Preferences and attitudes of older adults of Bialystok, Poland toward the use of over-the-counter drugs

Real-life dosing conditions in older adults and geriatric patients in Poland - An international questionnaire study to investigate the regional differences in drug intake behaviour in the older population

Older people represent approximately 20% of the Polish population and are the primary population using medications. Behaviours connected with drug intake (such as dosage form modifications, type and amount of fluid and/or food accompanying administration) are crucial for drug efficacy and avoidance of adverse effects. The presented study had three research aims; firstly, to investigate the real-life drug administration process among older adults and geriatric patients in Poland. Secondly, to compare data from Poland with data from a previous study performed in Germany, based on the same questionnaire. Thirdly, to discuss the potential influence of dosing conditions on the behaviour of orally administered medications (especially drug absorption) and identify potential problems with drug intake itself. This questionnaire-based study was conducted in the form of in-person interviews led by research team members. In this study, 174 participants, aged 65-94 years old were recruited from three settings in the Pomeranian region of Poland: home setting, nursing home and hospital. In Poland, the preferred method of medication intake was administration of all medications simultaneously. Patients were taking their medications most often directly after food ingestion, which commonly consisted of bread with butter, ham or cheese and black tea. The most common fluid for drug administration was either a few sips or 100 mL of non-carbonated water (mineral or tap water) as well as black tea. Dividing tablets (defined as splitting tablets in parts) was the most common modification. There were many similarities in the way of administering medications between the Polish and German older populations, specifically the use of non-carbonated water as the most common fluid for medication intake as well as bread as the main ingredient of breakfast and dinner. The biggest difference between populations was the choice of black tea as a medium for medication intake much more frequently in the Polish population than the German (who also preferred mint, herbal and fruit teas), and using a smaller volume of fluid. The presented study gives insight into the medication intake process in the older Polish population from the Pomeranian region in North Poland in comparison to the German population from the Pomeranian region in North East Germany. The results may help to identify factors that could decrease medication efficacy and safety, which is crucial, especially for the older population. Furthermore, the collected data may be useful for in vitro or in silico simulations to enhance drug development based on real-life data.

Attitudes and Behaviors of the Public Toward over the Counter (OTC) Medications in the Western Region of Saudi Arabia: A Cross-Sectional Study

Background: Over the counter (OTC) medications are readily accessible to the public and can be obtained without a prescription for self-care. Ensuring their safe and effective use is essential to safeguarding the well-being of the region's diverse population. This research explores public attitudes and behaviors toward OTC medications in the Western Region of Saudi Arabia in order to inform and advance public health initiatives. Method: This cross-sectional study was conducted in the Western Region of Saudi Arabia. A validated questionnaire was used to survey 200 respondents. The collected data were analyzed using frequencies and percentages. The demographic-OTC medication purchase relationship was examined using the chi-square test. Results: Among the 200 participants, 79.5% were aware of potential drug interactions, and 74% supported stricter regulations on OTC sales. However, only 29.5% believed OTC medications are generally safe without a doctor's prescription. Notably, 15.5% reported exceeding recommended dosages, and 66% admitted sharing medications. Participants commonly relied on healthcare professionals for advice (64.6%). Despite moderate knowledge, many exhibited risky behaviors, highlighting gaps in consumer awareness and safety practices. Conclusions: It is critical to determine the degree of public knowledge in this field in order to identify gaps in consumer awareness of OTC medications and specific areas that may demand targeted educational programs in Saudi Arabia. Information on potential side effects and circumstances that exclude the use of over the counter medications must also be examined. Attitudes towards symptom management and a tendency for self-medication may influence the use of OTC as an alternative to seeking medical advice.

Attitudes, attributions, and usage patterns of primary care patients with regard to over-the-counter drugs-a survey in Germany

