Self-Medication in Patients: hazards and consequences

DISCLAIMER

• The Content in this presentation is only intended for healthcare professionals in India . The medical information in this presentation is provided as an information resource only, and is not to be used or relied on for any diagnostic or treatment purpose. “

• “The views and opinions mentioned in the presentation is strictly that of the author and the individuals expressing the same and Pfizer may not necessarily endorse the same. Pfizer (including its parent, subsidiary and affiliate entities) makes no representation or warranties of any kind, expressed or implied; as to the content used in the presentation and/or the accuracy, completeness of its content.”

• Pfizer Limited, The Capital- A Wing, 1802, 18th Floor, Plot No. C-70, G Block, Bandra - Kurla Complex, Bandra (East), Mumbai 400 051, India

• For the use only of Registered Medical Practitioners or a Hospital or a Laboratory

PP-NXM-IND-0265 16th May 2019

Contents

• What is Self-medication?

• Health hazards of self medication

• Why is it important to visit a doctor?

WHAT IS SELF-MEDICATION?

What is Self-medication?

• “Self-medication is the selection and use of medicines by individuals to treat self-recognized illnesses or symptoms”-World Health Organization (1998) 1

• It is a common practice and a major health issue across the world 2, 3

1. World Health Organization, World Health Organization. The role of the pharmacist in self-care and self-medication. Geneva: WHO. 1998 Aug.2. Hanif A, Ashar SM, Rabnawaz R, Yasmeen S. Self-medication of Antibiotics among the Students of Hamdard University, Pakistan. Journal of Public Health in Developing Countries. 2016 May

19;2(1):145-8.3. apps.who.int. (2014). Sudan Journal of Rational Use of Medicine- Self-Medication. Issue No.6. [online] Available at: http://apps.who.int/medicinedocs/documents/s22205en/s22205en.pdf

[Accessed 15 May 2019].

Self-medication can include the following4

• Buying medicines without prescription

• Reusing old prescriptions to purchase medicines

• Sharing medicines with relatives or friends

• Consuming left-over medicines

According to World Health Organization, more than half of the medicines are inappropriately sold and most patients fail to take them as prescribed 3

3. apps.who.int. (2014). Sudan Journal of Rational Use of Medicine- Self-Medication. Issue No.6. [online] Available at: http://apps.who.int/medicinedocs/documents/s22205en/s22205en.pdf [Accessed 15 May 2019].

4. Zafar SN, Syed R, Waqar S, Zubairi AJ, Vaqar T, Shaikh M, Yousaf W, Shahid S, Saleem S. Self-medication amongst university students of Karachi: prevalence, knowledge and attitudes. Journal of the Pakistan Medical Association. 2008;58(4):214.

What are the pros and cons of self-medication?

Advantages 3

• Reduce medical services load

• Time efficient: Decrease in the time spent to see the physician

• Cost efficient: Especially in economically deprived countries with limited health resources

Disadvantages 3

• Increase the burden and expense due to adverse health effects

• Irrational medicine use (adding to antibiotic resistance)

• Delay in seeking appropriate medical advice

• Drug/food interactions

3. apps.who.int. (2014). Sudan Journal of Rational Use of Medicine- Self-Medication. Issue No.6. [online] Available at: http://apps.who.int/medicinedocs/documents/s22205en/s22205en.pdf[Accessed 15 May 2019].

What are the reasons for self-medication?

• Socio-economic factors

• Lifestyle

• Easy availability of drugs

• Cost of the drugs

• Educational level

• Age and gender

• High-cost fees of private consultations and long waiting-time

What are the reasons for self-medication?

cross-sectional study done in urban Puducherry with 352 subjects from 124 households

Selvaraj K, Kumar SG, Ramalingam A. Prevalence of self-medication practices and its associated factors in Urban Puducherry, India. Perspectives in clinical research. 2014 Jan;5(1):32.

Pattern of Self medication• Most common symptoms warranting self-medication were fever (75.31%)

and headache (62.04%), followed by cough and common cold (43.21%)

75.31

62.04

43.2134.88 31.79

19.75

0

10

20

30

40

50

60

70

80

Fever Headache Cough /Cold

Bodyache Gastritis Diarrhoea

Symptoms (%) reported for Self-medication

(N = 324)

Jain M, Prakash R, Bapna D, Jain R. Prevalence and Pattern of Self-medication Practices in Urban area of Southern Rajasthan. Ntl J of Community Med 2015; 6(4):474-477.

Method of procurement of medication for self medication

Selvaraj K, Kumar SG, Ramalingam A. Prevalence of self-medication practices and its associated factors in Urban Puducherry, India. Perspectives in clinical research. 2014 Jan;5(1):32.

Include (n) and study details

Drugs used as self-medication

Jain M, Prakash R, Bapna D, Jain R. Prevalence and Pattern of Selfmedication Practices in Urban area of Southern Rajasthan. Ntl J of Community Med 2015; 6(4):474-477.

