Who provides patients with drug information?

One hundred and fifty four patients were interviewed to determine the type and source of information that they had received about drugs that had been prescribed for them. Most had been told how often to take the drugs (145 (94%)) and how much to take each time (143 (93%)), but few had been informed about side effects (49 (32%)) and fewer had received written information (22 (14%)). Pharmacists most commonly supplied information about how often to take the drugs (105 (68%)), how much to take each time (99 (64%)), and the best way to take it (109 (71%)). Doctors most often gave information about duration of treatment (116 (75)) and possible side effects (126 (82%)). Few patients requested specific information on their own initiative. More research is needed to determine how best to communicate drug information to patients.     

Randomised clinical trial of manipulative therapy and physiotherapy for persistent back and neck complaints: results of one year follow up.

OBJECTIVE--To compare the effectiveness of manipulative therapy, physiotherapy, treatment by the general practitioner, and placebo therapy in patients with persistent non-specific back and neck complaints. DESIGN--Randomised clinical trial. SETTING--Primary health care in the Netherlands. PATIENTS--256 patients with non-specific back and neck complaints of at least six weeks'' duration who had not received physiotherapy or manipulative therapy in the past two years. INTERVENTIONS--At the discretion of the manipulative therapists, physiotherapists, and general practitioners. Physiotherapy consisted of exercises, massage, and physical therapy (heat, electrotherapy, ultrasound, shortwave diathermy). Manipulative therapy consisted of manipulation and mobilisation of the spine. Treatment by general practitioners consisted of drugs (for example, analgesics), advice about posture, home exercises, and (bed)rest. Placebo treatment consisted of detuned shortwave diathermy (10 minutes) and detuned ultrasound (10 minutes). MAIN OUTCOME MEASURES--Changes in severity of the main complaint and limitation of physical functioning measured on 10 point scales by a blinded research assistant and global perceived effect measured on a 6 point scale by the patients. RESULTS--Many patients in the general practitioner and placebo groups received other treatment during follow up. Improvement in the main complaint was larger with manipulative therapy (4.5) than with physiotherapy (3.8) after 12 months'' follow up (difference 0.9; 95% confidence interval 0.1 to 1.7). Manipulative therapy also gave larger improvements in physical functioning (difference 0.6; -0.1 to 1.3). The global perceived effect after six and 12 months'' follow up was similar for both treatments. CONCLUSIONS--Manipulative therapy and physiotherapy are better than general practitioner and placebo treatment. Furthermore, manipulative therapy is slightly better than physiotherapy after 12 months.     

Self-Medication Practices in Mekelle,Ethiopia

Background

Self-medication makes consumers more health conscious, reduces treatment burden on healthcare facilities and curtails the cost and time of obtaining access to treatment. However, it increases risks such as drug resistance, adverse drug reactions, incorrect diagnosis, drug interactions and polypharmacy. The purpose of this study was to assess the practices and factors associated with self-medication in Mekelle, Tigray region, Ethiopia.

Methods

A cross-sectional study was undertaken in Mekelle from February to March 2013. A structured and pre-tested questionnaire was used for data collection to assess self-medication practices. Data were analyzed using of Statistical Package for Social Sciences (SPSS) version 20.0.

Results

Among self-medicated study participants, 199(73.7%) were males and 71(26.3%) were females with mean age of 28.65 years. The most frequently reported illnesses or symptoms of illnesses that prompted self-medication of study participants were headache/fever (20.7%), gastrointestinal diseases (17.3%) and respiratory tract infections (15.9%) with the main reasons being mildness of the disease, prior experience and less expensive. The majority of drug consumers made their requests by telling their symptoms, by mentioning specific names of the drugs and by showing old samples. Analgesics/antipyretics, gastrointestinal drugs, respiratory drugs and oral rehydration salt were the most frequently requested categories of drugs. Pharmacists followed by other healthcare providers were the most frequently reported source of drug information for self-medication.

Conclusions

The results of this study demonstrated that self-medication practices were common for a wide range of illnesses. Health professionals, especially community pharmacists need to educate people on the benefits and risks of self-medication to encourage responsible self-medication.     