Studies show that over-the-counter drugs are widely used by consumers. Moreover, there is a huge selection available and they are prominently featured in advertising. To date, there exist only a few studies that shed light on the attitudes, attributions, and usage patterns of patients with regard to use of over-the-counter drugs. An anonymized explorative waiting room survey was conducted among 900 patients in 60 GP practices in the German states of North Rhine-Westphalia, Hesse, and Rhineland-Palatinate. As well as the descriptive analysis, a t test was applied to independent random samples, in order to identify significant differences between two groups. 65% of respondents reported using over-the-counter drugs frequently or occasionally. With regard to effects, risks, and side effects, 54% state that they usually take advice from their GP and/or pharmacist before purchasing or taking over-the-counter preparations. For 56%, the package information leaflet is a frequent source of information about the over-the-counter drugs used. The respondents consider over-the-counter preparations to be particularly suitable for (preventive) treatment of colds, flu symptoms, and pain management. The widespread perception of over-the-counter drugs as simple to use (62%), low-dose (69%), and low-efficacy (73%) products does not always correspond to the actual capabilities and risks of over-the-counter self-medication. Given the easy availability of over-the-counter drugs and their strong presence in advertising, it is important that patients have a realistic idea of the capabilities and risks of over-the-counter products. In addition to the advice provided by pharmacists, the trusting, long-standing support provided by GPs and their ongoing information and advice services play a central role in this. It would be advisable to give more attention to this public health concern and to promote initiatives to make patients more aware of the risks regarding consumption of drugs without medical consultation.

Over the Counter Pain Medications Used by Adults: A Need for Pharmacist Intervention

BACKGROUND

The safety of pharmacotherapy for geriatric patients is an essential aspect of the demographic perspective in view of the increasing size of this population. Non-opioid analgesics (NOAs) are among the most popular and often overused over-the-counter medications (OTC). The reasons for drug abuse are common in the geriatric population: musculoskeletal disorders, colds, inflammation and pain of various origins. The popularity of self-medication and the ability to easily access OTC drugs outside the pharmacy creates the danger of their misuse and the incidence of adverse drug reactions (ADRs). The survey included 142 respondents aged 50-90 years. The relationship between the prevalence of ADRs and the NOAs used, age, presence of chronic diseases, and place of purchasing and obtaining information about the mentioned drugs were evaluated. The results of the observations were statistically analyzed using Statistica 13.3. The most commonly used NOAs among the elderly included paracetamol, acetylsalicylic acid (ASA) and ibuprofen. Patients consumed the medications for intractable headaches, toothaches, fevers, colds and joint disorders. Respondents indicated the pharmacy as the main location for purchasing medications, and the physician as the source of information for selecting the therapy. ADRs were reported most frequently to the physician, and less frequently to the pharmacist and nurse. More than one-third of respondents indicated that the physician during the consultation did not take a medical history and did not ask about concomitant diseases. It is necessary to extend pharmaceutical care to geriatric patients that includes advice on adverse drug reactions, especially drug interactions. Due to the popularity of self-medication, and the availability of NOAs, long-term measures should be taken to increase the role of pharmacists in providing effective, safe health care to seniors. We are targeting pharmacists with this survey to draw attention to the problem of the prevalence of selling NOAs to geriatric patients. Pharmacists should educate seniors about the possibility of ADRs and approach patients with polypragmasy and polypharmacy with caution. Pharmaceutical care is an essential aspect in the treatment of geriatric patients, which can contribute to better results in their existing treatment and increase the safety of medication intake. Therefore, it is important to improve the development of pharmaceutical care in Poland in order to enhance patient outcomes.

Self-medication in Chinese residents and the related factors of whether or not they would take suggestions from medical staff as an important consideration during self-medication

Objective

To investigate the status of Chinese residents' self-medication behavior and the important factors to consider when purchasing OTC drugs, and to explore the related factors of the possibility that Chinese residents take medical staff's suggestions as important factors to consider when purchasing OTC drugs.

Study design

A cross-sectional survey.

Methods

A questionnaire was developed for exploring the sociodemographic characteristics of the respondents, their self-medication status, and important considerations. The questionnaire includes several scales including Health Literacy Scale-Short Form (HLS-SF), EQ-5D Visual Analog Scale (EQ-5D-VAS), Big Five Inventary-10 Items (BFI-10), and New General Self Efficacy Scale (NGSES). After carrying out a multi-stage sampling method, the questionnaire was conducted nationwide from July 10 to September 15, 2021. Next, descriptive statistics were conducted to analyze the general features. Logistic regression was then used to analyze the related factors of the possibility that the respondents took the suggestions of medical staff as an important consideration when purchasing OTC drugs.

