2010

PROBLEMSOLVING FORBETTERHEALTH PROJECTREPORT

PREVALENCEOFSELFMEDICATIONINGENERALPOPULATION

* DEPA ARTMENT OF COMMUN NITY M MEDICINE * * SM MT. N.H.L. M.M.C *

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* DEPA ARTMENT OF COMMUN NITY M MEDICINE * * SM MT. N.H.L. M.M.C *

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* DEPA ARTMENT OF COMMUN NITY M MEDICINE * * SM MT. N.H.L. M.M.C *

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Tv~xwzxxM

Takingthisopportunity,wewouldliketothankeveryonewithoutwhomwe couldnthavemovedaheadinourprojectwhichisindeedthefirststeptowards ourcomingclosertothecommunity. We would like to thank our project head, Dr. RAKESH SHAH and our facilitatorDr.V.MURUGAN,fornotonlythefaiththeyhadinusbutalsoweaning us with their ideas and knowledge. We appreciate the support and encouragementtheyprovidedusduringtheentirecourseofourproject. We express our sincere thanks to Dr. D.V.BALA, Head of the Department, Department of Community Medicine, Smt. N.H.L. Municipal Medical College, who introducedustothewholeconceptofPSBH,makingourjourneyinthisfieldmore interesting and worthwhile as well as giving us an opportunity to work one as a TEAM! We also thank all the staff members, especially the residents of the P.S.M. Department,fortheirhelpinmakingthisprojectasuccessfulone. Finally, we take this opportunity to extend our deep appreciation to our familyandfriends,fortheircooperationandhelpinthecompletionofourproject.

Index

Introduction

Aims And Objectives Materials And Methods Review Of Literature Methods Of Control & Awareness Benefits Of Self Medication Results And Observations Conclusion Bibliography Questionnaire

D G I L DL EG EK FL GE GG

INTRODUCTION

PSBH

PROBLEM SOLVING FOR BETTER HEALTH

Self-Medication is medication of oneself especially without the advice of a physician.

Introduction

Introduction
WHAT IS SELF MEDICATION?
Selfmedication, the ability of the patient to administer his or her own medication, can be useful in the rehabilitation setting in reducing the incidence of polypharmacy, medication abuse, and inappropriate medicationusage. SelfMedication, according to the WEBSTERs ENGLISH DICTIONARY, is medication of oneself especially without the advice of a physician. Use of non prescribing drugs without consultation of a physician is termed selftreatment. Self medication has always been a part of normal practice in human life from the ancient times. Such hollow practice is supposed to be a baseless and doubtful attitude. It has never been appreciated, for the fact that, it may induce severe effects on human body. There is a fundamentaldifferencebetweenmedicalprescribingandselfmedication. A qualified doctor is well trained about the symptoms and their causes, so he basically concentrates on symptoms as well as its causes. It would be difficult for an unqualified prescriber to investigate the basic causes. Essentiality must be given to the causes and secondly to the symptoms. Advertisement on Television, newspapers and other pharmaceutical publications have improved the rate of selfmedication. Selfmedication may treat the symptoms but not its causes. It may cause complexities if some internal disease is growing inside. It may be concluded that self medication or prescribing of an unqualified doctor can induce severe effectsonhumanbody. It has been observed that a large number of people, when they fall sick, do not consult the physician. They either consult a chemist and

Introduction

obtain a medicine from his self, or may consult a neighbor who may be havingsometabletsleftoverfromhispreviousillness,andreadilyspares them. If you have a fever, cold, cough, constipation or indigestion, your friends or even total strangers volunteer advice on medicines to take like expertphysicians.Almosteveryoneyoumeethasanexcellentremedyfor whatever ails you have. In short, this is what is meant to be self medication. May be most of the times nothing untoward happens on followingsuchadvice,butitcanbedangerous.

AIMS AND OBJECTIVES

PSBH

PROBLEM SOLVING FOR BETTER HEALTH

I Keep Six Honest Serving Men; They Taught Me All I Know. Their Names Are What, Why, When, How, Where And Who.

AIMS AND OBJECTIVES

AIMS AND OBJECTIVES

1. Tofindouttheprevalenceofselfmedicationin generalpopulation. 2. Tofindouttheknowledgeregardingdose&duration ofdrugs. 3. Tofindouttheknowledgeregardingsideeffectsofthe drugsconsumed.

MATERIALS AND METHOD

PSBH

PROBLEM SOLVING FOR BETTER HEALTH

One Of The First Duties Of The Physician Is To Educate The Masses When Not To Take Medicines.
-WILLIAM OSLER

MATERIALS AND METHODS

MATERIALS AND METHODS

StudyDesign: Subjects: CrossSectional. 156residentsofAhmedabadCity. None Medical&Paramedicalworkers. InclusionCriteria: ExclusionCriteria:

RESOURCES

Manpower
o Volunteers: o Teachers: Five Two

Materials
AMOUNT 4 50 1 200 7 COST (Rs.) 20 50 150 300 500 1030

MATERIALS Pen Printouts Laptop Photocopies Travel Charges Final report Total (approx)

MATERIALS AND METHODS T

TIMELINE

4th M March, 20 010 Introductio Of Pr on roject in PSBH w workshop p 5th M March, 20 010 Demonst D tration O Proje & Pre Of ect eparation Of Pro n oforma 10th M March, 2 2010 Subm mitting T Proje Profo The ect orma To Facilitator 10th A April, 20 010 Prep paration of Questionnai ire 1st Ma 2010 to 15th May, 2 ay, 0 h 2010 Data Collecti ion 16th M May, 2010 to 23r May, 2010 rd Review Of Liter rature 24th M May, 2010 to 14t june, 2010 th Comp puter Wo & Data Analy ork ysis 15th June, 2010 to 22n June, 2010 0 nd Dis scussion n 26th A August, 2 2010 Comple etion Of Project (Final Re eport)

REVIEW OF LITERATURE

PSBH

PROBLEM SOLVING FOR BETTER HEALTH

According To Paracelsus, The Alchemist-Physician Of The 16th Century, All Drugs Are Poisons.

