Over-the-counter Products Research Articles

Implications of Over-the-Counter Proton Pump Inhibitors for Patient Counseling by Pharmacists

The article reviews the literature on the role of the pharmacist in patient counseling and discusses how that role may apply to patients with frequent heartburn who are seeking an over-the-counter (OTC) treatment. Searches of the National Library of Medicine PubMed database were conducted using the terms "heartburn," "nonprescription," "therapy," "pharmacist," and "counseling," supplemented by additional searches on counseling for prescription products, and by the author's knowledge of pharmacy practice and the scientific literature. Accurate recognition of the signs of heartburn are an important first step in counseling a patient on the appropriate OTC medication; immediate referral to a health care provider is mandatory if cardiac pain or certain gastrointestinal symptoms are present. When counseling a patient about treatments for heartburn, the pharmacist should practice effective listening in an environment that is conducive to communication by the patient. Proton pump inhibitors are effective for the treatment of heartburn; the histamine2 receptor antagonists and antacids should also be considered for appropriate patients. Adverse events have been noted with proton pump inhibitors; however, overall the benefits significantly outweigh the risks and problems are unlikely to arise during the 2-week duration of OTC treatment of heartburn. Pharmacists can provide valuable services to patients with frequent heartburn, particularly with regard to counseling about the condition and appropriate OTC therapy. The availability of numerous OTC products, including antacids, histamine2 receptor antagonists, and proton pump inhibitors, enables pharmacists to fulfill an important clinical role and improve patient satisfaction.

Clinician identification of youth abusing over-the-counter products for weight control in a large U.S. integrated health system.

BackgroundAbuse of over-the-counter (OTC) products, such as diet pills and laxatives, for weight control by adolescents is well-documented and can precipitate serious medical conditions. Yet only a small percentage of youth with disordered weight control behaviors receive treatment. The objective of this study was to examine how often clinicians communicate with youth with symptoms consistent with abuse of OTC products for weight control about possible use of these products.We used electronic medical records and administrative claims for services for 53,229 12 to 17 year old patients receiving care from an integrated health system in the U.S. Northwest from August 2007 to December 2010. We examined electronic text of clinical notes to identify encounters in which the clinician noted one of 10 metabolic conditions potentially associated with abuse of OTC products (diet pills, laxatives, diuretics, ipecac, orlistat, and alli®) for weight control and then assessed whether clinicians noted communication with adolescent patients about possible use of OTC products for weight control.ResultsWe identified 130 (0.2% of sample) patients with clinical notes indicating one or more of the metabolic conditions. In clinical notes for only four (3.1%) of these patients did clinicians document suspicion or communication about possible abuse of the OTC products. All four had a previous eating disorder diagnosis. In the 12 months subsequent to the clinical encounter in which a metabolic disturbance was identified, medical notes for only three (2.3%) of the 130 patients indicated clinician suspicion or communication about possible abuse of these products or an eating disorder.ConclusionsClinicians are missing a critical window of opportunity to query adolescents when presenting with suspicious metabolic disturbances about possible abuse of OTC products for weight control. Clinicians may need more training to detect OTC product abuse, and electronic medical records should prompt more thorough enquiry.

OTC combination products in pharmacistassisted self-care

Over-the-counter (OTC) medicines provide a convenient, costeffective means to treat self-identifi ed symptoms and help to lessen the burden on the health care system by reducing the number of doctor visits and associated prescription costs. Containing either a single active ingredient or a combination of multiple active ingredients, OTC medicines are used by consumers for a number of reasons, including familiarity with self-treatment, perception that symptoms can be managed without health care provider intervention, and time and money savings. There are more than 80 therapeutic categories of nonprescription—or OTC—products available today. Common uses of OTC medicines include treatment of symptoms associated with the common cold, allergies, constipation, diarrhea, heartburn, mild pain, hemorrhoids, dental caries, smoking cessation, weight loss, emergency contraception, and most recently, overactive bladder control. 1 This article will review the benefi ts associated with OTC combination products surrounding cost, ease of dosing, and adherence.