Results

Nine thousand two hundred fifty-six qualified questionnaires were received. 99.06% of Chinese adults had self-medication behaviors. The types of OTC drugs purchased most by the respondents were NSAIDs (5,421/9,256 people, 58.57%) and vitamins/minerals (4,851/9,256 people, 52.41%). 86.2% of the respondents took the suggestions of medical staff as an important consideration when purchasing OTC drugs. The results of multi-factor logistic regression showed that women, those living in the central and western regions of China, those suffering from chronic diseases, those with high agreeableness, high conscientiousness, high neuroticism and openness, high health literacy, high EQ-5D-VAS, and those with high self-efficacy are more likely to take medical staff's suggestions as important factors to consider.

Conclusion

The vast majority of Chinese adults have self-medication behavior. Important considerations when purchasing OTC drugs include medical staff's suggestions, drug safety and drug efficacy. Whether residents take the suggestions of medical staff as an important consideration is related to their sociological characteristics, agreeableness, conscientiousness, neuroticism, openness, health literacy, self-assessment health status, and self-efficacy. When purchasing and using OTC drugs, residents should carefully listen to the suggestions from medical staff. They should also carefully consider their own conditions before buying OTC drugs.

Applicability of tools to identify potentially inappropriate prescribing in elderly during medication review: Comparison of STOPP/START version 2, Beers 2019, EU(7)-PIM list, PRISCUS list, and Amsterdam tool—A pilot study

Potentially inappropriate prescribing (PIP) is one of the major risk factors of adverse drug events in elderly patients. Pharmacotherapy assessment criteria may help reduce the instances of PIP among geriatric patients. This study aimed to verify the applicability of selected tools designed to assess prescribing appropriateness in elderly and to identify PIP in the study population. Based on pharmacist-led medication reviews that were performed among patients attending senior day-care centers based in Poland, aged 65 years and over, the following tools were applied for assessing the appropriateness of pharmacotherapy: PILA (patient-in-focus listing approach): STOPP/START v.2 and Amsterdam tool, DOLA (drug-oriented listing approach): PRISCUS list, and DOLA+: Beers criteria v.2019 and the EU(7)-PIM list–the criteria oriented on medications requiring indications. Fifty patients participated in the study. The prevalence of prescribing issues in the study population was very high and ranged from 28% to 100%, depending on the criteria applied. The highest number of PIP cases was identified based on the PILA criteria: STOPP/START v.2 (171, a mean of 3.4 PIP cases per patient), and the Amsterdam criteria (124, a mean of 2.5 PIP cases per patient). The lack of protective vaccinations against pneumococci identified using the START criterion was found to be the most common PIP (identified in 96% of the patients). Proton-pump inhibitors (PPIs) were identified as the most problematic group of medications. The STOPP, EU(7)-PIM and Beers criteria revealed cases of inappropriate prolonged PPI use, whereas the Amsterdam tool identified cases where PPIs should have been prescribed but were not. The highest number of PIP cases in the study population were identified with the PILA tools, and on this basis the most comprehensive assessment of pharmacotherapy appropriateness in geriatric patients was conducted. Further studies should be designed, covering a larger group of patients across different healthcare settings (inpatient and outpatient), with access to comprehensive patient data.

Sociodemographic and Health-Related Factors Influencing Drug Intake among the Elderly Population

Excessive drugs intake among the elderly population, including self-medication, constitutes an important public health problem. Polypharmacy may lead to numerous adverse health effects, which become more prevalent when combined with biological changes in seniors. In this cross-sectional study, 500 Polish adults aged ≥60 years (M = 67.9 ± 4.2) were asked to complete a questionnaire via telephone calls, allowing us to identify sociodemographic and health-related factors influencing the daily medications consumption. Our findings revealed that all of the participants were receiving medications; 60.2% of them receive at least 1 to 3 drugs per day (301/500). The most commonly used medications included antihypertensive drugs and analgesics (51.0% and 46.0%, respectively). Taking into account clinical conditions, independent predictors of receiving over 3 medications per day turned out to be (1) coronary artery disease (OR = 6.77; CI 95%, 2.86–16.1), (2) diabetes (OR = 3.23, CI 95%, 1.75–5.95), (3) asthma (OR = 4.87, CI 95%, 2.13–11.1), (4) heart failure (OR = 3.38, CI 95%, 1.59–7.19) and (5) gastroesophageal reflux disease (OR = 1.93, CI 95%, 1.03–3.62). Participants suffering from depression were more likely to take drugs for hypertension (OR = 1.70, CI 95%, 1.04–2.78), while those with anxiety and social loneliness took more painkillers (OR = 2.59, CI 95%, 1.58–4.26 and OR = 2.08, CI 95%, 1.38–3.13, respectively). The most significant sociodemographic factors increasing the drugs intake among the population included in our study were high body mass and subsequent increased BMI values (OR = 2.68, CI 95%, 1.50–4.77). Furthermore, living in a city with over 400,000 inhabitants increased the likelihood of taking antidepressants (OR = 2.18, CI 95%, 1.20–3.94). Our study revealed factors increasing the risk of excessive medications intake and hence, increased susceptibility to some iatrogenic diseases among the elderly population. These factors should be considered by primary care physicians while prescribing appropriate drugs to elderly patients.

