On Over-the-counter Research Articles

Scoping review of interventions to de-implement potentially harmful non-steroidal anti-inflammatory drugs (NSAIDs) in healthcare settings

ObjectivesPotentially harmful non-steroidal anti-inflammatory drugs (NSAIDs) utilisation persists at undesirable rates worldwide. The purpose of this paper is to review the literature on interventions to de-implement potentially harmful NSAIDs in...

The impact of burnout on over-the-counter counseling: a survey of community pharmacists in Vietnam

Abstract Background In many countries, self-medication is, in fact, the main service provided, exhausting pharmacist time and increasing their workload. However, there are currently no reports describing the impact of burnout on patient medication counseling. Objectives This study was conducted to determine the influence of burnout on over-the-counter (OTC) medication counseling services in Vietnam. Methods A cross-sectional study was conducted in community pharmacies across four districts in Can Tho City, Vietnam, between April and May 2023. Burnout was assessed using the Maslach Burnout Inventory-Human Services Survey (MBI-HSS), comprising three subscales: emotional exhaustion (EE; 9 items), depersonalization (DP; 5 items), and personal accomplishment (PA; 8 items). OTC medication counseling activities were evaluated using 12 questions. Results Of the 385 participants recruited, 22.3% reported high work intensity as a common factor contributing to burnout. Pharmacists with burnout had significantly lower medication counseling scores than those without burnout (mean = 4.35 vs. mean = 4.55, P = 0.005). Of the 12 OTC medication counseling activities, 6 activities, including inquiring about the recent medications used by the patient (P = 0.044), discouraging long-term medication use (P = 0.021), warning about the possibility of self-misdiagnosis (P < 0.001), warning about the possibility of the patient choosing the wrong treatment method (P = 0.001), providing advice on improving health (P = 0.005), and inquiring about allergies in the patient (P < 0.001), had significantly lower scores in pharmacists with burnout. Conclusions There was a significant negative association between burnout and medication counseling activities. Increasing staff numbers may be a useful solution for reducing work intensity, as this factor is reported to contribute the most to burnout among current pharmacists.

Bilirubin Elevation Caused by Naproxen Overdose: A Case Report Highlighting Laboratory Interference.

BACKGROUND Overdoses on over-the-counter (OTC) drugs are increasing in the United States, which includes widely available non-steroidal anti-inflammatory drugs (NSAIDs) like naproxen. Symptoms of NSAID toxicity are well known and nonspecific, including nausea, vomiting, abdominal pain, and headaches. Extreme cases can present with confusion, seizures, and renal failure. CASE REPORT We present the case of 63-year-old man with a history of hyperthyroidism and polysubstance use who had an elevated total bilirubin level after attempting suicide via ingestion of 16 tablets of naproxen. The patient presented with vague abdominal pain and nausea in the setting of 2 weeks of worsening psychiatric symptoms, including suicidal ideation. Vital signs, physical examination, and review of systems revealed no significant findings. Medical workup was notable only for an elevated total bilirubin level; workup for hemolysis, biliary stasis, hepatic dysfunction was all within normal limits. Direct bilirubin was not elevated. The patient received intravenous fluids and antiemetic medications, and indirect hyperbilirubinemia resolved by the following day. After ruling out other causes of hyperbilirubinemia, it was determined that his elevated bilirubin was due a naproxen metabolite, O-desmethylnaproxen (ODMN), that has been shown to interfere with certain bilirubin assays when naproxen is ingested over the therapeutic dose. CONCLUSIONS Supratherapeutic naproxen ingestion can lead to laboratory findings of elevated total bilirubin in some assays due to ODMN interference. With the rise in suicide attempts in the United States with OTCs, clinicians should consider laboratory error in such clinical circumstances where the clinical data does not fit the history and physical examination.

Abstracts 13th PCNE Working Conference “Pharmacies' new roles in pharmaceutical care: bridging research and practice”

Abstracts 13th PCNE Working Conference “Pharmacies' new roles in pharmaceutical care: bridging research and practice”

Prioritizing research on over-the-counter (OTC) hearing aids for age-related hearing loss.