A study on impact of media advertising on consumption of OTC cough and cold medicines

Self-medication for common ailments like cough, cold, headache, indigestion, etc. is on rise in India, especially in urban areas. This is due to the advent of technology, improving literacy levels, increasing health awareness, and high work stress levels. This obviously leads to growing potential for over-the-counter (OTC) medicines. According to industry analysts, the OTC healthcare segment in India is estimated at Rs 15 000 crore. In order to grab the larger share of this growing market, the companies marketing OTC products are increasing their advertising spends so as to woo the consumers. The study was therefore undertaken to understand the impact of media advertising on consumption of OTC cough and cold products (since cough and cold are the most frequently occurring routine ailments).

Students’ attitude toward use of over the counter medicines during exams in Saudi Arabia

PurposeTo explore the use of over the counter (OTC) medicines among students during exams in Riyadh City, Kingdom of Saudi Arabia. MethodA cross-sectional study was designed; using a self-administered twenty-two item online questionnaire for the students’ convenience and easy response disclosure. Data were analyzed using Statistical Package for Social Science (SPSS) version 13®. ResultsA total of N=1596 students participated in this survey, of whom 829 (51.9%) were university students and 767 (48.1%) were high school students. Overall, 80.0% of the respondents disclosed the use of OTC non-steroidal anti-inflammatory drugs for headache and pain relief. In addition, other substances used during the exams were Energy Drinks (5.0%), Flu Medication (5.0%), Vitamins (5.0%) and Antibiotics (5.0%). Female students were found to be more knowledgeable about safety issues concerning the use of OTC medicines (5.11±1.27, p=<0.001) than male students. Ease in access to OTC medicine, availability of pharmacist consultation and advertisement in print and electronic media were the main factors disclosed by the respondents that may result in an increase in the use of OTC products. The use of OTC medicines was generally higher among female students (p=0.001). ConclusionThe use of OTC medication during exams was more among high school and university students. Gender, age and educational institution were found significantly affecting the use of OTC medicines during exams.

Identification of compounds in hexane extracts of Elephantorrhiza elephantina and their comparison with selected over the counter products

The purpose of this study was to analyze hexane extracts of Elephantorrhiza elephantina(Ee) roots and to compare their chemical composition with some selected over the counter (OTC) products. Selection of the OTC products was based on their usage in treating stomach ailments, similar to the usage of E. elephantina in some regions of Southern Africa. A gas chromatography/mass spectrometer (GC/MS) and a Fourier transform infrared/attenuated total reflection (FTIR/ATR) spectrometer were used for data acquisition. OTC products included dulcolax, fish oil, imodium, senokot, stool softener, castor oil, and triphala. GC/MS results indicated that E. elephantina roots contained hexadecanoic, 9,12-octadecadienoic, 9-octadecenoic, and octadecanoic acids as major components, making up about 3 mg fatty acids/g E. elephantina roots. The OTC products contained at least two fatty acids in common with E. elephantina, namely, hexadecanoic and octadecanoic acids. Principal component analysis of the FTIR/ATR data indicated high similarities between E. elephantina roots and senokot or triphala, and the least similarities between E. elephantinaand fish oil, castor oil, and stool softener. Key words: Fourier transform infrared/attenuated total reflection (FTIR/ATR) spectrometry,Elephantorrhiza elephantina, gas chromatography/mass spectrometry (GC/MS), hexane extracts, fatty acids, over the counter (OTC) products.

43. Clinician Identification of Adolescents Abusing Over-the-Counter Products for Weight Control: Results From a Large Health Maintenance Organization

National data from the United States suggest that a substantial number of adolescents abuse over-the-counter (OTC) products, such as laxatives or diet pills, for weight control but few of these youth receive clinical intervention for their unhealthy behaviors. Using a large medical claims database, we examined how often clinicians queried youth with symptoms consistent with abuse of OTC products for weight control about possible use of these products. We hypothesized that clinicians would rarely inquire about abuse of these products even in symptomatic patients.