REVIEW OF LITERATURE

REVIEW OF LITERATURE
e today are a crazy pillpopping generation. It is rightly said that the desire to take medicines, is one feature that distinguishes man from animals. Recent advances in drug research have provided many synthetic medicines for the treatment of disease, leadingto adrug explosion. Today over 7000 drugs and drugcombinations are available. Many of them have been released for general use, and are sold directly to the public as overthecounter (OTC) remedies. A large number of potent drugs are thus available to the individual for selfmedication. There is anobviousdifferencebetweendrugsandothercommoditiesoflife. Paracelsus (14931541), the alchemistphysician, in the 16th century observed that all drugs are poisons. The availability of potent and dangerous drugs has increased considerably since the close of the 19th century. At the sametimeexpandingavailabilityofmedicalcare,exposesalargepopulationof peopletodrugs,leadingtoagreaternumberoftoxicreactions.Thissituationis further worsened in our country by the slack implementation of Drug Control. Even certain prescription drugs are available to the lay person without the physician's advice. As people vary greatly in their sensitivity to drugs, an appropriate dose for one person can be an overdose for another. Even skilled physicians sometimes fail to avoid such reactions. Thus, the lay person is ill advised in subjecting himself to potentially dangerous selfmedication. Proprietary drugs which are sold overthecounter include pain relievers, cough remedies, antiallergic medicines, laxatives, vitamins, tonics, antacids and many others. Even dangerous drugs like the antibiotics and the hormones canbeprocured,somehowortheother,withoutavalidprescription.Thisisan entirelydifferentfacetofdrugging.Itisencouragingtonotethatstricter'drug control'isbeinggraduallyclampedcountrywide.

10

REVIEW OF LITERATURE

Selfmedication usually involves common drugs which are freely available.AstudycarriedoutintheUnitedStatesshowedthatnearly2billion dollars per year were spent on such remedies. It is questionable whether the benefits outweigh the potential hazards. They account for poisonings, allergy, habituation, addiction, and other adverse reactions. Above all their use often delayspropertreatmentofthedisease. The most misused drugs are the analgesics or pain relievers. In fact, age old, ordinary aspirin is as effective and even safer than any of the modern analgesics like fenamates, oxicams, or Cox2 inhibitors like rofecoxib and celecoxib.Aprobablefactorcausinglavishprescribingandsellingofsuchdrugs isvigorouspromotiongimmicksbypharmaceuticalfirms.Todayitmayevenbe difficulttoobtainsimpleaspirininthemarket.Thephysicianshaveapparently accepted the manufacturer's claims and recommend the "modern analgesics" despite their greater cost. Similarly cough remedies, antiallergic medicines, laxatives, vitamins, tonics, and antacids can lead to serious side effects. Even lavish use of vitamins, especially the fatsoluble (A, D, E, &K) can cause problems.IamremindedofthegreatEnglishphilosopherphysicianSirWilliam Osler (18491919) who said, "One of the first duties of the physician is to educatethemasseswhennottotakemedicines." Anotherhazardistheavailabilityofmanyirrationaldrugcombinationsin the market, which expose the individual to several drugs needlessly, each of whichcancauseadverseeffects.Veryfewcombinationshavealegitimateplace inmodernmedicine.Yetirrationalcombinationsaboundandarebeingusedby someprofessionals. Thus, to avoid or minimize thedangers of selfmedication, firstly, the lay person should be educated about the dangers of indiscriminate use of drugs. Secondly, the physicians should be more judicious in prescribing, and must insist on drugs being supplied by the chemist only on a valid prescription. Thirdly, a proper statutory "Drug Control" must be implemented, rationally

11

REVIEW OF LITERATURE

restricting the availability of drugs to the public. These three measures would definitely reduce the incidence of drugrelated mishaps, and help in maintaininggoodhealthoftheindividualandsociety.

COMMON SIDE EFFECTS 1)ANTIBIOTICS

TheMainClassesOfAntibiotics: Aminoglycosides Cephalosporins Fluoroquinolones Macrolides Penicillins Tetracyclines Sideeffects: The most common side effects from antibiotics are diarrhea, nausea, vomiting. Fungal infections of the mouth, digestive tract and vagina can also occur with Antibiotics because they destroy the protective 'good' bacteria in the body (which help prevent overgrowth of any one organism), as well as the 'bad' ones, responsible for the infection being treated. Some people are allergic to antibiotics, particularly penicillin. Allergic reactionscauseswellingoftheface,itchingandaskinrashand,insevere cases, breathing difficulties. Allergic reactions require prompt treatment. Children are more likely to suffer side effects such as diarrhea and

12

REVIEW OF LITERATURE

abdominal pain from antibiotics. In some instances, using antibiotics for earinfectionsincreasethelikelihoodofgettinganotherearinfection.