Hearing aids are the most commonly used treatment for people with age-related hearing loss, however, hearing aid uptake is low, primarily due to high cost of the device, stigma, and a lack of perceived need. To address accessibility and affordability issues, the U.S. Food and Drug Administration created a new over-the-counter (OTC) hearing aid category. Various types of hearing devices are available for both individuals with hearing loss and for those with normal hearing, as hearing enhancement devices. Hearing aids (i.e., prescription hearing aids, self-fitting OTC hearing aids, and pre-set OTC hearing aids) are regulated by the FDA. The purpose of this article is to (a) provide a summary of existing research on direct-to-consumer (DTC) hearing devices such as Personal Sound Amplification Products (PSAPs) that informs OTC service delivery models; (b) provide an update on existing and ongoing randomized controlled trials on currently marketed OTC hearing aids; and (c) highlight the need for immediate research on OTC hearing aids and service delivery models to inform policy and clinical care. It remains to be seen what effect OTC hearing aids have on improving the uptake of hearing aids by individuals with mild-to-moderate hearing loss. However, there is scant research on all aspects of OTC hearing aids that are currently on the market. We conclude that high quality independent research must be prioritized to supplement evidence provided by the OTC hearing aid manufacturers for regulatory approval purposes.

The impact of caller characteristics on levonorgestrel emergency contraception access in West Virginia community pharmacies

ObjectiveAccess to levonorgestrel (LNG) emergency contraception (EC) has increased since the FDA removed age restrictions on over-the-counter (OTC) LNG EC in 2013, but availability is highly variable and numerous barriers to access remain. The purpose of this study was to assess availability and accessibility of LNG EC at community pharmacies in West Virginia (WV). MethodsA mystery caller cross-sectional study was conducted to assess availability and accessibility of LNG EC. Inquiries were made by identified ‘research’ staff and by staff presenting as a 16 y/o. ResultsNearly half of community pharmacies reported having LNG EC in stock. Pharmacy staff were significantly more likely to tell research callers LNG EC was in stock (53%) and more likely to report willingness to order it (50%) than ‘teen’ callers (45% and 34%, respectively). There was no significant difference between caller types on the five barriers assessed. ConclusionLack of availability may contribute to teen and unintended pregnancies.

Burnout in U.S. Audiologists

Research on burnout in audiologists is limited, especially in the United States. Recent changes to the profession may have increased burnout. The purpose was to investigate burnout in the U.S. audiologists in diverse work settings. This study used three surveys: demographics/workplace stressors, Maslach Burnout Inventory (MBI), and professional quality of life (ProQOL). Participants were 149 U.S. audiologists. Participants were diverse regarding experience, work setting, and location. The first survey provided demographics, perspectives on over-the-counter (OTC) hearing aids, stressors, and stress rating. The MBI assessed three dimensions of burnout: emotional exhaustion, depersonalization, and personal accomplishment. The ProQOL assessed burnout, compassion fatigue, and compassion satisfaction. Analyses included descriptive and inferential statistics of quantitative data and thematic analysis of qualitative data. Audiologists had low burnout, low compassion fatigue, and high compassion satisfaction. Experience was not related to stress rating; however, more experienced audiologists had greater compassion satisfaction and lower burnout, emotional exhaustion, and depersonalization compared with less experienced audiologists. Concern about OTC hearing aids was associated with stress rating. Thematic analysis identified 11 stressors, with 50% of stressors classified under work duties, time, and patients. The U.S. audiologists had low burnout rates. Burnout was greatest in less experienced audiologists. Stress was not related to experience. Stressors included insufficient time to see patients, heavy caseload, time-consuming administrative tasks, pressure to sell hearing aids, and stressful interpersonal communication.