Drug advertising, response shift in patients with hypertension, and medication error interception

concluded that dif- ferences in the Food and Drug Administra- tion (FDA) and Federal Trade Commission (FTC) regulation of advertising affected the balance of risk and benefit informa- tion that appeared and the specificity of risk information available. Adequacy of information about a pharmaceutical prod- uct after switching from legend to over- the-counter (OTC) status is an important public health issue. Information abstract- ed from pre-and postswitch advertise- ments for loratadine (Claritin—Schering- Plough), cetirizine (Zyrtec—McNeil-PPC), and omeprazole (Prilosec—Procter & Gamble) was evaluated. Information was abstracted from 2,002 ads obtained from the Vanderbilt Television News Archive. Ads for the legend product were sig- nificantly longer than those for the OTC products. Compared with OTC advertise- ments, prescription ads had fewer asser- tions about the product's benefit and more about its risks, possibly because of their longer length. When equal length ads were examined, prescription ads had an equal number of assertions about the products' benefits and risks (1.5 vs. 1.8, P > 0.05) but OTC ads had significantly more as- sertions about benefits versus risk (6.6 vs. 1.2, P < 0.001). Moreover, toll-free numbers and Internet URLs were found more frequently in prescription (97% and 100%, respectively) than OTC (4% and 10%) ads. Implications. For instances in which the product must be prescribed by a health professional, the benefit-to-risk assertion ratio in ads was equal. In the case of OTC ads, where patients are left to their own devices to correctly interpret the mes- sage, the benefit-to-risk assertion ratio is heavily unbalanced toward the benefits. Pharmacists are among the most acces- sible and trusted of professionals. When it comes to self-care decisions based on pro- motional information for these products, pharmacists' counsel may be essential to offset an unbalanced presentation of ben- efit-to-risk information. Response shift in patients with hypertension Gandhi et al. 2 found that some hyperten- sive patients with CAD (coronary artery disease) experienced a response shift over a 1-year period in their physical functioning (n = 909). Recalibration re- sponse shift is based on changes in one's internal standards and not necessarily objective evidence. In the case of physi- cal functioning, the individual's standard of performance for important life tasks may be lowered for health reasons. Self- reported physical functioning was mea- sured using mailed surveys containing items from SF-36 at both baseline and 1 year later. Response shift was assessed using structural equation modeling sta- tistical techniques. Some patients recali- brated perceptions of their health, most likely because they changed their idea of how their health limited their physi- cal activity (e.g., walking, climbing stairs). Implications. After starting treat- ment, how many of you have asked a pa- tient, are you feeling? How do you explain it when the patient replies much better when they can't walk up a flight of stairs without gasping for breath? Are they lying? Identifying response shift is impor- tant to effectively monitoring health out- comes because patients may adjust their perceptions of the benefits of treatment or disease progression to maintain a sense of optimism or protect their self-image. Medication error interception

The influence of evidence-based medicine training on decision-making in relation to over-the-counter medicines: a qualitative study

To explore the role of evidence of effectiveness when making decisions about over-the-counter (OTC) medication and to ascertain whether evidence-based medicine training raised awareness in decision-making. Additionally, this work aimed to complement the findings of a previous study because all participants in this current study had received training in evidence-based medicine (unlike the previous participants). Following ethical approval and an e-mailed invitation, face-to-face, semi-structured interviews were conducted with newly registered pharmacists (who had received training in evidence-based medicine as part of their MPharm degree) to discuss the role of evidence of effectiveness with OTC medicines. Interviews were recorded and transcribed verbatim. Following transcription, all data were entered into the NVivo software package (version 8). Data were coded and analysed using a constant comparison approach. Twenty-five pharmacists (7 males and 18 females; registered for less than 4 months) were recruited and all participated in the study. Their primary focus with OTC medicines was safety; sales of products (including those that lack evidence of effectiveness) were justified provided they did no harm. Meeting patient expectation was also an important consideration and often superseded evidence. Despite knowledge of the concept, and an awareness of ethical requirements, an evidence-based approach was not routinely implemented by these pharmacists. Pharmacists did not routinely utilize evidence-based resources when making decisions about OTC medicines and some felt uncomfortable discussing the evidence-base for OTC products with patients. The evidence-based medicine training that these pharmacists received appeared to have limited influence on OTC decision-making. More work could be conducted to ensure that an evidence-based approach is routinely implemented in practice.