2)STIMULANTS:
Amphetamines are commonly used by students. These medications are usedtoincreaseadrenalin. They can be very helpful in increasing a persons energy. But you may rememberthesayingspeedkills. Sideeffects: Insomnia, Tourettes syndrome (movement disorder consisting of grimaces, ticks, an involuntary outbursts), Nervousness, Mood Lability, Tachycardia,Hypertension,Tics,Headaches,Seizures.

3)ANTIHISTAMINICS:
Common sideeffects of antihistaminic drugs include Sleepiness, Dry mouth,Nausea,Headache,FatigueandSorethroat.

4)OCPILLS:
Most common side effects of the birth control pills includenausea, headache,breast tenderness, weight gain,irregular bleeding, and mood changes. Scanty menstrual periods or breakthrough bleeding may occur, butareoftentemporary,andneithersideeffectisserious.Womenwitha history ofmigrainesmay notice an increase in migraine frequency. Contribute toincreased blood pressure,blood clots,heart attack, andstroke.

13

REVIEW OF LITERATURE

5)ANTIDIARRHEAL:
The Common Side effects Of AntiDiarrheal Drugs Include Severe allergic reactions, Rash, Hives, Itching, Difficulty breathing, Tightness in the chest, Swelling of the mouth, face, lips, or tongue, Constipation, Decreased urination, Red, swollen, blistered, or peeling skin, Stomach bloating,swelling,orpain

6)ANTACIDS:

They raise the risk of bone fracture, especially when used for a year or more or at high dose. Increase risk of infection withC.Difficile, a bacterium that can cause severe diarrhea. Those who experience side effects most commonly suffer from changes in bowel functions, such as diarrhea, constipation, or flatulence. Other more serious side effects includestomachorintestinalbleeding.

7)COUGHSYRUPS:
Common sideeffects include Confusion, impaired judgment, dizziness, slurred speech, nausea, vomiting, abdominal pain, irregular heartbeat, highbloodpressure,dryanditchyskinandseizures.

8)CONSTIPATIONDRUGS:
Theyleadtostomachache,cramping,weakness,sweating,irritationof therectalarea,diarrhea.

9)ANTIEMETICS:
Theyleadtosedation,apnea,bloodpressure,nausea,pyrexia, restlessness,stridor,wheezing.

14

REVIEW OF LITERATURE

LAWS FOR PREVENTION OF SELF MEDICATION

1. THE DRUGS AND COSMETICS ACT, 1940
ThisActmaybecalledtheDrugAct,1940 It deals with prohibition of manufacture and sale of certain drugs and cosmetics Any drug which by means of any statement design or device accompanying it or by any other means, purports or claims to prevent or cure any such disease or ailment, or to have any such other effect as may beprescribed Any cosmetic containing any ingredient, which may render it unsafe or harmfulforuseunderthedirections,indicatedorrecommended; Sellorstockorexhibitorofferforsale,]ordistributeanydrugwhichhas been imported or manufactured in contravention of any of the provisions ofthisActoranyrulemadethereunder, Any drug which is not of a standard quality, or is misbranded, adulteratedorspurious; Penaltyformanufacture,sale,etc.,ofdrugs a) any drug deemed to be adulterated or spurious under or which when used by any person for or in the diagnosis, treatment, mitigation, or prevention of any disease or disorder is likely to cause his death or is likely to cause such harm on his body as would amount to grievous hurt within the meaning of section 320 of the Indian Penal Code solely on

15

REVIEW OF LITERATURE

account of such drug being adulterated or spurious or not of standard quality, as the case may be, shall be punishable with imprisonment for a term which shall not be less than five years but which may extend to a term of life and with fine which shall not be less than ten thousand rupees; b)Anydrug (i)Deemedtobeadulteratedunder,butnotbeingadrugreferredto inclause(a),or (ii) without a valid license as required under clause , shall be punishable with imprisonment for a term which shall not be less than one year but which may extend to three years and with fine whichshallnotbelessthanfivethousandrupees: Provided that the Court may, for any adequate and special reasons to be recorded in the judgment, impose a sentence of imprisonment for a term of less than one year and of fine of less than five thousandrupees: (c) Any drug deemed to be spurious under, but not being a drug referred to in clause (a) shall be punishable with imprisonment for a term which shall not be less than three years but which may extend to five years and withfinewhichshallnotbelessthanfivethousandrupees: Provided that the Court may, for any adequate and special reasons, to be recorded in the judgment, impose a sentence of imprisonment for a term oflessthanthreeyearsbutnotlessthanoneyear, (d) any drug, other than a drug referred to in clause (a) or clause (b) or clause (c), in contravention of any other provision of this Chapter or any rule made there under, shall be punishable with imprisonment for a term which shall not be less than one year but which may extend to two years andwithfine:

16

REVIEW OF LITERATURE

Provided that the Court may for any adequate and special reasons to be recorded in the judgment impose a sentence of imprisonment for a term oflessthanoneyear.

