The incidence of self-medication of upper –gastrointestinal symptoms in Albanian community pharmacies ALBA THEMELI, EDMOND PISTJA MEDICAL HEALTH TRAINING CENTER “SANTA MARIA” LEZHE,ALBANIA
Introduction There is an increasing trend in self-medicating minor ailments with over the counter (OTC) medications. This trend may be related to the increased number of drugs available without prescription ,easier access to internet and advertising. In Albania, upper gastro-intestinal symptoms are very frequent and they are, if mild to moderate a common reason for self-medication. Although these symptoms are often trivial , inappropriate self-medication may mask underlying serious conditions. This highlights the public health role of community pharmacists as an intermediary between the patients and the medical products.
Objectives The objective of this study was to investigate : 1.
The nature of GI symptoms that people tend to self-medicate.
2.
The prevalence of alarm symptoms
3.
Adherence to referral advice given by the pharmacists.
4.
Self-reported efficacy and frequency of use of OTC medications for minor complaints.
Methods
Symptoms
All pharmacy customers seeking selfmedication for GI complaints were eligible to participate. Inclusion criteria: age 18-65 years, albanian citiziens and agreeing to pay a follow-up visit to the pharmacy after 4 weeks. Pregnancy was the only exclusion criterion. Participants ( n=162) completed a questionnaire to assess symptom characteristics and previous medical consulting. Based on this information the pharmacist referred subjects to a physician or advised self-treatment. Four weeks later the participants were presented a follow-up questionnaire evaluating their adherence to referral advice or efficacy of self-treatment. Statistical data analysis was performed using SPSS 17.0 for Windows. To compare results we used Pearsons’s Ẋ2 test. A p value less than 0.05 was considered significant.
Table 2. Follow- up on Pharmacist’s Advice and Referral
Referred to physician
N
After 4 weeks
N
50/162
Adhered to referral advice
35/162
25/162
Consulted gastroenterologist
7/162
90/162
Symptom relief
79/162
47/162
Still Taking OTC drugs
35/162
Domperidone
43/162
Still using nonpharmacological measures
37/162
Antacid + Domperidone
12/162
Prevalence (%)
Acid Regurgation
49.2 % 53.2 %
Initiation of selftreatment
Dyspepsia Bothersome postprandial fullness
Four weeks after the pharmacy visit 95.6 % of the participants completed the follow-up questionnaire. Only 51.7 % of the customers who were advised to contact a physician actually adhered to the advice. The majority of them had consulted their general practitioner and only 4 % of them contacted the gastroenterologist. Reasons for non-adherence to the pharmacist’s referral were: a. The complaints were not considered to be severe enough to contact a physician b. Lack of time c. Spontaneous resolution of the complaints d. Financial concerns e. Other reasons The vast majority of the participants who were advised by the pharmacist to self –treatment, reported symptom relief with the OTC drug used. Almost half of them were still taking the medication and almost 72.3 % still adhered to the pharmacist’s non-pharmacological advices 4 weeks after the pharmacist’s first consultation.
Mild GI symptoms will mostly resolve with self treatment. Yet the value of the community pharmacist counseling on OTC treatments should be recognized , as community pharmacists can play an important role in distinguishing symptoms that warrant further medical examinations.
51.2 %
Early satiation
29.2 %
Epigastric pain
38.9 %
Epigastric burning
22. 8 %
Alarm Progressive unintentional weight loss
The majority of the participants experienced (74.8%) experienced multiple symptoms. Sixty-five percent of the participants reported symptoms of heartburn and 72 % experienced dyspeptic symptoms.
Conclusions
consulted general practitioner
Heartburn Burning retrosternal discomfort or pain
The most frequently reported GI complaints were burning retrosternal discomfort /pain, acid regurgation, and bothersome postprandial fullness , occurring in about half of the participants. ( Table 1).
This descriptive study was made in 13 community pharmacies located in Tirana ( capital of Albania).
Baseline
Table 1. Nature of Gastrointestinal symptoms and Prevalence of Alarm Symptoms
Results
2.2%
Persistent vomiting
7.1 %
Difficulty in swallowing
15.4 %
Hematemesis
0.2 %
Melena
0.7 %
Chest pain
5.4 %
antacid
However this is a small scale study and further investigation need to be done
References 1. Sihvo S, Hemminki E. Self-medication of dyspepsia: how appropriate is it? Scand J Gastroenterol 1997; 32;9: 855-61 2. Tully MP, Hassel K, Noyce PR. Advice-giving in community pharmacies in the UK. J Health Serv Res Policy 1997;2: 38-50 3. Hassel K, Noyce PR, Rogers A,Harris J, Wilkinson J. A pathway to the GP: The pharmaceutical consultation as a first port of call in primary health care. Fam Pract 1997;14: 498-502