Evaluation of the 20% D-Methamphetamine Requirement for Determining Illicit Use of Methamphetamine in Urine

In urine drug testing, enantiomer analysis is used to determine whether a positive methamphetamine result could be due to use of an over-the-counter (OTC) nasal inhaler containing L-methamphetamine. D-methamphetamine at more than 20% of the total is considered indicative of a source other than an OTC product. This interpretation is based on a 1991 Department of Health and Human Services (HHS) Technical Advisory. We performed studies to verify the methamphetamine enantiomer content of current OTC nasal inhalers and to evaluate current laboratory testing capabilities. This study demonstrated that OTC inhalers contain less than 1% D-methamphetamine. A proficiency testing (PT) set for HHS-certified laboratories performing methamphetamine enantiomer testing found D-methamphetamine percentages that were consistently 1 to 3% higher than theoretical due to optical impurity of the derivatizing reagent N-trifluoroacetyl-L-prolyl chloride (L-TPC). The PT results also demonstrate that laboratories can accurately determine 20% D-methamphetamine in samples with total methamphetamine concentrations down to 250 ng/mL. Based on these studies, the guideline of >20% D-methamphetamine is appropriate for interpreting results obtained using current laboratory methods.

Trends in the use of topical over the counter products in the management of dermatologic disease in the United States

Over the counter (OTC) products play an important role in treating and preventing disease in the U.S. Topical OTCs are widely used but use in dermatology is not well defined. To characterize topical OTC use in the U.S. The National Ambulatory Medical Care Survey was queried for physician visits in which topical OTCs were recorded. Physician specialty, patient demographics, and diagnoses were examined and linear regressions were performed to determine trends over time. From 1989 to 2008, there were an estimated 320 million visits documenting topical OTC recommendations; the majority of which were visits to a dermatologist (33.5%). Dermatologists most commonly recommended hydrocortisone (16.9%), benzoyl peroxide (13.3%), and sunscreen (7.4%). Dermatologists were more likely than other providers to use moisturizers in the treatment of dermatologic disease. Overall, topical OTC recommendations by all physicians has decreased over time (p < 0.0001). However, dermatologists' recommendations for moisturizers and sunscreens has increased significantly. Topical OTC products have an important role in the prevention and treatment of dermatologic disease. Topical OTC recommendations are decreasing over time whereas their use as complementary components (sunscreen/moisturizers) appears to be increasing. Increased awareness of the utility of these agents may help to improve patient outcomes.

Brand salience of OTC pharmaceuticals through package appearance

PurposeThe changing health care market is affecting consumers who are now expected to take greater responsibility for their health. Their means for doing this include purchasing self‐medication and medical self‐service, which coincides neatly with an increase in the number of over‐the‐counter (OTC) pharmaceuticals. Additionally, OTC pharmaceuticals are progressively becoming available in a wider range of stores, where the pharmacists' knowledge of the OTC products is absent. This study aims to examine packaging as media that conveys the product message at the point of purchase, and to explore the impact of its extrinsic verbal and visual product cues.Design/methodology/approachAn exploratory conjoint analysis was conducted in Finland, the USA, and Ghana. In total, 89 respondents conducted conjoint tasks for two product types, i.e. a painkiller and sore throat medicine.FindingsThe results showed differences and similarities in the impact of the packaging product cues across Finland, the USA, and Ghana. Differences and similarities were also detected across the two different, but related, product types. The study found that the impact of product cues is contextual, varying across the samples and product types.Practical implicationsThe results are limited by the exploratory nature of the conjoint analysis. They highlight that medical marketers should recognize the varying impact of salient cues on consumers' product preferences and choices.Originality/valueThe study deals with a mostly unexplored issue and provides exploratory insights into the phenomenon.

Do patients tell their clinicians they are using both prescribed and over the counter allopathic and traditional medicines?