2. THE PHARMACY ACT, 1948 3. THE NARCOTIC DRUGS & PSCHYCOTROPIC ACT, 1985 4. THE DRUGS AND MAGIC REMEDIES (OBJECTIONABLE ADVERTISEMENTS) ACT, 1955
An Act to control, the advertisement of drugs in certain cases, to prohibit the advertisement for certain purpose of remedies alleged to possess magic qualities and to provide for matters connected therewith. The Act defines drugs and registered medical practitioners besides defining magic remedy. According to Act the Magic remedy includes a talisman mantra kavacha, and any other charm of any kind which is alleged and possess miraculous powers for or in the diagnosis, cure, mitigation treatment or prevention of any disease in human beings or animals or for affecting or influencing in any way the structure or any organicfunctionofhumanbeingsoranimals. Unless prescribed by registered medical practitioners or after consultation with the Drugs and Cosmetics Act 1940, no person or company, shall take any part in the publication of any advertisement referringtoanydrugthatisusedfor: a) Miscarriageinwoman. b) Maintenance or improvement of the capacity of human beings for sexualpleasures.

17

REVIEW OF LITERATURE

c) Correctionofmenstrualdisorderinwomen.

d) The diagnosis, cure, mitigation, treatment or prevention of any disease. No person or company will take part in advertisement which give false impression or makes a false claim for the drug or mislead the people.WhosoevercontravenesanyoftheprovisionofthisActshall be punishable with imprisonment extended to six months or with fine, or with both for first time conviction. It may extend to one year imprisonment or with fine or with both on subsequent convictions. The schedule for diseases specified under the Act are: appendicitis, atherosclerosis, blindness, blood poisoning, Brights disease, cancer, cataract, deafness, diabetes, brain diseases or disorder, uterus diseases, disorder of menstrual flow, disorders of nervous system, prostatic gland disorders, dropsy, epilepsy, female disease (in general), fever (in general), Fits, Forms and structure of the female breast, gall bladder stones, kidneystones, bladder stones, gangrene, glaucoma, goiter, heart diseases, high or low blood pressure, hydrocele, hysteria, infantile paralysis, insanity, leprosy, leucoderma, lock jaw, loco motor ataxia, lupus, nervous debility, obesity, paralysis, plague, pleurisy, pneumonia, rheumatism, ruptures, sexual impotence, small pox, stature of person , sterility of women, trachoma, TB, tumors, typhoid fever, ulcersofGItract,venerealdiseasesincluding,AIDS.

18

METHODS OF CONTROL AND AWARENESS

PSBH

PROBLEM SOLVING FOR BETTER HEALTH

The MIMH program seeks to equip patients with the knowledge and tools they need to establish healthy and informed decision-making habits from the time they start making self-medication decisions.

19

METHODS OF CONTROL AND AWARENESS

METHODS OF CONTROL AND AWARENESS

1) MEDICINES IN MY HOME (MIMH)
Medicines in My Home (MIMH) is a new educational program about the safe and effective use of OvertheCounter (OTC) medicines developed by the Food And Drug Administration (FDA) to provide practical teaching tools and information to enable adolescents and adults to make careful and correct medicine use decisions. The lesson and materials are written at a 6th to 7th grade reading level and focus on teaching patients to use the"DrugFacts"label.Allprogrammaterialscanbeaccessedthroughthe Internet and downloaded for local presentation. Pharmacists and other health care professionals can refer patients to the Web site, where they can either use the program materials online or download them. The MIMH program can also be useful to pharmacists when speaking to studentsoradultcommunitygroupsaboutmedicinerelatedissues. With input from Maryland's Montgomery County Public Schools health educators, the FDA originally developed MIMH as an inclassroom lesson for 6th to 8th graders. It was piloted in 25 6th grade classes during the 20052006 school year. The lesson has been successfully taught by FDA physicians, nurses, and educators and by health education teachers. Currently, most MIMH materials are directed toward teachers and students. The MIMH Web site is located at www.fda.gov/medsinmyhome and is organizedinto"rooms."TheTeachers'Roomprovidesabriefintroduction to the program, key concepts, and learning objectives. The Teacher's Kit contains a linked list to all lesson teaching materials including an

20

METHODS OF CONTROL AND AWARENESS

animated slide presentation with slide notes, a mock Drug Facts label, a takehome booklet and learning activity, and student assessment materials (pretest, posttest, and inclass worksheet). It also provides links toadditionalonlineresources thatoffer related information on the use of medicines. The Students' Room provides a doctor's visit sheet called "All About Me" that children (and adults) may use to write down important information to discuss with their health care professionals at an upcoming visit. Online puzzles and games are also located in the Students'Room. The current materials available online can be easily adapted for presentation to a variety of audiences. During the coming year, program development will focus on creating more interactive learning opportunities on the Web site, adapting current presentation and learning materials to adult audiences, and developing resources that support parents in teaching their children about wise medicineuse decisions. Future developments may include an OTC medicines Jeopardy like game and interactive activities that familiarize Web site visitors with correct use of the Drug Facts label and provide practice with medicine use decisions through scenarios. Before the end of 2006, an online animated slide presentation and MIMH booklet geared toward adult audienceswillbeposted. The MIMH program seeks to equip patients with the knowledge and tools they need to establish healthy and informed decisionmaking habits from thetimetheystartmakingselfmedicationdecisions.