Patient Safety in a Box: Implementation and Evaluation of the Emergency Box in Geriatric and Parkinson Patients

In an industrial society, the proportion of geriatric people increases with rising age. These people are likely to use polypharmacy and experience medical emergencies. However, their emergency care can be complicated by unclear comorbidities and medication. The aim of this prospective interventional study was to assess the demand for a drug safety tool in clinical practice and to analyze whether the emergency box can improve acute care in a geriatric cohort. Therefore, emergency room (ER) doctors in a German tertiary hospital recorded the number of geriatric patients lacking medical information and its impact on diagnostics/treatment. Furthermore, the emergency box was distributed to patients on the neurological ward and their current drug safety concepts were assessed. After 6 months, we evaluated in a follow-up whether the tool was helpful in emergency cases. Our study revealed that 27.4% (n = 28) of the patients came to the ER without their medical information, which caused a relevant delay or possible severe complications in 11.8% (n = 12). The emergency box was perceived as easily manageable and 87.9% (n = 109) of the participants wanted to keep it after the study. Subjectively, participants benefitted in emergencies. In conclusion, the emergency box is a cheap tool that is easy to use. It can save valuable time in emergencies and increases the safety of geriatric patients.

Analysis of the Interventions of Medical Emergency Teams in Older Patients in Selected Polish Cities with County Status: A Retrospective Cohort Study

Introduction: Geriatric patients account for a large proportion of interventions of medical emergency teams (METs). The aim of this study was to analyse medical emergency interventions in the Biała Podlaska and Chełm (Poland) between 2016 and 2018 in a group of patients ≥ 65 years of age. Materials and Methods: We analysed medical records of 1200 older patients treated by METs in Biała Podlaska and Chełm (Lublin Province, Poland). The research was conducted from June 2019 to March 2020 at the Emergency Medical Service Station in Biała Podlaska and the Medical Rescue Station in Chełm (Independent Public Complex of Health Care Facilities). Results: A total of 92.5% of medical emergency service interventions took place at the patient’s home. The mean time of stay at the scene was 20 min. The highest number of interventions occurred between 8:00 p.m. and 8:59 p.m. There were no statistically significant differences in the type of ambulance used depending on the patient’s sex, while there was a statistically significant relationship between priority code and sex. Cardiovascular diseases were diagnosed in 40% of patients, and the symptoms were not precisely classified in almost the same percentage of patients. Mortality cases accounted for 3.1% of the 1200 interventions analysed. Ambulance dispatch resulted in the patient being transported to the hospital emergency department in 69.1% of cases. Conclusions: METs were called for a variety of diseases due to the fact that geriatric patients are not able to distinguish a life-threatening condition. Medical procedures performed by METs from Biała Podlaska and Chełm were closely related to the initial diagnoses made by these teams. It was irrelevant whether a specialist or non-specialist medical emergency service was used. Paramedics are very well trained to practice their profession and are able to provide treatment to older patients in a state of sudden life threat.