INTRACTABLE COUGH CAUSING SPONTANEOUS RECTUS SHEATH HEMATOMA

TOPIC: Signs and Symptoms of Chest Diseases TYPE: Medical Student/Resident Case Reports INTRODUCTION: Cough is a physiologic mechanism that causes airways to be cleared of foreign materials and excess secretions. The violent expiration is associated with rapid contraction of the diaphragm and the abdominal wall muscles leading to an increase in intraabdominal pressures. Longstanding untreated cough can lead to spontaneous abdominal wall hematomas. (1) CASE PRESENTATION: A 65-year-old gentleman presented to the Emergency Room with right lower quadrant abdominal pain of one-week duration. He had no past medical history. He was noted to have a persistent intractable cough for one month. Prior to the onset of cough, he had one week of loss of taste and smell, nasal congestion, nasal discharge and postnasal drip. According to him, the cough was so bad that he felt like he was going to burst. Although his family insisted, he did not get the cough evaluated. His vital signs were stable. Physical examination showed ecchymosis, a small palpable mass and tenderness in the right lower quadrant. Lung exam was unremarkable. Lab work unremarkable with normal platelet count and coagulation profile. Computed Tomography (CT) of the abdomen/pelvis showed an intramuscular vascular mass of 9 cm within the right rectus abdominis suggestive of a hematoma which was managed conservatively. Of note, he was not on any anticoagulants. On 1 month follow-up, he had complete resolution of abdominal pain, ecchymosis, mass and tenderness in the right lower quadrant. However, he continued to have a persistent cough for which he was referred to pulmonology. He visited the pulmonary clinic after 5 months of referral. At that time, he had become dependent on over-the-counter (OTC) oral decongestants and antihistamines. He had no reflux symptoms, no allergies, was a lifetime nonsmoker, employed as a banker and had a Labrador for 11 years. CT chest showed normal lung parenchyma. Pulmonary function tests revealed features of mild obstructive lung disease. His OTC medications were stopped and he was given a course of oral prednisone along with fluticasone and azelastine nasal spray with dramatic improvement and complete resolution of cough. DISCUSSION: Sustained cough results in over contraction and overstretching of abdominal muscles with an increase in intra-abdominal pressures. (2) Vigorous coughing plausibly generates shear forces high enough to tear superior and inferior epigastric vessels along the posterior aspect of long rectus muscle which results in rectus sheath hematomas. Almost 29% of spontaneous rectus sheath hematomas are the result of sustained cough the risk of which increases with the use of anticoagulants. (3) While these hematomas are conservatively managed, patients should undergo a thorough evaluation and treatment of cough to prevent its recurrence. CONCLUSIONS: This case highlights the potential of sustained vigorous cough to cause abdominal wall hematomas even in the absence of anticoagulants. REFERENCE #1: 1. Fuller RW, Jackson DM. Physiology and treatment of cough. Thorax. 1990;45(6):425-430. doi:10.1136/thx.45.6.425 REFERENCE #2: 2. Kodama K, Takase Y, Yamamoto H, Noda T. Cough-induced internal oblique hematoma. J Emerg Trauma Shock. 2013;6(2):132-134. doi:10.4103/0974-2700.110789 REFERENCE #3: 3. Cherry WB, Mueller PS. Rectus sheath hematoma: review of 126 cases at a single institution. Medicine (Baltimore). 2006;85(2):105-110. doi:10.1097/01.md.0000216818.13067.5a DISCLOSURES: No relevant relationships by Fady Jamous, source=Web Response No relevant relationships by Swaminathan Perinkulam Sathyanarayanan, source=Web Response

PSS10 Through the Patient's Eyes: A Presbyopia Patient Journey Survey

Presbyopia is a very common age-related condition that reduces the eye’s ability to focus on near objects with increasing age. Individuals are impacted by their decreased ability to see clearly up close in everyday situations like reading, working, and using smartphones. We report findings from a survey aimed at understanding the experience of individuals with presbyopia. A total of 1739 participants (age 40-60, US residents) self-identified as having presbyopia were surveyed online between October 2019 and March 2020. Participants had a household income of $60,000+, at least some discretionary income, needed assistance for at least 1 of 3 tasks (reading a menu, book, or phone), did not have a history of LASIK surgery or use of bifocal, monofocal, or contact lenses, and did not have a medical reason for declining vision. A survey of individuals between the age of 40-55 (n=1339) with presbyopia (27% male, 73% female) revealed that only two-thirds talk to their eye care providers (ECPs) about presbyopia and are motivated to obtain treatment. Consumers start on over-the-counter (OTC) readers (31%) or prescription readers (35%) and continue to use them even though they are not satisfied. Non-treaters tend to be newer presbyopes. They have not consulted an ECP because they either bought OTC readers (30%), do not find the symptoms bad enough (30%), or did not realize there were remedies (15%). 58% of non-treaters would see an ECP only if their symptoms get worse. Consumers less likely to talk to their ECPs about presbyopia are more likely male (33% vs 23% female) and are less likely to have taken action about their presbyopia (40% vs 14%). These findings suggest that individuals with presbyopia vary in their perception of their condition and seek treatment (professional treatment or self-manage) based on how it impacts their daily activities.