73.77

41.98

29.94

20.3727.47

12.9617.9

9.88

0

10

20

30

40

50

60

70

80

Paracetamol NSAIDs Cough / coldremedies

Antibiotics Drugs foracidity

Laxatives /anti-diarrheal

Anti-allergic others

Frequency (%) of drugs used by the respondents for self-medication (n = 324)

HEALTH HAZARDS OF SELF MEDICATION

Health hazards of self-medication10

• Inaccurate self-diagnosis and choice of therapy

• Failure to inquire about suitable medical advice promptly

• Unable to recognize pharmacological risks and adverse events

• Lack of awareness about contraindications, warnings, precautions

• Failure to distinguish between the same active drug that has already being taken under a different name

• Failure to identify double medication/ harmful interaction

• Incorrect route of administration

• Over dose, prolonged use and risk of addiction or abuse

• Drug-food or drug-drug interaction

• Incorrect storage or taking expired medicines

Individual level

• Increase in drug-induced disease

• Tolerance

• Resistance of drug in the body

• Wasteful public expenditure

Community level

Chouhan K, Prasad Sb. Self-Medication And Their Consequences: A Challenge To Health Professional. Self. 2016;9(2).

Antibiotic Resistance

• Antibiotics are used to treat the infection caused by bacteria.

• Antibiotic resistance occurs when bacteria resist to the effect of these antibiotics to prevent or kill bacterial growth (8).

• Antibiotic resistance is currently a global health problem predominately in developing countries where antibiotics are sold without any prescription (6).

• This resistance is caused mainly due to inappropriate use of medicines for instance; self-medication with antibiotics, taking antibiotics when not needed, for the wrong reason, incorrect dose and dose intervals and wrong duration (9).

• World Health Organization. (2016). Antibiotic resistance. [online] Available at: http://www.who.int/mediacentre/factsheets/antibiotic-resistance/en/ [Accessed 15 May 2019].

• Bennadi D. Self-medication: A current challenge. Journal of basic and clinical pharmacy. 2013 Dec;5(1):19• Eu-patient.org. (2015). Self-medication and antibiotic resistance | European Patients' Forum Blog. [online] Available at: http://www.eu-patient.org/blog/?p=396

[Accessed 15 May 2019.

What are the consequences of antibiotic resistance?

• More expensive medicines and extended hospital stay

• Longer duration of illness

• Prolonged treatment

• Increase in health care costs and economic burden

• Increased mortality

• Chemotherapy/ surgeries become much more dangerous

World Health Organization. (2016). Antibiotic resistance. [online] Available at: http://www.who.int/mediacentre/factsheets/antibiotic-resistance/en/ [Accessed 15 May 2019].

How can you prevent or control antibiotic resistance?

• Use antibiotics only when prescribed by a doctor

• Do not demand antibiotics

• Follow doctors’ instruction when using antibiotics

• Never share or use leftover antibiotics

• Prevent infections by washing hands, prepare food in hygienic conditions, take vaccinations on time

World Health Organization. (2016). Antibiotic resistance. [online] Available at: http://www.who.int/mediacentre/factsheets/antibiotic-resistance/en/ [Accessed 15 May 2019].

WHY IS IT IMPORTANT TO VISIT A DOCTOR?

Why is it important to visit a doctor?

• Health professionals play an important role in preventing risk of self-medication 6

• Good doctor-patient relationship is one of many effective ways to avoid inappropriate use of medicines by giving and receiving necessary information and instructions 3

Bennadi D. Self-medication: A current challenge. Journal of basic and clinical pharmacy. 2013 Dec;5(1):19.

apps.who.int. (2014). Sudan Journal of Rational Use of Medicine- Self-Medication. Issue No.6. [online] Available at: http://apps.who.int/medicinedocs/documents/s22205en/s22205en.pdf [Accessed 15 May 2019].

Role of doctors’ counseling in promoting the rational use of medicine

Info

rmat

ion

Doctors provide clear instructions and explain the use and purpose of drugs

Ther

ape

uti

c ad

vice

It is important for patients to have a good understanding of therapeutic condition and its treatment aim to avoid misuse

Doctors follow set guidelines of the medication (like dose, frequency of dose, treatment course, how to take it, limitations of a drug, etc.)

Edu

cati

on

Proper health education for patients is important to avoid inappropriate use of drugs

Doctos and the educated large sectors of the population can directly influence their friends and family, caregivers, etc. to avoid self-medication practices among the youth

Role of doctor-patient conversations that may be helpful

Effects of the medicine

• Doctor will discuss about:

-The need and use of the prescribed medicines

-The effect of medicine on the symptoms and when the effect is expected to start?

Side effects

• Doctors will inform patients about:

-Possible side effects that may occur and how to recognize it

-Duration of the side effects

-Any serious concerns

-Action to take in such events

Instructions

• Doctors give clear instruction to the patients about:

-How and when to take medicine

-Duration and storage of medication

-Also guide with left-over medicines

Warnings

• Doctors will advise patients about:

-When the medicine should not be taken

-What is the maximum dose of the drug

Future consultations

• During a visit, the doctor will inform the patient about the future visit or in what circumstances to visit early

Everything clear or not?

• Patients should ask all questions or concerns they have and make sure that everything is clear

Summary

• Avoiding self-medication habits can greatly ease the economic burden on a country and also prevent the emergence of new antibiotic-resistance patterns in resource limited countries

• HCPs as well as patients have to make equal efforts to avoid the growing practices of self-medication.