2) HEALTH EDUCATION
Several programs have addressed medication misuse through the use of computer technology. Personal Education Program (PEP). A randomized

21

METHODS OF CONTROL AND AWARENESS

clinicaltrialfoundthatadultsusingthePersonalEducationProgram(PEP) software increased knowledge regarding the potential drug interactions that can result from selfmedication with OTC medications and alcohol, compared to controls and those receiving an information booklet. PEP usersalsoreportedfeweradverseselfmedicationbehaviorsovertime.

3) HOSPITAL DISCHARGE-BASED PROGRAMS

Several studies have explored strategies to improve medication compliance and reduce medication misuse among adults upon hospital discharge. AlRashid and colleagues found that patient knowledge and compliance to a medication regimen was significantly better among patients receiving a 30minute consultation with a pharmacist prior to hospital discharge compared to those receiving standard discharge procedures. Those patients receiving the pharmacist consultation also had significantly fewer unplanned trips to the doctor and hospital admissions,andpersonallyalteredtheirmedicationslessthancontrols.

4) HOME AND NURSING HOME SETTINGS

A number of studies have examined the effectiveness of homebased medication review as an early intervention strategy to prevent medication misuse among adults. The HOMER program was a large British clinical trial in which a pharmacist reviewed medications, provided education, and addressed barriers to compliance (such as inability to open pill bottle tops) with adults in their homes two and eight weeks after hospital discharge. Surprisingly, the intervention group had significantly more emergency hospital readmissions and physician home visitsthancontrols.

22

METHODS OF CONTROL AND AWARENESS

5) RECOMMENDATIONS TO PREVENT MEDICATION MISUSE IN ADULTS

Compileanddisseminatealistofmedicationsconsideredpotentially inappropriateforuseinolderpersonsandmandatethatthelistbe usedasascreeningtool. Providegeriatricsrelevantlabelinginformationforoverthecounter medications. Fundandencourageresearchonmedicationrelatedproblemsin olderpersonstodeterminewhichmedicationsaremost troublesomeandwhichpatientsaremostatrisk. Provideincentivestopharmaceuticalmanufacturerstostudyeffects intheelderlyinpreandpostmarketingclinicaltrials. Establishmechanismsfordatacollection,monitoring,andanalysis ofmedicationrelatedproblemsbyagegroup. Toimprovecliniciansknowledgeregardinggeriatric pharmacotherapy. Fundandprovideeducationandresourcesforcaregiversproviding medicationassistancetoolderpeople.

23

BENEFITS OF SELF MEDICATION

PSBH

PROBLEM SOLVING FOR BETTER HEALTH

There is a financial correlation between the savings to public funds and savings to individuals when an extension in self-medication occurs.

24

BENEFITS OF SELF MEDICATION

BENEFITS OF SELF MEDICATION

1) FREED UP DOCTORS TIME
A volume shift to selfmedication would also have an impact on doctors time. Fewer consultations on minor illnesses would free up time that could be spent on longer consultations for more serious conditions and reduce waiting time in the doctors surgery, thus providing a real impact on the quality of care. The model calculates freed up doctors time based on the total number of medical doctors per country. Given that in practice it is the general practitioners who usually deal with minor conditions, the freed up time per general practitioner is considerably more than indicated in this study. This benefit has however proved impossibletoevaluateinfinancialterms.

ABSENCEFROMWORKCAUSEDBYTREATMENT.
This item represents absence from work attributable to patients seeking treatmentduringworkinghours.Twoassumptionshavebeenmade: 50%ofdoctorvisitsaremadebytheactivepopulation. 25%ofthesepersonsvisitthedoctorduringworkinghour. This means that the average number of doctor visits avoided has been divided by a factor of 8 (25% of 50%). The resulting figure has been multiplied bythetreatment time,based on the average time missed from work, and by the cost to employers for each working day of missed time. It has been assumed that there is no loss of productivity to the national economyforabsenceslastinglessthanoneday.

25

BENEFITS OF SELF MEDICATION

2) ABSENCE FROM WORK CAUSED BY ILLNESS

It has been assumed that people are absent from work for a shorter periodoftimewhentheypracticeresponsibleselfmedicationthanwhen they go to see a doctor as they generally return to work sooner without official endorsement from a doctor that they are ill. This item represents the average cost to the employer in lost compensation and to the national economy in lost productivity for each working day missed due to illness due to minor ailments. It has been estimated in the model that 10% of working days lost for absences lasting less than three days attributableto minorailments could be avoided through responsibleself medication.

3) TRAVEL-RELATED COSTS
Travelling to the doctor and the pharmacy involves time and transportation costs. It has been proven that patients spend less time going to the pharmacy than going to the doctor, and that travelrelated costs are also higher when going to both the doctor and the pharmacy than only to the pharmacy. As visits to the pharmacy do not need an appointment and can be made during lunch hour or after work, no loss of working time has been assumed for purchases of nonprescription medicines.

26

BENEFITS OF SELF MEDICATION

4) FINANCIAL IMPLICATIONS OF VOLUME SHIFTS TOWARDS SELF-MEDICATION

Thereisafinancialcorrelationbetweenthesavingstopublicfundsand savingstoindividualswhenanextensioninselfmedicationoccurs.