Virtual pharmacist interventions on abuse of over-the-counter medications during COVID-19 versus traditional pharmacist interventions

ObjectivesThis study aimed to investigate the frequency, nature, and clinical significance of pharmacist interventions on over-the-counter (OTC) medicines with abuse potential across community pharmacies with and without virtual care. MethodsIn this prospective observational study, a trained research team observed the dispensary teams of 12 community pharmacies in the United Arab Emirates (UAE), 6 of which were operating virtual pharmacy care. A standardized data collection form was used to include information about dispensing of OTC medicines and pharmacist interventions on those with abuse/misuse potential. The clinical significance of the interventions was evaluated by a multidisciplinary committee. ResultsThe frequency of pharmacist interventions on OTC medicines with abuse potential across pharmacies with and without virtual services was 83.2% versus 91.0%, respectively, whereas the frequency of pharmacist interventions on OTC medicines with misuse potential across pharmacies with and without virtual services was 79.8% versus 41.2%, respectively. The proportions of clinically significant interventions across pharmacies with and without virtual services were 19.7% versus 10.5%, respectively. Cough medicines were dispensed significantly more across pharmacies with virtual care than across pharmacies without virtual care (25.6% vs. 9.7%, respectively; P = 0.04). Asking the patient to seek the advice of an addiction specialist (adjusted odds ratio = 4.11; P = 0.001) versus refusing to sell the drug was more likely to be associated with pharmacies with virtual services than with pharmacies operating traditional pharmacy services. ConclusionVirtual pharmaceutical care is a potential approach to reduce the abuse/misuse of OTC medicines but needs some improvements regarding detection of these cases. The UAE is the first country in the region to implement and regulate virtual pharmacy practice.

Vulnerability of poorly literate adult consumers regarding over-the-counter drugs

Purpose This study aims at verifying the impact of literacy on over-the-counter (OTC) drug consumer vulnerability as evaluated by health literacy and label comprehension. Design/methodology/approach The item response theory (IRT) was used to estimate the health literacy of two groups and the two-way analysis of variance tests was used to test the hypotheses for the existence of mean differences between the two populations. The convenience sample involved 188 OTC consumers: 94 (50%) poorly literate and 94 (50%) university students/graduates. Findings University consumers/graduates have a level of health literacy and label comprehension that is superior to those presented by poor literate consumers. Also, age does not influence the level of health literacy by OTC drug users but has a significant impact on the understanding of OTC drug labels. Finally, the level of schooling and the “age group,” simultaneously, does not impact the understanding of OTC drug labels or health literacy. Research limitations/implications This study has added in the field of knowledge by investigating the behavior of poor literate consumers in Brazil, a developing country. The results may be relevant to Marketing professionals, especially those in the pharmaceutical industry, and to police makers, as they help identify the main problems faced by poorly literate consumers. Practical implications It is necessary to raise awareness of the dangers of self-medication and wrong use of medications, mainly focused on people with low literacy. As a suggestion, a simple glossary presented along with the label could provide explanations of scientific terms, thus increasing health literacy and reducing the vulnerability of the consumers. Social implications This study showed that when using common words such as gastritis to define a health problem, there is a higher degree of correctness. These results suggest the adoption of a more straightforward language and more precise explanations. By doing that, the pharmaceutical industry and policymakers will improve their social impact by increasing consumer power and taking care of the health of the most vulnerable population: the illiterate people. Originality/value This study contributes to the international literature, as it enhances and clarifies the knowledge about the customers’ power and vulnerability in developing countries. It fills a gap by evaluating label comprehension and heath literacy at the same time, giving an academic contribution for pharmaceutical consumers’ studies.