ObjectiveTo investigate the simultaneous use of over-the-counter (OTC) and prescription medicines across allopathic western medicine (WM) and traditional Chinese medicine (TCM) modalities amongst urban Chinese patients. MethodSecondary analysis of the Hong Kong population representative Thematic Household Survey 2007 dataset (n=28,923, response rate 76.8%). ResultsOf the enumerated population, 1.9% reported ever having used TCM OTC medications and WM prescription medicine simultaneously, of whom 59.3% did not disclose this to their WM doctors. Of respondents, 1.3% reported figure co-usage of WM OTC and TCM prescription medicines and 40.1% did not disclose this to their TCM practitioners. The top two reasons for non-disclosure were: the belief that WM and TCM medicines do not interact with each other, and clinicians did not initiate the discussion. Those with regular healthcare providers were more likely to disclose their co-usage. The majority of respondents cited healthcare professionals as their main source of information for OTC products. ConclusionSince self medication is common, clinicians should proactively ask patients about their medication in both modalities of care; and provide appropriate education on potential risks. The population prefers to integrate WM and TCM under supervision of both types of clinicians, instead of making their own choices on medication use across modalities. DiscussionPolicy makers should enhance interprofessional education for and communication between WM and TCM clinicians. However, further research on patients’ knowledge of herb–drug interactions, as well as accurate ascertainment of co-utilization patterns for each modality is needed before drawing firmer conclusions.

Evaluation of creatine content and stability from over-the-counter dietary supplement by ion pair chromatography with UV detection

Background Creatine is an endogenous guanidine compound found in the skeletal muscles and plays an important role in the metabolism of proteins. A perusal of the information available on the Internet concerning creatine revealed that its activity receives a great deal of attention, with much speculation about its ability to increase lean body mass, high-intensity power output, and strength in humans. Many of the entries available on the World Wide Web come from vendors of creatine. However, creatine differs from many other dietary supplements because its use is advocated by many physicians for many indications. Clinical laboratory monitoring of creatine therapy is currently available and uses HPLCUV. The plasma creatine concentration increases following oral administration of creatine supplement, and the degree of increase is related positively to the dosage. A method has been developed for the determination of creatine in dietary supplements by using ion pair chromatography (IPC) with UV detection. The objectives of this study were (1) to determine the content of creatine in over-the-counter (OTC) dietary supplements, and (2) to evaluate the stability of creatine in aqueous solutions during storage. Methods Samples were dissolved in type II water to obtain an initial creatine concentration of 10 mg/mL. The final creatine concentration in solutions was 1 mg/mL. Two such solutions were kept at room temperature and 2 others at refrigerated condition. Samples were collected on day zero, day 1, day 2, day 7, day 14, day 21, and day 28. Creatine concentration in the diluted sample was determined by IPC. The internal standard used was guanidinoacetic acid (GAA). 20µL of sample was injected onto the IPC. Separations of creatine, GAA and creatinine were achieved by using a 5-µm reversed-phase C18 column (250 x 4.6 mm) and a mobile phase consisting of phosphate buffer (pH = 2.8, 0.045 M), methanol, sodium dodecyl sulfate, and acetonitrile. The flow rate of IPC run was at 1 mL/min and column temperature at 35°C. Peaks of creatine, GAA and creatinine were monitored at 198 nm. Results The method achieved a linear concentration range of 0.01-2 mg/mL. The limit of detection was 0.003 mg/mL. Both within-run and between-run precision for three controls (0.4, 0.8, and 1.6 mg/mL) were lower than 5%. Analytical recoveries were greater than 95%. Some of the OTC products tested contained lower contents of creatine in contrast to their label claims. Greater degradation occurred in room temperature samples as compared with the refrigerated ones. Sixty percent degradation was observed within 28 days for room temperature samples in citric acid solution. However, at refrigerated condition this degradation was around 40%. Conclusion

Self-medication with nutritional supplements and herbal over-thecounter products

In recent years, the popularity increased for nutritional supplements and herbal products. Prescription drugs, but not herbal therapies are paid by health insurances. They are sold over-the-counter (OTC) on the patients’ own expense. However, there are potential risks of self-medication, e.g. incorrect self-diagnosis, severe adverse reactions, dangerous drug interactions, risk of addiction etc. They are often used by patients at their own discretion without knowledge of and control by their physicians. Certain users are at risk of intoxication. Multiple medications taken by older patients increase the risk for adverse drug reactions, drug-drug interactions, and compliance problems for this age group (polypharmacy). Herbals should be discontinued prior to operations to avoid interactions with anesthetics or anticoagulants. Herbal preparations may also be carcinogenic or interfere with cancer treatments. Pregnant women use various OTC preparations. However, in many cases, it is unclear whether their use is safe for mother or baby. Self-medication with herbals is also largely distributed among anxious and depressive patients, and patients with other conditions and symptoms. The popularity of herbal products has also brought concerns on quality, efficacy and safety. Cases of botanical misidentification, contaminations with heavy metals, pesticides, radioactivity, organic solvents, microbials as well as adulteration with chemical drugs necessitate the establishment of international quality control standards. Hepatotoxic effects have been reported for more than 300 plant species, and some commonly used herbs have been demonstrated to interact with Western medication. Health care professionals have a critical responsibility assessing the self-care ability of their patients. Databases are available for pharmacists with information on action, side effects and toxicities as well as herb-drug interactions. There is a need for established guidelines regarding the correct use of nutritional supplements and herbal OTC preparations (phytovigilance). Physicians, pharmacists, and other health care professionals have to counsel patients and the general public on the benefits and risks associated with herbal drugs. Information centers for consumers and general practitioners are needed, and convincing evidence on safety and efficacy of herbal products has to be demonstrated in placebo-controlled, double blind and randomized clinical trials.

