A STUDY OF OVER THE COUNTER MEDICATION USE, AMONG PATIENTS PRESENTING TO FAMILY PHYSICIANS, AT A TEACHING HOSPITAL IN KARACHI

Dr. Waris, Qidwai Mr. Syed, Iqbal Azam Mr. Faisal M Khan

ABSTRACT
Objective: To study the use of the Over the Counter medications, among patients visiting the Family Physicians, at a teaching hospital in Karachi. Design: A Cross-sectional survey Place and Duration of study: Family Practice Center, the Aga Khan University Karachi, from August to October, 2001 Subjects and Methods: A total of 393 patients were surveyed against a sample size estimated at 347. A questionnaire was developed and administered to collect information on the demographic profile and the Over the Counter medications use, among the respondents. Results: The demographic profile showed that the respondents were young and well educated and better placed socio-economically. Over the Counter medication use within the previous 6 months, was found in 153 (39%) respondents. Analgesics were the most commonly used Over the Counter medication group among the respondents. Cousins/neighbor were the group most commonly advised to use Over the Counter medications by the respondents. Awareness regarding misuse/abuse of OTC medications was found in 167 (42.49%) of the respondents. Reasons for abuse as quoted by the respondents were, the need to save money by avoiding doctors consultation, addiction potential and easy availability of medications in the open market. With regards to the Over the Counter use of medications in future, 250 (63.61%) of the respondents said they would like to see a doctor before taking any medicines. Conclusions: We have found substantial use of over the counter medications in our study. We recommend a strong patient education program and government legislative control over the sale of medications in the country. Key-words: OTC MEDICATION SELF-MEDICATION SELF-CARE

INTRODUCTION
Safe care and the Over the counter (OTC) medication use, is the use of medications largely outside the control of licensed medical practitioners. Diabetic patient spends almost as much money on OTC medications and alternative medications together, as they do on their diabetic medications1. In the United States of America alone, non-steroidal anti-inflammatory drugs (NSAIDs), account for 30 billion OTC medications sold2. Significant concerns are expressed regarding the use of OTC medications. The use of NSAIDs is associated with significant gastrointestinal complications3,4. Migraine is a common condition in which most patients never seek medical advice, and one assumes that their headaches are under control with simple OTC analgesics5,6. Also the use of OTC medications is associated with liver toxicity7, as well as fatal civil aviation accidents8. It has been argued that resistance takes place if OTCs medications are used without proper control9. Also, secondary haemochromatosis is reported from the use of OTC preparations containing iron 10. Recently, the safety and effectiveness of the OTC antidepressants available in the market has been questioned11. Physicians are advised to inquire about all medications their patients are taking on account of the likelihood of drug interactions12. A new range of OTC medications, continue to flood the markets with the passage of every day, further complicating the situation13.

OBJECTIVES

To study the use of over the counter medications, among patients visiting the Family Physicians at the Aga Khan University, Karachi.

PATIENTS AND METHODS

It was a cross sectional survey, conducted from August to October, 2001, at the Family Practice Center, the Aga Khan University Hospital, Karachi. On an average 150 patients are seen daily at the center by 10 Family Physicians. After extensive literature search and feedback from colleagues, a questionnaire was developed to collect information on the demographic parameters of the respondents and the OTC medication use, among the respondents. The questionnaire was administered by convenience sampling, in the waiting area of the clinic. The ethical requirements for the study were met, including the signing of the informed consent form by the participants after assurance of maintaining confidentiality was provided.

Sample size estimation

Sample size estimated based on following assumptions for cross-sectional surveys14 Population size: 3600 Estimated prevalence: 50% +/-Maximum error: 5% Sample size: 347

RESULTS
The cross sectional survey covered 393 respondents. There were 08 non-responders. The mean age of the respondents was 29.4 years, 165 (42%) were men and 228 (58%) women. The majority was married, with over matriculate education and in private or government service or housewives (Table-I) The use of OTC medications in the previous six months was found in I53 (39%) of the respondents. Analgesics and antibiotics were found to be the most commonly used OTC medications (Table-II) Cousins, neighbors, friends and immediate family members were the categories of people advised to use OTC medications (Table-III) Central nervous system symptoms, addiction, drowsiness, cardiovascular system symptoms, behavioral problems, disturbance in thinking, suicide, coma and death were quoted as side effects of sleep inducing medications (Table-IV) Awareness about the misuse/abuse potential of OTC medications was found in 167 (42.49%) of the respondents. Potential reasons for misuse/abuse were quoted as, the need to save money by avoiding a doctors consultation, addiction potential and easy availability of medications in the open market without a doctors prescription. With regard to future use of OTC medication, 250 (63.61%) of the respondents said they would like to see a doctor before taking any medicines.