27

RESULTS AND OBSERVATIONS

PSBH

PROBLEM SOLVING FOR BETTER HEALTH

28

RESULTS AND OBSERVATIONS

RESULTS AND OBSERVATIONS

TABLE: 1 AGE WISE DISTRIBUTION
AGE 1120 2130 3140 4150 5160 >61 TOTAL FREQUENCY 29 43 26 36 11 11 156 % 19 28 17 23 7 7 100

Table 1 SHOW That 28% Of The Total People Taking Self Medication BELONGS To Age Group 21 To 30, Which Is The Maximum.

TABLE: 2 SEX WISE DISTRIBUTION

FREQUENCY MALE FEMALE TOTAL 52 104 156 % 33 67 100

Table 2 shows that 67% of our study population comprised of females.

29

RESULTS AND OBSERVATIONS T R

TABLE: 3 DISTRIBUTION BASED ON EDUCATION

EDUCATIO FREQ ON QUENCY GRADUAT G TE PHD P PG P SCHOOL S TOTAL 90 5 20 41

% 58 3 13 26

PH.D.

PO OST-GRADUAT TE 3%

GRADUA ATE

SCHOO OL

26%

13%

58%

156 1 100

TABLE 3 AND CH HART Shows That Maxim mum Percenta Of People Consumin Self age ng Medic cines Are Gr raduates While Only 26% Have Done Schooling. % .

TABLE: 4 PEOPLE PRACT T E TICING S SELF MED DICATIO ON

FREQU UENCY
95%

% 95 5 5 100 0

YES NO TOTAL
5%

148 8 8 156 6

Table 4 AND CHA Shows A e ART About 95% O The Total Study Popu Of l ulation Do Se Medicatio elf on From Our Study Group Containing 156 In G ndividuals Se elected Rand domly.

30

RESULTS AND OBSERVATIONS

TABLE: 5 AGE WISE STATISTICS

Age 1120 2130 3140 4150 5160 >61 TOTAL YES 28 42 25 35 11 7 148 NO 1 1 1 1 0 4 8

Table 5 reveals the fact that out of the total study of 148, 42 are young up to the age of 30 while 35 people were upto 50 yrs.

TABLE: 6 AGE AND EDUCATION WISE CONSUMPTION

1120 2130 3140 4150 5160 >61 GRADUATE 16 28 13 19 9 5 PHD 0 0 0 5 0 0 PG 1 10 3 5 0 1 SCHOOL 12 5 10 7 2 5

Table 6 shows that 28 graduates belonging to age group 21-30 take self medicines of the total 148.maximum consumption are found amongst the graduates and second largest in those whose education is Upto School.

TABLE: 7 TYPES OF MEDICINES CONSUMED

FREQUENCY ALLOPATHY AYURVEDIC HOMEOPATHY TOTAL 149 11 5 165 % 90 7 3 100

Table 7 shows that mostly people consume allopathic medicines without prescription. Only 3% of the study group consumed homeopathic medicines.

31

RESULTS AND OBSERVATIONS

TABLE: 8 SOURCE OF DRUGS

FREQUENCY DOCTOR PHARMACIST MR TV AD NEWSPAPER DRUG LITERATURE OTHER TOTAL 100 35 3 26 5 6 12 187 % 53 19 2 14 3 3 6 100

TABLE 8 Shows That Most of The People Get To Know About Their Medicines From The Doctor. The Pharmacists Were A Source For 19% Of People.

TABLE: 9 WHETHER THE SYMPTOMS WERE RELIEVED OR NOT

SYMPTOMS RELIEVED? YES NO TOTAL FREQUENCY 145 3 % 98
Yes 2%

No

148 100
98%

TABLE 9 AND CHART Shows That In 98% Of People Their Symptoms Were Relieved Even Though Self Prescribed!

32

RESULTS AND OBSERVATIONS T R

CHART: 10 AWA C ARENESS REGAR DING DO S OSE

38% Yes No

62%

CHAR 10 Shows That Only 3 RT s 37% Of The People Kno How Muc Dose To B Taken For e ow ch Be The D Drugs, The Re Take The Blindly! est em

CHART: 11 AWA C ARENESS REGAR DING DU S URATIO N

36%

Yes

No

64% 6

CHAR 11 Shows That 64% P RT s People Dont Even Know The Time P t w Period For Th he Consumption Of The Drugs!

33

RESULTS AND OBSERVATIONS

CHART: 12 KNOWLEGDE REGARDING SIDE EFFECTS

25%

Yes

No

75%

CHART 12 Shows That Its An Irony That 76% Of Consumers Do Not Even Know Whether There Can Occur Any Side Effects About The Drugs They Take!

TABLE: 13 RELATION BETWEEN KNOWLEDGE ABOUT SIDE EFFECTS AND EDUCATION

EDUCATION GRADUATE PHD PG SCHOOL TOTAL KNOWLEDGE ABOUT SIDE EFFECTS YES NO 23 64 3 2 2 16 8 30 36 112

TABLE 13 Shows That 64 People Although Graduates Didnt Know Anything About The Side Effects of Their Drugs. There is no significant association between the educational qualification of the individuals and their knowledge regarding side-effects of the drugs.

34

RESULTS AND OBSERVATIONS

TABLE: 14 INCIDENCE OF SIDE EFFECT

SIDE EFFECTS INCIDENCE YES NO FREQUENCY 18 130 148 % 12 88 100

TABLE 14 Reveals The Fact That Only 12% Of People Experienced Any Kind Of Side Effect Compared To The Massive 88% Who Were Fortunate Enough!

