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.
OLDER ADULTS’ SELF-MANAGEMENT OF DAILY SYMPTOMS: COMPLEMENTARY THERAPIES, SELF-CARE, AND MEDICAL CARE.
By: TA Arcury, JG Grzywacz, RH Neiberg et al.
Journal of aging and health 2012 June 24(4): 569-97.
Summary: This study was to describe older adults’ use of complementary therapies, self-care practices, and medical care to treat daily symptoms, and to delineate gender, ethnic, age, and education differences, using interviews. The use of complementary therapies to treat daily symptoms, though important, is substantially less than the use of self-care practices and medical care. In considering the percentage of individuals who use a therapy and the frequency with which therapies are used, this analysis adds a new dimension to understanding how older adults manage daily symptoms. Older adults are selective in their use of health self-management.
COMMUNITY PHARMACISTS’ ADOPTION OF MEDICINES RECLASSIFIED FROM PRESCRIPTION-ONLY STATUS: A SYSTEMATIC REVIEW OF FACTORS ASSOCIATED WITH DECISION MAKING.
By: V Paudyal, D Hansford, S Cunningham, et al.
Pharmacoepidemiology and Drug Safety 2012 Aug 21(4): 396-406.
Summary: More than 90 prescription-only medicines have become available in the UK without a prescription with similar changes taking place internationally. A systematic review of published literature from 1990 to 2010 was conducted to study community pharmacists’ decision making around adoption of these reclassified medicines into practice. A total of 38 studies were included. Twenty-eight factors associated with pharmacists’ decision making were identified. Medicine safety was consistently shown to be a key factor, however the importance of evidence base and financial benefits of reclassification were less obvious. Patient safety appears to be the key to pharmacists’ decision making. However, the study quality limitations indicate the need for further robust research.
OVER-THE-COUNTER ACNE TREATMENTS: A REVIEW
By: A Decker, EM Graber
Journal of Clinical and Aesthetic Dermatology 5. 5 (May 2012): 32-40.
Summary: Due to convenience, lower cost, and difficulty getting an appointment with a dermatologist, the use of over-the-counter acne treatments is on the rise. It is important that dermatologists are well-versed on this subject to provide appropriate information about treatment regimens and potential drug interactions and that their patients see them as well-informed. This article reviews the efficacy of various over-the-counter acne treatments based on the current literature. Many of the key over-the-counter ingredients are incorporated in different formulations to broaden the spectrum and consumer appeal of available products. Many OTC products are not well-supported by clinical studies, with an absence of double-blind or investigator-blind, randomized, vehicle-controlled studies. Overall, over-the-counter acne therapies can be classified into the following five major groups: cleansers, leave-on products, mechanical treatments, essential oils, and vitamins.
SELF-MEDICATION OF REGULAR HEADACHE: A COMMUNITY PHARMACY-BASED SURVEY
By: E Mehuys, K Paemeleire, T Van Hees, et al.
Summary: This observational community pharmacy-based study investigated headache characteristics and medication use in 1205 participants with regular headache presenting for self-medication. Forty-four percent of the study population (n=528) had no physician diagnosis of their headache, and 42.6% were found to be Migraine Screener (ID-M) positive. The most commonly used acute headache drugs were paracetamol (62%), NSAIDs (39%), and combination analgesics (36%). Only 12% of patients physician-diagnosed with migraine used prophylactic migraine medication, and 25% used triptans. About 24% chronically overused acute medication, which was combination analgesic overuse (n=166), simple analgesic overuse (n=130), triptan overuse (n=19), ergot overuse (n=6), and opioid overuse (n=5). Only 14.5% was ever advised to limit intake frequency of acute headache treatments. This study identified underdiagnosis of migraine, low use of migraine prophylaxis and triptans, and high prevalence of medication overuse amongst subjects seeking self-medication for regular headache.
SELF-MEDICATION IN OPHTHALMOLOGY: A QUESTIONNAIRE-BASED STUDY IN AN ARGENTINEAN POPULATION
By: GE Marquez, VE Torres, VM Sanchez, et al.