TABLE-I Demographic Profile of the Study Population

S.NO PARAMETER NUMBER ( PERCENT ) 1. SEX: Males Females Mean Age (SD*) (In years) Marital Status: Single Married Others Educational Status: Illiterate Primary Secondary Matriculation Intermediate Graduate Post-graduate Diploma Not known 165 (42) 228 (58)

2. 3.

29.4 (7.89) 137 (34.9) 255 (64.9) 01 (0.2)

4.

23 (5.9) 29 (7.4) 27 (6.9) 47 (12) 76 (19.3) 106 (27) 27 (6.9) 4 (1.0) 54 (13.7)

5.

Occupational status: Private service Government service Self employed Student Laborer Unemployed * Others Standard deviation including housewives

51 (13) 19 (4.8) 34 (8.7) 77 (19.6) 6 (1.5) 16 (4.1) 190 (48.3)

393

TABLE-II GROUPS OF OTC MEDICATIONS USED BY THE RESPONDENTS

S.NO 1. 2. 3. 4. GROUP OF MEDICATION Analgesics Antibiotics Tranquilizers Others: Antihistamines Antipyretics Vitamins Herbal medicines n NUMBER (PERCENT) 109 (71.24) 26 (16.99) 9 (5.88) 5 (3.26) 2 (1.3) 1 (0.65) 1 (0.65) 153

TABLE-III GROUPS OF PEOPLE ADVISED TO USE OVER THE COUNTER MEDICATIONS*

S.N O 1 2 3 RELATIONSHIP Cousin/Neighbor Friends Immediate family n NUMBER (PERCENT) 67 (60.90) 30 (27.27) 13 (11.81) 110

* Advised by the respondents

DISCUSSION
We have documented the use of OTC medications among our study population. Respondents in our study were young, therefore in better health and with less number of co-morbid conditions. Since they were visiting a family physician with a medical problem, one can argue that these patients probably

are the ones who prefer to seek medical advice, rather then
take an OTC medication. Self-medication has been found to increase with improvement in socio-economic status15. Since respondents in our study were better placed socio-economically, therefore the use of

OTC medication may be more among them.

An earlier study on the use of anti-microbial agents, conducted in Karachi, showed that 6.3% of the patients used them as self-medication, over a four weeks period. We have found a much higher 17% use of antibiotics in our study, but over a 6 month period. Antibiotic resistance can be an outcome of such antibiotic misuse. In another study conducted in Karachi, self- medication was found in 51.3% of the households with a sick child, over a period of four weeks16. This reported use of OTC medication is significantly higher than the finding among our respondents.

DISCUSSION
We have found analgesics to be the most commonly used OTC medication group, which is similar to the findings of an earlier study conducted in the west17. Analgesics use can have serious side effects2, and can lead to serious

consequences for the patients.

Benzodiazepines are available over the counter in Pakistan. It is because of this reason that their use has been reported in 84% cases of self-poisoning in Pakistan18. Their use is known to cause increased sedation, decreased attention and

amnesia19. We need strict control over the sale of

tranquilizers in the country. The assumption that increased access leads to irrational use of over-the-counter medicines has not been substantiated20. This shows that the availability of medicines over the counter but with proper safeguards and regulations is required. It is expected that patients will continue to place an increasing emphasis on selfcare, and we have to remain up-to-date in our knowledge, in order to make such practice is safe and useful21.

CONCLUSION

The use of OTC medication among our respondents is found to be substantial. The medical community must ensure that the practice is safe and useful for our patients. Education of patients on this issue and effective government control over the sale of medications are strongly recommended.