TABLE: 15 AGEWISE INCIDENCE OF SIDE EFFECTS

AGE 1120 2130 3140 4150 5160 >61 TOTAL SIDE EFFECTS INCIDENCE YES NO 2 26 9 32 3 23 2 33 1 10 1 6 18 130

TABLE 15 shows that maximum incidence of side effects had occurred between the age of 21-30. There is no significant association between the age of the individual and occurrence of the side effects.

TABLE: 16 DOCTOR CONSULTATION FOR SIDE EFFECTS

SIDE EFFECTS: CONSULTED DOCTOR? YES NO TOTAL FREQUENCY 7 141 148 % 5 95 100

TABLE 16 Shows That Of The Total Sufferers Of Side Effects Only 5% Consulted The Doctor.

35

RESULTS AND OBSERVATIONS

TABLE: 17 RELATION BETWEEN EDUCATION AND CONSULTATION TO THE DOCTOR ABOUT SIDEEFFECT:
EDUCATION GRADUATE PHD PG SCHOOL TOTAL SIDE EFFECTS CONSULT DOCTOR YES NO 5 82 0 5 1 17 1 37 7 141

TABLE 17 Shows That Most Of The Educated People Dint Consult The Doctor For The Side Effects While Only 5 Graduates Did.

TABLE: 18 EDUCATION WISE DISTRIBUTION OF REPITION OF DRUGS AFTER SIDE EFFECTS APPEARED
EDUCATION GRADUATE PHD PG SCHOOL AFTER SIDE EFFECTS: REPEATED THE DRUG? YES NO N/A 9 11 0 1 1 2 2 2 67 4 15 34

TABLE 18 Shows 9 People Although Graduates Repeated The Same Drug After The Side Effects Appeared.

TABLE: 19 DURATION OF CONSUMPTION OF DRUGS

DRUG TAKEN TILL? AS PER DOSE TILL SYM RELIEF FOR LONGER DURATION FOR PROPHYLAXIS OTHER TOTAL FREQUENCY 30 115 2 0 1 148 % 21 77 1 0 1 100

TABLE 19 Shows That 77% Consume The Drugs Till They Get Some Relief, Then Irrespective Of The Dose They Are Stopped. The Rest Usually Consume As Per Dose.

36

RESULTS AND OBSERVATIONS

TABLE: 20 RELATION BETWEEN EDUCATION AND DURATION OF CONSUMPTION OF DRUG

EDUCATION AS PER DOSE 18 2 5 7 DRUG TAKEN TILL? SYMPTOMATIC LONGER PROPHYLAXIS OTHER RELIEF TIME 66 3 13 31 2 0 0 0 0 0 0 0 1 0 0 0

GRADUATE PHD PG SCHOOL

TABLE 20 Shows That Maximum Number Of People Preferred The Drugs For Symptomatic Relief And These Included Most Of The Graduates, While Few Also Followed The Dose Regime.

TABLE: 21 WHETHER DRUG IS REFERRED TO ANYONE ELSE

REFERRED TO ANYONE ELSE? YES NO TOTAL FREQUENCY 81 67 148 % 55 45 100

TABLE 21 shows that 55% Of People Tend To Spread The Knowledge About Their Drugs To Others Even Though They Themselves Are Not Sure!

37

RESULTS AND OBSERVATIONS

CHART: 22 AGE WISE DISTRIBUTION OF STUDY POPULATION.

27 23

18

17

6 2

11--20

21--30

31--40

41--50

51--60

61--70

71--80

AS SHOWN IN CHART 22 MAJORITY OF THE PEOPLE UNDER STUDY FELL IN THE AGE GROUP OF 20 TO 50 YEARS OF AGE.

38

CONCLUSION

PSBH

PROBLEM SOLVING FOR BETTER HEALTH

Published studies suggest that some children start to self-medicate at 11 or 12 years of age, and that use of OTC medicine among adolescents is common.

39

CONCLUSION

CONCLUSION
Ourstudywasconductedon156people.95%ofthetotalstudy populationtakesselfmedicationandonly5%donot. Majorityofthepopulationfallsintheagegroupof21to50. 58%ofpeopleconsumingselfmedicinesareGraduateswhile26%have doneonlyschooling. Mostlypeopleconsumeallopathicmedicineswithoutprescription. 28%ofpeoplegettoknowaboutmedicinesfromdrugcommercialslike TVandnewspaperadvertisementsandothersources. 53%ofpeoplegettoknowaboutdrugsfromDoctorswhichisagoodsign. 98%ofpeoplehadsymptomaticreliefwhentookdrugontheirown! Just37%ofthepeopleknowtherightdoseforthedrugs,theresttake themblindly! 64%peopledontevenknowthetimeperiodfortheconsumptionofthe drugs! 76%ofconsumerswerenotawareaboutthesideeffects. Theactualoccurrenceofsideeffectsisamere12%

Just8%ofpeoplerepeatedthedrugeventheyexperiencedtheside effects. Just21%ofalltakedrugsasperdose. 77%ofalltakeittillsymptomaticreliefirrespectiveoftheactualdoseor durationofthedrug.