Headache as an Adverse Reaction to the Use of Medication in the Elderly: A Pharmacovigilance Study

There is a consensus that elderly individuals are quite vulnerable to adverse drug reactions (ADRs), and headaches are one of the most frequent clinical presentations of central nervous system problems in the general population, which can be an ADR. The purpose of our work was to analyze reports of "headache" associated ADRs in the elderly sent to the Portuguese Pharmacovigilance System (PPS), and also which drugs were more frequently associated with this adverse reaction. A retrospective analysis of suspected ADR reports involving patients aged 65 years or older received by the PPS in the last 10 years was conducted. A search of all the terms associated with the High Level Term "headache" was performed. All duplicate reports were excluded from the analysis. A total of 155 ADRs reports were included, in which 15 reported isolated "headache" as suspected ADR, while the remaining 140 ADRs reports reported "headache" together with several other adverse reactions. Most reports of "headache" ADR occurred in women (74.8%; n = 116). About half (46.5%; n = 72) of the ADR reports were considered serious. Anti-viral medication, anti-depressants, anti-dyslipidemic agents and central nervous system-acting analgesics were the most frequent drugs associated with "headache" ADR reports in this population. In elderly patients, most ADR reports involving headaches occurred in women and a high percentage (46.5%) were considered serious. Thus, it is important that healthcare professionals pay more attention to headaches reported as ADRs in the elderly and drugs suspected to cause them, in order to increase knowledge about this type of reaction and contribute towards safely using drugs in this age group.

[Choosing of therapy for a patient with dorsalgia]

Dorsalgia is one of the most common skeletal muscle syndromes. Dorsalgia often develops in patients of older age groups with polymorbidity that requires the appointment of a large number of medications. In these conditions, the choice of effective and safe therapy is a difficult problem. Discusses management of a patient suffering dorsalgia with comorbidities, the risks of complications of therapy, possible safety treatment, in particular, through the use of combination therapy.

Ascorbic acid in urine still compromises urinalysis results

Background

The aim of this work was to determine the frequency of ascorbic acid-positive urine samples and to evaluate the potential risk on patient safety.

Materials and methods

A total of  27,856 samples submitted for urinalysis in previous year were retrospectively analysed from the laboratory information system. Urinalysis was done on Iris IQ200 analyzer using 11-parameter iChem Velocity test strips. Risk analysis combined the impact of potentially erroneous results (due to ascorbic acid interference) on patient safety (severity – S) with their frequency (occurrence – O). Potential risk was identified as high, intermediate and low.

Results

One thousand one hundred and ninety-nine (4.3%) and 1646 (5.9%) samples were mildly (20 mg/dL, 1+) and highly positive (40 mg/dL, 2+) for ascorbic acid, respectively. Severity (S1 to S5) was assigned to four possible errors: false-negative glucose (U-Glc: S2), blood (U-Hb: S5), nitrite (U-Nit: S4) and bilirubin (U-Bil: S1). Based on the frequency of errors, occurrence was categorized as: O2 for U-Glc, and O3 for U-Bil, U-Nit and U-Hb. The risk analysis matrix revealed that false-negative U-Hb was associated with potentially high risk, false-negative U-Nit with intermediate risk, while false-negative U-Glc and U-Bil were associated with low risk on patient safety.

Conclusions

Positive ascorbic acid can cause potentially high risk for patient safety by missing positive blood in urine.

Analysis of spontaneous reporting of suspected adverse drug reactions for non-analgesic over-the-counter drugs from 2008 to 2017

BACKGROUND

Adverse drug reaction (ADR) reporting practices by health care professionals remain poor. Over-the-counter (OTC) drugs are perceived as safe; however, they can also cause ADRs. The objective of this study was to analyze ADR reporting for OTC drugs in a 10-year period, in order to evaluate frequency of ADRs, population that ADRs most affect and reporters of ADRs of OTC drugs in Croatia.

METHODS

Spontaneously reported ADRs of non-analgesic OTC drugs, collected from January 2008 to December 2017 were analyzed. Data was obtained from Agency for Medicinal Products and Medical Devices of Croatia (HALMED).

RESULTS

There were 547 ADRs of OTC drugs reported in total and an increase in number of reports through the years was observed. Pharmacists reported 45.4% of all ADRs, and were most frequent reporters (p < 0.001). In 2017 majority of reports, 62 (49.2%), were obtained from consumers. ADRs were most frequently observed in patients aged 70 years and older (15% of ADRs). Five percent of all reports were accidental exposures among children.

CONCLUSIONS

Pharmacists most frequently reported ADRs of OTC drugs and consumers' awareness of ADR reporting has risen. Other health care professionals (e.g., nurses and dentists) must be offered proper education in order to improve reporting practice of ADRs. Health care professionals should address concerns about OTC drug safety in elderly and children.