Effectiveness of Pharmacist Intervention on Self Medication: Perspective from a Community based Prospective Study

INTRODUCTION: Medicaments that are safe and effective for use by the general public without the aid of a prescription from a registered medical practitioner are called as "over the counter (OTC) drugs". They are also known as Non prescription medicines.[1] There are three categories of medicine in terms of their availability to the public; (a) prescription only (POM), which can only be obtained on a medical or dental prescription; (b) pharmacy only (P), which do not require such a prescription, but can only be purchased in a pharmacy under the supervision of a registered pharmacist; and (c) medicines on the General Sales List, which are available, usually in restricted quantities, through other non-pharmacy retail outlets. Any drug or preparation, which is not included within the first and third of these categories falls into the pharmacy only list. Medicines available in the second and third categories are often referred to as over-the-counter or OTC medicines.[2] The term "OTC drug" is a loose and legally undefined term. The United States Department of Food and Drug Administration (FDA) defines OTC drugs as "drugs that are safe and effective for use by the general public without seeking treatment by a health professional". Because there are over 3,00,000 marketed OTC drug products, FDA reviews the active ingredients and the labelling of over 80 therapeutic classes of drugs. For each category, an OTC drug monograph is developed and published in the Federal Register. These monographs define the safety, effectiveness and labelling of all marketing OTC active ingredient.[3] The therapeutic categories of OTC drugs are further grouped in 12 broad therapeutic classes : 1. Analgesics and antipyretics, 2. Cold, cough, and allergy products, 3. Night-time sleep-aids, 4. Gastrointestinal products, 5. Dermatological products, 6. Other topical products (including dermal and vaginal antifungals, anorectal medications, head lice products, hair loss products, and otics), 7. Ophthalmic products, 8. Oral health care products, 9. Menstrual products, 10. Nicotine replacement products, 11.Weight loss aids, 12. Vaginal contraceptives and emergency contraceptives.AIM & OBJECTIVES: To study the effectiveness of pharmacist intervention on self-medication in community setting. a) To determine the utilisation pattern of commonly used Over The Counter drugs, b) To prepare Patient information leaflets (PIL) and posters on OTC medicine, c) To provide tele-counselling for subjects using OTC medication , d) To assess the outcomes of pharmacist interventions, e) Conduct direct counselling in palliative care patient. DISCUSSION: The study was designed to evaluate the effectiveness of tele-counselling and leaflets in Malappuram population. A questionnaire based assessment regarding self-medication was performed in both groups. Control pharmacy (group A) and test pharmacy (group B) The results of our study were consistent with the result of the study carried out by Dr.Muhammed saleem TK et al70 on comparing the result of gender wise distribution of respondents. It was found that the explanation were provided by males and rest of them were females. As per our study it was found that 78% of the total respondents were males, out of which 82% were young adults and the remaining 18% were middle age group. Rest of the 22% of total population were females, out of which 84% were young adults and 16% were middle age group. The result of age wise distribution of our project opposes the result of study of Dr.Muhammed saleem TK70 where, 47% of middle group were under OTC purchasing. As per our study young adulthood are having more tendency for OTC purchasing. But during tele-information we obtained another result that female population had more tendency to self-medication than OTC purchasing. It meant that they were taking medicines at home. The results of our study were consistent with the result of Pankaj Jain et al68 2012, on the aspect that education level of the respondents are important, while considering the self medication pattern. Our study found that, out of 200 respondents with secondary school qualification 30% are more under self medication. This result is very much similar to the study conducted by Pankaj Jain et al where out of 1403 respondents who were under self medication are with secondary school qualification. This result concludes that literate people have more tendency to self medication. Major reasons for self treatment was categorized as lack of time, lack of money and lack of trust in doctor treatment. From this perspectives, our study was supported by the study of Dr.Muhammed Saleem TK et al70. Both studies reported that the main reason for self medication was the lack of time. Asper our study, 56.7% of respondents practice self medication due to lack of time. The results show that the spot counselling cannot be applied to the OTC purchaser. To these people tele-counselling are the only effective option. CONCLUSION: The prevalence of self-medication with the over the counter drug in Perinthalmanna is high. Self-medication has been a modern trend for more than 10 year. Self-medication is higher in respondents with secondary school qualification, most of the respondent was depended on self-medication due to lack of time, most of the respondent were male with middle age category. The study found that the main indication for self-medication was pain. The most commonly used self-medication was found to be analgesic and antipyretic, the knowledge of respondents about drug was found to be less and it was also reported that most of them did not spot counselling by the pharmacist on phase 1. Due to tele counselling and leaflets, test sample have improvement to enquire about the drugs to pharmacist. In phase 2, we compare the two group, test and control. The effectiveness of drug due to tele counselling and leaflet was found to be higher in test group. it was also noted that in phase 1 and phase 2 the control group had side effect and test group was free from side effect of self-medication in phase 2, where they had side effect in phase 1. We also included the new term, "DRUG INFORMATION CENTRE" in our project. DIC is not that much familiar to Malappuram population. Based on this point of view, we included DIC as parameter in our project. We gathered the information of respondents about DIC and it was found that most of them are not aware about DIC. From our study, test group realise the importance of patient counselling in rational drug therapy. Patient counselling is a important role for rational drug therapy. The household medicine are using as self-medication of future use. It was noted that the amount of house hold medicine storage was found to be decreased in phase 2. That is the frequency of consuming self-medicament in future will decrease. Most of the house hold medicine include antibiotic which indicate the less adherence of the patient to antibiotic. And which can lead to antibiotic resistant. We counsel the patient about importance of adherence to antibiotic therapy