Perspectives on prescribing hormonal contraception among rural New Mexican pharmacists

ObjectivesNew Mexico is a large rural state with high rates of unintended pregnancy and limited access to contraception. In 2017, the New Mexico Pharmacist Prescriptive Authority Act was amended to allow pharmacists to prescribe hormonal contraception. We explored pharmacist perspectives on prescribing hormonal contraceptives, including perceived barriers and facilitators to implementation in rural New Mexico and opinions on over-the-counter (OTC) access, and prescribing and inserting subdermal contraceptive implants. MethodsThis qualitative study recruited rural pharmacists using contact information from the New Mexico Board of Pharmacy and at a state-level pharmacist conference. We conducted semistructured telephone interviews with pharmacists focusing on benefits and concerns about prescribing hormonal contraception, resources required, perspectives on OTC access, and interest in prescribing and placing contraceptive implants. Deidentified transcribed interviews were analyzed by 2 independent coders for emerging themes. ResultsFrom November 2017 to January 2018, we recruited 25 rural pharmacists and conducted 21 interviews. The majority of participants were male (71%), aged over 60 years (43%), and in practice for over 20 years (52%). Interviewees were mostly positive about prescribing hormonal contraception citing community benefits. The top 3 perceived barriers were training needs, reimbursement, and liability. The top 3 facilitators were the availability of private areas within pharmacies, pharmacists’ role as knowledgeable health care team members, and pharmacist accessibility without appointments. Most pharmacists did not support OTC access to hormonal contraception, and over half were interested in certification to prescribe and place subdermal contraceptive implants. ConclusionNew Mexico pharmacists identified community benefits of pharmacy access to hormonal contraception and were interested in training. Several barriers must be addressed to realize the potential of this practice expansion.

Research Advances on Acupuncture Analgesia.

Pain is a widespread and complex symptom which causes serious emotional and social burdens to individuals and society. Most patients with pain rely heavily on over the counter (OTC) and prescription pain killers. However, there would be a number of issues that arise from the use of pain killers, in which safety and addiction are the most critical issues. For traditional Chinese medicine (TCM), pain is a result of the meridians being blocked. This could occur as a symptom of or be caused by various diseases. In this case, the key to relieve pain depends on dredging the meridian or meridians. Acupuncture has been practiced in China for over 2000 years to lessen pain. It is based on the "meridian theory". Acupuncture is being used more widely and with a growing number of people in the treatment of pain because it is safer and has fewer side effects. Along with growing use and interest in acupuncture to treat pain, more attention has been paid to the mechanism underlying its analgesic effect, which is mainly associated with the changes of neurotransmitters. In this review, we summarize and analyze the range and mechanism of acupuncture analgesia treatment.

‘For pain, no shame’ and ‘My secret solace’: Accounts of over-the-counter codeine dependence using Q methodology

BackgroundDependence on over-the-counter (OTC) codeine is recognised internationally as a rising public health issue. The effectiveness of health intervention strategies may be influenced by the beliefs held by those who are dependent. Applying Q methodology, this study aimed to identify shared accounts of OTC codeine dependence. MethodsTwenty-six participants from Tasmania, Australia, met eligibility criteria for the study as long-term OTC codeine users with a Severity of Dependence Score of five or higher. Forty-six opinion statements about OTC codeine dependence were sourced from the literature and online discussion forums. These were rank-ordered by participants from least to most agree and explanatory comments for the most strongly positioned statements were provided. By-person factor analysis was used to group participants who had sorted the statements similarly. ResultsTwo distinct accounts of OTC codeine dependence were identified. Participants representing Factor One, ‘For pain, no shame’, were not ashamed of their OTC codeine use, believed access should not be restricted and regarded it as necessary for the relief of physical pain. In contrast, Factor Two, ‘My secret solace’, was characterized by feelings of guilt and shame. Participants in this group intentionally used codeine for its effects on mood; to help them relax and to relieve stress, rather than solely for pain relief. They did not consider regular use of codeine to be socially acceptable and hid their use from others. ConclusionThe way in which OTC codeine use is viewed by those who are dependent is not uniform. Two distinct accounts were identified in this sample. Participants from each group varied in their beliefs about access, causality, reasons for use and feelings of legitimacy and shame. An understanding of these differences can be used to better target interventions and guide policy for the prevention and management of OTC codeine dependence.