A cross sectional study of sex differences in self-medication practices among university students in Slovenia

Self-medication patterns in adults depend on sex. Self-medication among students is very common, but little is known about the influence of sex. The aim of the study was to determine the incidence of self-medication college students and to determine the effect of sex on self-medication patterns. A web based incidence study conducted on a sample of Slovenian university students. The main outcome measures were percentages of male and female students reporting the use of self-medication in the past year. A majority of students (92.3%) reported the use of some sort of self-medication in the past year. Most female students (94.1%) and most male students (90.9%) reported the use of self-medication in the past year. The difference was not statistically significant. More female students than male ones (p < 0.05) acquired the drugs for self-medication in pharmacies, used OTC drugs, herbal teas, herbs, vitamins and minerals, remedies for muscle mass gain, antibiotics, benzodiazepines, antacids, acetylsalicylic acid, topical corticosteroids, and nasal decongestives only with the advice of physicians or pharmacists, and thought that increasing drug dosage can be dangerous, that in case of side effects physicians' help must be sought, that no drug can be used during pregnancy, and that self-treatment can mask the symptoms and signs of diseases so the physicians can overlook them easily. Sex appears to be important factor in self-medication patterns even in young adults, such as students. The physicians should actively seek the presence of self-medication in this population. Inappropriate or unsafe use should be properly addressed and managed.     

Patients as a direct source of information on adverse drug reactions.

To determine whether patients should participate directly in detecting adverse reactions to drugs their ability to provide written reports of symptoms experienced during treatment with amoxycillin or trimethoprim-sulphamethoxazole was investigated. When compared with telephone interviews forms on which patients reported events were reliable (the observed agreement with the same statements posed during telephone calls was 85%, kappa = 0.56) and valid (sensitivity = 54%, specificity = 94%). Patients were also supplied with forms that invited them to report adverse reactions, and their perceptions were compared with those of a panel of experts, who were informed of all clinical events that had been reported during the detailed telephone interviews. Patients were more conservative than the experts in attributing clinical events to drug treatment. The extent of agreement varied and was notably poor for skin and bowel complaints (kappa = 0.13 in each case). The performance of event report forms and reaction report forms as instruments of detection was compared in a hypothetical situation in which the experts'' views represented the "truth" about adverse reactions to a new drug. Event reporting had a higher sensitivity than reaction reporting (42% v 24%) but a lower specificity (58% v 98%). National centres monitoring adverse drug reactions should probably resist pressure to accept reports of reactions directly from the public, but a system based on large scale reporting of events might be valuable in aiding the early detection of symptomatic reactions to new drugs.     

Patients' and practitioners' views of knee osteoarthritis and its management: a qualitative interview study

Purpose

To identify the views of patients and care providers regarding the management of knee osteoarthritis (OA) and to reveal potential obstacles to improving health care strategies.

Methods

We performed a qualitative study based on semi-structured interviews of a stratified sample of 81 patients (59 women) and 29 practitioners (8 women, 11 general practitioners [GPs], 6 rheumatologists, 4 orthopedic surgeons, and 8 [4 GPs] delivering alternative medicine).

Results

Two main domains of patient views were identified: one about the patient–physician relationship and the other about treatments. Patients feel that their complaints are not taken seriously. They also feel that practitioners act as technicians, paying more attention to the knee than to the individual, and they consider that not enough time is spent on information and counseling. They have negative perceptions of drugs and a feeling of medical uncertainty about OA, which leads to less compliance with treatment and a switch to alternative medicine. Patients believe that knee OA is an inevitable illness associated with age, that not much can be done to modify its evolution, that treatments are of little help, and that practitioners have not much to propose. They express unrealistic fears about the impact of knee OA on daily and social life. Practitioners'' views differ from those of patients. Physicians emphasize the difficulty in elaborating treatment strategies and the need for a tool to help in treatment choice.

Conclusions

This qualitative study suggests several ways to improve the patient–practitioner relationship and the efficacy of treatment strategies, by increasing their acceptability and compliance. Providing adapted and formalized information to patients, adopting more global assessment and therapeutic approaches, and dealing more accurately with patients'' paradoxal representation of drug therapy are main factors of improvement that should be addressed.