Misunderstanding and Potential Unintended Misuse of Acetaminophen Among Adolescents and Young Adults

Acetaminophen is highly accessible yet potentially dangerous when used incorrectly. In attempts to address concerns about acetaminophen, the U.S. Food and Drug Administration (FDA) has identified gaps in evidence about unintentional misuse among adolescents. Therefore, our objectives were to assess adolescents' (1) health literacy, (2) knowledge about acetaminophen, (3) recent use of over-the-counter (OTC) medicines, and (4) understanding of medication dosing (instructions for how to use the medicine, i.e., “acetaminophen skills”). We conducted a cross-sectional survey of adolescents and young adults (ages 16–23 years) recruited from education settings and health care sites in Monroe County, New York, from 11/08–9/09. Using structured in-person interviews, we assessed acetaminophen knowledge and recent use of over-the-counter (OTC) medicines. Through role-plays of everyday health scenarios, we assessed participants' abilities to identify acetaminophen in OTC products and answer questions about instructions for acetaminophen use. We measured health literacy with the Rapid Estimate of Adult Literacy in Medicine (REALM) for participants >18, and the REALM-Teen for those <18. Confusion about acetaminophen and its use was common. Limited health literacy was an independent risk factor for poor knowledge, misunderstanding, and potential unsafe use of acetaminophen-containing medicines; however, most participants at all health literacy levels erred dangerously in “unsafe” understanding of acetaminophen use from label instructions. Individuals with limited health literacy could face disproportionate risk of unsafe use of acetaminophen because of confusion and misunderstanding of label information. Better labeling, public health programs, and educational efforts could facilitate safer use of acetaminophen.

Changing Oral Contraceptives from Prescription to Over‐the‐Counter Status: An Opinion Statement of the Women's Health Practice and Research Network of the American College of Clinical Pharmacy

Addressing the issue of unintended pregnancy is a national priority. One proposed strategy to reduce unintended pregnancy is to improve access to oral contraceptives by changing them to over-the-counter (OTC) status. Existing data indicate that oral contraceptives meet safety criteria required of OTC products. Available literature demonstrates that women can self-screen for contraindications to oral contraceptives and can do this as well as clinicians, and experience with OTC emergency contraception suggests that OTC oral contraceptives would not increase sexual risk-taking behavior. Women support OTC access to oral contraceptives, but express an interest in accessing pharmacist counseling. On the basis of these data, the Women's Health Practice and Research Network of the American College of Clinical Pharmacy supports changing oral contraceptives to OTC status under two conditions: that they are sold where a pharmacist is on duty and that there are mechanisms in place to cover OTC contraceptives through Medicaid. Future research should address the issues of out-of-pocket costs to individuals, label-comprehension studies, and models for pharmacist reimbursement for time spent counseling on contraception.