40

CONCLUSION

55%ofpeopletendtospreadtheknowledgeabouttheirdrugstoothers eventhoughtheythemselvesarenotsure! 28Graduatesbelongingtoagegroup2130takeselfmedicincesofthe total148.maximumconsumptionisfoundamongstthegraduatesand secondlargestinthosewhoseeducationisuptoschool. Maximumincidenceofsideeffectshadoccurredbetweentheageof21 30. Thecommonlyusedantibioticsweencounteredduringourstudyare Azithromycin,Norfloxacin,Tinidazole,Metronidazole. Nosignificantassociationwasfoundbetweenanindividualstendencyto optforselfmedicationandhis/hersociodemographicdeterminantslike education,age,sex,residentiallocation.

TO CONCLUDE SELF-MEDICATION IS A FAIRLY COMMON PRACTICE IN THE SOCIETY IRRESPECTIVE TO THE INDIVIDUALS AGE, SEX, OCCUPATION, EDUATIONAL QUALIFICATION, RELIGION, SOCIOECONOMIC STATUS AND AREA OF RESIDENCE. HOWEVER, THE KNOWLEDGE REGARDING THE DOSE, DURATION, SIDE-EFFECTS, AND APPROPRIATE INDICATION FOR MAJORITY (ALMOST ALL) OF THE DRUGS IS VERY POOR, WHICH IS AN IMPORTANT FINDING.

41

BIBLIOGRAPHY

PSBH

PROBLEM SOLVING FOR BETTER HEALTH

42

BIBLIOGRAPHY

BIBLIOGRAPHY
WEBSTERS ENGLISH DICTIONARY Dr. Frank S.K. Barar retired as Sr. Professor and Head, Dept. of Pharmacology, SMS Medical College, Jaipur-302004 in November 199O. The Drugs & Cosmetic Rules 1955 vide Gazette Notification-85 (E) dt. 6.2.02. The Drugs and Magic Remedies (Objectionable Advertisement) Rules: 1955 The Gazette of India. The Drugs and Magic Remedies (Objectionable advertisements) Act 1954. No. 21 of 1954. Dr. Feibus, a medical officer with the FDA's Office of Nonprescription Products. PHARMACY TIMES WWW.ANSWERS.COM WWW.BLOGSPOT.COM U.S. Department of Health and Human Services Food and Drug Administration-SAFE DRUG USE BROCHURE NOV 4, 2009 WHO AWARENESS PROGRAM WWW.BIOINFOBANKLIBRARY.COM OAS.BIOMEDCENTRAL.COM WWW.BOLOJI.COM WWW.NCBI.COM

43

PSBHPROJECTSELFMEDICATION

ROLLNO:111115

NAME: AGE: Years SEX:Male/Female ADDRESS: EDUCATION: OCCUPATION: 1)HAVEYOUTAKENANYMEDICINESINPASTSIXMONTHSONYOUROWN? 1)YES 2)NO 2)WHICHTYPEOFMEDICINESDOYOUUSUALLYPREFER? 1)ALLOPATHY2)AYURVEDIC3)HOMOEPATHY4)OTHER IFOTHER:_________________________________

3)FROMWHEREDIDYOUCOMETOKNOWABOUTTHEDRUGTHATYOUTOOK? 1)DOCTOR 2)PHARMACIST 3)MEDICALREPRESENTATIVE 4)TELEVISIONADVERTISEMENTS 5)NEWSPAPERS 6)DRUGLITERATURES 7)OTHERS IFOTHER:____________________________________ 4)FORWHATAILMENTDOYOUCOMMONLYTAKEDRUGSONYOUROWNANDWHICH? 1)FEVER 2)PAIN 3)HEADACHE 4)COMMONCOLD 5)BACKACHE 6)COUGH 7)VOMITING 8)DIARRHEA 9)CONSTIPATION 10)WEAKNESS 11)OTHERS:A)_____________________________________ PAGE1 B)_____________________________________

PSBHPROJECTSELFMEDICATION 5)WEREYOURSYMPTOMSRELIEVEDONTAKINGTHEDRUG? 1)YES 2)NO 6)AREYOUAWAREABOUTTHEAPPROPRIATEDOSEOFTHEDRUG? 1)YES 2)NO 7)AREYOUAWAREABOUTTHEAPPROPRIATEDURATIONOFTAKINGTHEDRUG? 1)YES 2)NO 8)AREYOUAWAREABOUTTHESIDEEFFECTSOFTHEDRUG? 1)YES 2)NO 9)WERETHEREANYSIDEEFFECTS? 1)YES 2)NO 10)IFYES,WHATKINDOFSIDEEFFECT/S? A)______________________________________________ B)______________________________________________ C)______________________________________________

ROLLNO: 111115

11)DIDYOUCONSULTDOCTORFORTHESIDEEFFECTS? 1)YES 2)NO 12)DIDYOUREPEATTHESAMEDRUGAFTERSIDEEFFECTSAPPEARED? 1)YES 2)NO 13)FORWHATDURATIONDOYOUUSUALLYTAKETHATDRUG? 1)ASPERDOSE 2)TILLSYMPTOMATICRELIEF 3)FORLONGERDURATION 4)FORPROPHYLAXIS 5)OTHER IFOTHER:____________________________________ 14)DIDYOUSUGGESTTHESAMEDRUGTOANYONEELSE? 1)YES 2)NO

3)N/A

PAGE2