Drug-related problems and pharmacy interventions in non-prescription medication, with a focus on high-risk over-the-counter medications

Abstract

Background The risks associated with over-the-counter medication are often underestimated by consumers. The incorrect use of certain medications can lead to significant patient harm. Inappropriate use can be prevented by pharmaceutical counselling. Objective To determine the number and nature of drug-related problems in over-the-counter medication with a special emphasis on high-risk over-the-counter medications. Setting Fifty-two community pharmacies in Finland. Method This observational study was conducted as a questionnaire survey. The pharmacists working in participating pharmacies documented the observed drug-related problems and pharmacy interventions in over-the-counter medication during 1 week using an electronic study form based on the Westerlund drug-related problem classification system. Main outcome measure The prevalence of drugrelated problems and problem types in different medication categories. Results The 52 community pharmacies documented 339 drug-related problems in 0.6% of over-the-counter customers, the most common problem being "Uncertainty about the indication for the drug" (39.2%). A significant proportion of the documented problems (26.3%) concerned high-risk over-thecounter medications, and the majority of these cases were associated with non-steroidal anti-inflammatory drugs (21.8%). In total, pharmacies made 641 interventions to resolve the drug-related problems. For majority of drug-related problems (87%), pharmacist's intervention involved counselling. In more than half of the problem cases, the pharmacy intervention was precautionary. Conclusion Pharmacists intervene in and prevent problems related to over-the-counter medications, including high-risk medications like analgesics, in which inappropriate use due to consumers' lack of knowledge can lead to severe consequences. As the selection and use of over-the-counter medications is continuously increasing, pharmaceutical counselling should be readily available and actively provided for consumers to achieve safer self-medication.

Generic versus brand-name over-the-counter analgesics: knowledge and attitudes among Swedish pharmacy customers

“…Paracetamol may, however, present a Table 3 Adjusted odds ratios (ORs) for choosing a generic over-the-counter (OTC) analgesic (n = 145) over an original brand (n = 64), in relation to sex, age, educational level, frequency of OTC analgesic use and experience with generic substitution of prescription drugs special case, since this substance received a lot of media attention in 2015 after its sale was withdrawn from nonpharmacy outlets [30]. On the other hand, official statistics in Sweden show that this act was followed by an increase in the defined daily doses of ibuprofen sold outside pharmacies that equalled the respective decrease in the sale of paracetamol [31]. This suggests that individuals are either unaware or careless about when it is appropriate to use one drug instead of the other.…”

“…Paracetamol may, however, present a special case, since this substance received a lot of media attention in 2015 after its sale was withdrawn from non-pharmacy outlets [ 30 ]. On the other hand, official statistics in Sweden show that this act was followed by an increase in the defined daily doses of ibuprofen sold outside pharmacies that equalled the respective decrease in the sale of paracetamol [ 31 ]. This suggests that individuals are either unaware or careless about when it is appropriate to use one drug instead of the other.…”

Policy and vision for community pharmacies in Finland: A roadmap towards enhanced integration and reduced costs

“…Community pharmacies have been actively developing new tools, services and collaborative procedures that reflect systems thinking in preventing medication-related risks (i.e., building up systemic defenses). 5 , 6 , 26 - 28 , 34 , 37 , 38 , 46 , 57 …”

“…As many medication safety tools already exist, the current mission is to enhance their implementation and use in routine practice. 5 , 6 , 26 - 28 , 32 - 34 , 37 , 38 , 46 , 57 This has been carried out through the national coordination group for professional community pharmacy practice development (AATE, since 2000), pilot implementation projects, undergraduate education, specialization, accreditation and other forms of continuing education, and creating awareness of systems approach to medication safety in primary care and community pharmacy contexts. Also, development of information technology has supported medication risk management (e.g., databases assisting in medication reviews).…”

“… 5 , 6 , 18 , 26 - 30 , 34 , 37 , 38 , 49 An essential element has been research to inform progress in medication safety and indicating high-risk patients, medications, practices and processes needing further improvement. 6 , 7 , 13 , 15 , 20 , 54 - 57 …”