Summary: A study to identify practices of self-medication in the treatment of ocular conditions and to profile patients who self-medicate, with a descriptive survey of patients, over the age of 17 years seen in an ophthalmology practice in Cordoba, Argentina. Prior to looking for medical attention 97 patients (25.6%) reported self-medicating. The most frequently used products included non-steroidal anti-inflammatory drops in combination with a vasoconstrictive agent (32%) followed by a combination of antibiotics and steroids (9%), however, 14% of patients did not remember the name or type of medication applied. A total of 31% of patients used drugs recommended by a pharmacist; 25% used drugs of their own choosing and 24% followed suggestions from a friend or family member. Only 12% of patients knew the drug’s components and only 3% were aware of any possible side effects. Patients commonly attempt to treat conditions that require ophthalmologic care by self-medicating with over-the-counter eye drops.
HEALTH LITERACY ASSESSMENT OF LABELING OF PEDIATRIC NONPRESCRIPTION MEDICATIONS: EXAMINATION OF CHARACTERISTICS THAT MAY IMPAIR PARENT UNDERSTANDING
By: SH Yin, RM Parker, MS Wolf, et al.
Summary: Poor quality and variability of medication labeling have been cited as key contributors to medication misuse. This study assessed the format and content of labels and materials packaged with common pediatric liquid nonprescription medications. Although almost all products listed active ingredients on the Drug Facts panel (side panel), nearly 1 in 5 (37 [18.5%]) did not list active ingredients on the PDP. The format and content of labels for nonprescription pediatric liquid medications could be improved to facilitate parent understanding of key medication information, including active ingredient information and dosing instructions. Copyright © 2012 by Academic Pediatric Association.
A NEW MODEL OF PRESCRIPTION TO NONPRESCRIPTION RECLASSIFICATION: THE CALCIPOTRIOL CASE STUDY
By: Gauld, N., Emmerton, L., Kelly, F., & Buetow, S.
Summary: Medicines reclassification from prescription to nonprescription (switch) has slowed in some countries, including the United States. New thinking may be necessary to drive this area, including third-party reclassification and better use of the pharmacist, collaborative care, or innovative technologies. The goal of this study was to describe a recent, successful, third-party reclassification of topical calcipotriol, a treatment for psoriasis, including the process, challenges, and solutions. The third-party reclassification of topical calcipotriol generated challenges, mainly due to initial manufacturer opposition. The greatest hurdle was an inability to change the label. However, requiring mandatory pharmacist consultation, with supply under specified conditions, overcame the barriers. An algorithm for supply was developed. The flexibility of the MCC, an advisory committee, and the medicines regulator, both in considering a third-party approach and in allowing an exemption to prescription supply under specific conditions, was vital to the success of the reclassification. Third-party reclassification may be possible in some countries, particularly where supply can be limited to pharmacists only.
GENDER AND HEALTH LIFESTYLE: AN IN-DEPTH EXPLORATION OF SELF-CARE ACTIVITIES IN LATER LIFE
By: JG Grzywacz, EP Stoller, A Brewer-Lowry et al.
Summary: This was a study to evaluate similarities and differences in the self-care domain of health lifestyle among older, rural-dwelling women and men in the USA. Both older women and men rely heavily on over-the-counter medications and home remedies for self-care; professional health care is typically sought when self-care is not effective. However, relative to men, women were more knowledgeable about different approaches to self-care, especially home remedies; they used a wider range of self-care activities; and they placed greater priority on self-care over professional health care.
IS IT TIME TO REGULATE OVER-THE-COUNTER WEIGHT-LOSS FORMULATIONS?
By: A Hackett & J Krska.
Summary: Many products claiming to promote weight loss are freely available to purchase over the counter and are used by a substantial proportion of the population in many countries, who are often seeking rapid weight loss without long-term lifestyle changes. Surveys in England and Australia have found that at least 70% of community pharmacies stock these products and they are also available through internet pharmacies. Consumers may regard them as medicines, particularly when sold from a pharmacy. Manufacturers often make extravagant claims for their products, suggesting they suppress appetite, increase metabolism, block absorption of fat or carbohydrates and/or bring about diuresis, but there is little robust evidence of efficacy. Most products contain a variety of herbal ingredients and are not without adverse effects. Since very few of the hundreds of products sold in pharmacies are licensed medicines, they are not subject to the controls required for over-the-counter medicines, in terms of efficacy, safety, quality or provision of a standardised patient information leaflet. We question the widespread supply through pharmacies of ineffective products with extravagant claims and suggest that tighter regulation of their promotion and supply may be required.