Building a Strong Brand Equity in Pharmaceutical Industry

The pharmaceutical industry has begun to exploit the potential of brand management very late compared to other industry. From 2013 to 2017, pharmaceutical companies have worked on the brand rather than on patents, following the example of companies operating in the consumer goods industry. This drives companies to adopt branding strategies that tend to explore the potential of the brand, which until then had remained unexpressed in the pharmaceutical sector. The analysis is focused on over-the-counter (OTC) drugs, a category of pharmaceutical products in which companies have managed to better express the brand's potential, also because they are not subject to prescription or strict regulations. The objective of this article is to analyze: a) at first, the levers of creating brand equity for OTC drugs and b) to evaluate subsequently, the impact of the non-conventional communication of this type of drugs on the consumer in the Italian market. The research methodology used was qualitative and quantitative, based on a dual approach. In the first phase through a comparative case studies of companies operating in the pharmaceutical industry. In the second phase with a field research through a consumer questionnaire and analyzing the data with a statistical-descriptive method. The research results show that the traditional drug selection criteria still prevail, such as the experience and the advice of the doctor and pharmacist, but a non-negligible percentage of consumers considers the brand and the way in which it is communicated also important. in the pharmaceutical sector for their choices. Therefore, managers should exploit this important brand awareness on the part of consumers, implementing appropriate strategies of line or brand extention. Lastly, managers should develop unconventional marketing tools for OTC products, which build consumer experiences that go beyond the mere therapeutic functionality of the product.

Interplay between Attitude and Purchase Intention: An Empirical Survey on Over-the-Counter (OTC) Drugs Consumer Behaviour

Over-the-Counter drugs (OTC) segment is rapidly growing within the pharmaceutical sector in India. In 2009, the Indian OTC market exhibited a growth of US$1.8 billion however as per the estimates by PwC India is likely to witness a growth of US$11 billion-a CAGR of 18% by 2020. As OTCs are self medicated it is essential to evaluate the stimulus that triggers a particular behaviour1. In recent past, India has also witnessed an increase in OTC drugs purchase of health supplements2. An empirical survey was conducted based on a validated questionnaire to assess the consumer behavioural intention towards OTC purchase. The survey involved assessment of key variables like “perceived behavioural control, attitude and subjective norm as per the theory of planned behaviour (TPb)”3. As per the survey the TPb model exhibited a variation of 39.4% in the purchase intention, wherein attitude appeared as the most important driver of intention closely followed by perceived behavioural control. Findings indicate that the TPb based model appropriately explains the interplay between the key variables influencing purchase intention of OTC drug products. Attitude was attributed to having the strongest influence (β = 0.401, p = 0.000) on intention among the variables studied. Perceived behavioural control was identified as the next most important variable.

Adherence of safety information on over‐the‐counter product labels and leaflets to the regulatory guidelines in Malaysia

AbstractAimTo evaluate the adherence of medication safety information provided on over‐the‐counter (OTC) product labels and patient information leaflets (PILs) to the Malaysian and international regulatory guidelines.MethodsA total of 133 randomly sampled OTC medications (gastrointestinal = 31, pain = 36, skin = 35, coughs and colds = 31) from 17 community pharmacies located around Klang Valley, Malaysia were evaluated. The adherence of relevant safety information provided on the OTC product labels and PILs from the manufacturing companies to the Malaysian and international regulatory guidelines was evaluated.ResultsThe majority of the products (n = 81) were locally manufactured, followed by 34 products from the European region. About 31% (n = 41) of the sampled OTC products were sold without PILs. Overall, 98% of the labels adhered to all the criteria, but none of the PILs adhered to all the parameters. Information on action to be taken in the case of a missed dose (96%), advice on consulting a doctor/pharmacist for further information (92%) and disposal instructions (98%) were generally missing. Surprisingly, none of the PILs included the compulsory statement which is essential for adverse drug reaction reporting. In addition, only 30% of the studied PILs provided information on the date of revision. Overall, imported products had slightly better adherence compared to locally manufactured products.ConclusionThe safety information stated on the OTC products marketed in Malaysia has room for improvement to ensure safe and effective use of these products. A uniform format and collective effort is needed to ensure consumers receive adequate information about OTC products.

Understanding older adults' medication decision making and behavior: A study on over-the-counter (OTC) anticholinergic medications.

