifaximin provides protection for trips lasting 2 weeks or less. TD vaccines are also currently in development. All individuals planning trips to developing regions should be armed with 1 of the 3 agents that have shown efficacy for self-treatment of TD: ciprofloxacin (or levofloxacin), rifaximin, or azithromycin, depending upon the location of the trip. Although global epidemiologic changes in etiologic agents as well as antibiotic resistance patterns have been better understood recently, changes should be expected during the next decade due to new prevention and treatment approaches.
OVER-THE-COUNTER ORLISTAT: EARLY EXPERIENCES, VIEWS AND ATTITUDES OF COMMUNITY PHARMACISTS IN GREAT BRITAIN.
By: AE Weidmann, S Cunningham, G Gray et al.
Summary: To describe community pharmacists’ early experiences, views and attitudes with over-the-counter orlistat, 9 months post legal re-classification from November 2009 to January 2010. Using a cross-sectional postal questionnaire survey in 13,200 (81%) randomly selected registered community pharmacies across Great Britain out of a potential 16,200. Despite community pharmacists welcoming orlistat re-classification to increase medicines availability as an opportunity to extend their healthcare professional role there were concerns about poor public uptake, high cost and the potential for misuse. Exploratory studies collecting the views and experiences of the general public about the access and provision of weight management services through community pharmacies are warranted.
HOW DO PHARMACISTS RESPOND TO COMPLAINTS OF ACUTE INSOMNIA? A SIMULATED PATIENT STUDY.
By: C Kippist, K Wong, D Bartlett, B Saini.
Summary: Many people with insomnia choose to self medicate and present at community pharmacies, particularly in cases of acute insomnia. The objective of this study in community pharmacies in NSW Australia is to investigate how community pharmacists respond to complaints of acute insomnia from people who seek self treatment and determine the factors affecting this response. Of the 100 pharmacies, upon simulated patient presentation, 96% supplied a product, the remaining 4% referred to a physician. Non-pharmacological advice was provided in 42%. The results of this study suggest that many pharmacists are responding appropriately to complaints of sleeplessness in terms of eliciting insomnia type and counseling about medicines use.
EFFECTIVENESS OF OVER-THE-COUNTER NICOTINE REPLACEMENT THERAPY: A QUALITATIVE REVIEW OF NONRANDOMIZED TRIALS.
By: JR Hughes, EN Peters, S Naud.
Summary: Randomized trials conducted in over-the-counter (OTC) settings have shown that nicotine replacement therapy (NRT) is effective. This paper reviews nonrandomized tests of the effectiveness of OTC NRT. Some lines of evidence appear to confirm the effectiveness of OTC NRT, but others do not. We believe further secondary analyses using nonrandomized comparisons are unlikely to resolve this issue due to sensitivity, specificity, and selection bias problems.
ADOLESCENTS’ SELF-REPORTED REASONS FOR USING NICOTINE REPLACEMENT THERAPY PRODUCTS: A POPULATION-BASED STUDY.
By: S Raisamo, DT Doku, AH Rimpelä.
Summary: The present study examined the reasons for NRT use among 14-18-year-old Finnish adolescents, in a survey in 2009 (N=4834, response rate 55%). Overall, 10% had used NRT. Boys used NRT more often than girls (11.5% versus 8.7%, p<.001). The three most commonly reported reasons were ‘just try’ (56%), ‘to quit’ (33%) and ‘smoking not possible’ (24%). “Just try” was the most common reason given by non-smokers/experimental smokers whereas daily/occasional smokers used NRT mainly for quitting purposes and when smoking was impossible. These findings suggest that when planning treatment plans for adolescent smokers, health care personnel should pay particular attention to adolescents’ primary reasons and motives for using NRT before suggesting its use.
BUYER BEWARE? DOES THE INFORMATION PROVIDED WITH HERBAL PRODUCTS AVAILABLE OVER THE COUNTER ENABLE SAFE USE?
By: DK Raynor, R Dickinson, P Knapp et al.
Summary: Herbal products obtained over the counter are commonly used in Europe, North America and Australia. Although there is concern about a lack of information provided to consumers to allow the safe use of these products, there has been no published research to confirm these fears. In this study, we evaluated written information provided with commonly used herbal products in the UK in advance of a European Union Directive issued in April 2011 that tightened regulations for some herbal products, including requirements to provide safety information. Most of the herbal medicine products studied did not provide key safety information which consumers need for their safe use. The new European Union legislation should ensure that St John’s wort and echinacea products will include the previously missing information in due course. The legislation does not apply to existing stock. Potential purchasers need to know, in both the short term and the long term, how to purchase herbal products which provide the information they need for the safe use of these products.