Contraindications to Combined Oral Contraceptives Among Over-the-Counter Compared With Prescription Users

To compare the estimated proportion of contraindications to combined oral contraceptives between women who obtained combined oral contraceptives in U.S. public clinics compared with women who obtained combined oral contraceptives over the counter (OTC) in Mexican pharmacies. We recruited a cohort of 501 women who were residents of El Paso, Texas, who obtained OTC combined oral contraceptives in Mexico and 514 women who obtained combined oral contraceptives from family planning clinics in El Paso. Based on self-report of World Health Organization category 3 and 4 contraindications and interviewer-measured blood pressure, we estimated the proportion of contraindications and, using multivariable-adjusted logistic regression, identified possible predictors of contraindications. The estimated proportion of any category 3 or 4 contraindication was 18%. Relative contraindications (category 3) were more common among OTC users (13% compared with 9% among clinic users, P=.006). Absolute contraindications (category 4) were not different between the groups (5% for clinic users compared with 7% for OTC users, P=.162). Hypertension was the most prevalent contraindication (5.6% of clinic users and 9.8% of OTC users). After multivariable adjustment, OTC users had higher odds of having contraindications compared with clinic users (odds ratio [OR] 1.59, 95% confidence interval [CI] 1.11-2.29). Women aged 35 years or older (OR 5.30, 95% CI 3.59-7.81) and those with body mass index 30.0 or more (OR 2.24, 95% CI 1.40-3.56) also had higher odds of having contraindications. Relative combined oral contraceptive contraindications are more common among OTC users in this setting. Progestin-only pills might be a better candidate for the first OTC product given their fewer contraindications.

Non-dispensing of NHS prescriptions in community pharmacies

Abstract Objective To explore non-dispensing of National Health Service (NHS) prescriptions in community pharmacies. Method Prospective study on prescription items that were presented and not dispensed. Pharmacy staff recorded reasons for non-dispensing of NHS prescription items and process outcomes, including substitution through other means. Setting Sixteen community pharmacies in the North of England. Key findings Data are available on 587 items (514 patients). Two main reasons for non-dispensing were identified: those related to the cost of the prescription charge (n=308) and those unrelated to cost (n=279). The latter generally suggested a prescribing issue involving the general practitioner's (GP's) computer system. Cost-related reasons included cheaper availability of over-the-counter (OTC) products (78.6 per cent) and incidents where customers were unwilling or unable to pay the prescription charge (20.1 per cent). Unsurprisingly, cost-related reasons were encountered almost exclusively for patients who were non-exempt from prescription charges, while non-cost reasons were more commonly seen for exempt patients. As a result of non-dispensing because of cost, 242 OTC products were sold, 97.0 per cent of which contained the same active ingredient as had been prescribed by the doctor. There were 62 incidents where a prescribed item was not dispensed, or substituted, because of cost, and more than one-third of these items (n=22) could be considered to be clinically important. Conclusions In addition to issues of GP prescribing, the cost of the prescription charge was identified as a major factor in non-dispensing. Many of the items were substituted by cheaper OTC products, yet some clinically important drugs were not dispensed or substituted, suggesting that a review of the UK charge system is appropriate.

Skin conditions in the pharmacy: consumer satisfaction and economic considerations

Abstract Objective To evaluate whether consumers were satisfied with advice about skin conditions received from community pharmacists in Victoria, Australia, and to estimate costs and potential savings to the consumer and government associated with managing these conditions in the pharmacy. Methods In 1997–1998, a consumer survey on costs and satisfaction was carried out in Victoria as part of a statewide education programme with community pharmacists. Pharmacists recorded details of dermatological consultations involving over-the-counter (OTC) products, and recruited pharmacy consumers for follow-up by a member of the research team. Results Consumer consultations were recorded at 126 pharmacies. One hundred and five (58.0 per cent) of the 181 consumers who were subsequently interviewed reported being very satisfied with their consultation. One hundred and thirty-two (73.0 per cent) spent up to 10 minutes consulting the pharmacist and 78 (43.1 per cent) spent between $A5 (£1.95) and $A10 on OTC products. A total of 37 consumers (20.4 per cent) consulted a medical practitioner on the advice of their pharmacist. While most of the 37 consumers spent under $A10 in the pharmacy, if the cost of medical consultation and the subsidised nature of items supplied on medical prescription were taken into account, the costs to the consumer and government would have been greater. The direct costs for a pharmacist consultation on the management of skin conditions were lower than the expected direct costs associated with a general practitioner (GP) consultation. Conclusions Consumers were satisfied with the advice and treatment they received from the pharmacist on the management of skin conditions. Pharmacists' advice also appeared to be cost-effective for both the consumer and government. Community pharmacists appear to be satisfactory primary providers of advice and treatment for people with minor skin conditions.