Older adults purchase and use over-the-counter (OTC) medications with potentially significant adverse effects. Some OTC medications, such as those with anticholinergic effects, are relatively contraindicated for use by older adults due to evidence of impaired cognition and other adverse effects. To inform the design of future OTC medication safety interventions for older adults, this study investigated consumers' decision making and behavior related to OTC medication purchasing and use, with a focus on OTC anticholinergic medications. The study had a cross-sectional design with multiple methods. A total of 84 adults participated in qualitative research interviews (n = 24), in-store shopper observations (n = 39), and laboratory-based simulated OTC shopping tasks (n = 21). Simulated shopping participants also rank-ordered eight factors on their importance for OTC decision making. Findings revealed that many participants had concerns about medication adverse effects, generally, but were not aware of age-related risk associated with the use of anticholinergic medications. Analyses produced a map of the workflow of OTC-related behavior and decision making as well as related barriers such as difficulty locating medications or comparing them to an alternative. Participants reported effectiveness, adverse effects or health risks, and price as most important to their OTC medication purchase and use decisions. A persona analysis identified two types of consumers: the habit follower, who frequently purchased OTC medications and considered them safe; and the deliberator, who was more likely to weigh their options and consider alternatives to OTC medications. A conceptual model of OTC medication purchase and use is presented. Drawing on study findings and behavioral theories, the model depicts dual processes for OTC medication decision making - habit-based and deliberation-based - as well as the antecedents and consequences of decision making. This model suggests several design directions for consumer-oriented interventions to promote OTC medication safety.

Interest in Over-the-Counter Access to a Progestin-Only Pill among Women in the United States

BackgroundA progestin-only pill may be the first pill formulation to become available over the counter in the United States; however, no research on over-the-counter (OTC) pill interest has focused on progestin-only pills or a representative sample of teens. The objective of this study was to assess U.S. women and teens’ interest in OTC progestin-only pill use. MethodsIn October 2015, we conducted a nationally representative, cross-sectional, online survey with 2,026 sexually active adult women aged 18 to 44 not currently desiring pregnancy, and 513 female teens aged 15 to 17. Logistic regression was used to identify characteristics associated with likely OTC progestin-only pill use. We also assessed reasons for use or nonuse, duration of use, and willingness to pay. ResultsThirty-nine percent of adults and 29% of teens reported likely use, with a greater likelihood if covered by insurance. Adults were willing to pay $15 per month and teens $10 per month on average. Among adults, women who were never married or living alone (vs. married), uninsured (vs. privately insured), current pill or less effective method users (vs. ring, patch, injectable, or intrauterine device), tried to get a birth control prescription in the past year, or ever used an oral contraceptive pill or progestin-only pill had higher odds of likely use. Among teens, Spanish speakers and those who ever had sex had higher odds of likely use; Black teens (vs. White) had lower odds. ConclusionsTeens and adults are interested in using an OTC progestin-only pill. These findings indicate a large pool of interested users and the potential for improved contraceptive access by making an OTC progestin-only pill available.

Patients’ intention to consume prescribed and non-prescribed medicines: A study based on the theory of planned behaviour in selected European countries

Polypharmacy has a significant impact on patients' health with overall expenditure on over-the-counter (OTC) medicines representing a substantial burden in terms of cost of treatment. The aim of this study, which was conducted within the framework of a European Project funded by the European Union under the Seventh Framework Programme and was entitled OTC-SOCIOMED, was to report on possible determinants of patient behaviour regarding the consumption of medicines, and particularly OTCs, in the context of primary care. A multicentre, cross-sectional study was designed and implemented in well-defined primary healthcare settings in Cyprus, the Czech Republic, France, Greece, Malta and Turkey. Patients completed a questionnaire constructed on the basis of the theory of planned behaviour (TPB), which was administered via face-to-face interviews. The percentage of patients who had consumed prescribed medicines over a 6-month period was consistently high, ranging from 79% in the Czech Republic and 82% in Turkey to 97% in Malta and 100% in Cyprus. Reported non-prescribed medicine consumption ranged from 33% in Turkey to 92% in the Czech Republic and 97% in Cyprus. TPB behavioural antecedents explained 43% of the variability of patients' intention to consume medicines in Malta and 24% in Greece, but only 3% in Turkey. Subjective norm was a significant predictor of the intention to consume medicines in all three countries (Greece, Malta and Turkey), whereas attitude towards consumption was a significant predictor of the expectation to consume medicines, if needed. This study shows that parameters such as patients' beliefs and influence from family and friends could be determining factors in explaining the high rates of medicine consumption. Factors that affect patients' behavioural intention towards medicine consumption may assist in the formulation of evidence-based policy proposals and inform initiatives and interventions aimed at increasing the appropriate use of medicines.