gms | German Medical Science

Background and aim: In German community pharmacies prevalence of drug-related problems (DRPs) in OTC use is not known yet. Therefore, we initiated a study to quantify DRPs in self-medication. Further, we assessed factors having an impact on safe OTC use.

Material and method: Community pharmacists (CPs) were asked to document 100 consecutive customers presenting symptoms or requesting OTC (pharmacy-only) drugs by means of a standardized documentation form. A number of 10,000 encounters seemed reasonable in order to evaluate the set objectives. For each encounter, data like age, gender, first or repeated request, availability of a patient file including drug history and indication were documented. Additionally, identified DRPs, problem descriptions, and solutions were documented. Data were transcribed electronically, coded if necessary, checked for validity, and analyzed.

Results: In total, 109 CPs documented 12,567 OTC requests in 11,069 patients identifying DRPs in 17.6% (n=2206) of all cases.

In more than 75% of all cases patients requested a specific product. About 80% of all DRPs were documented in these cases. More than 70% of all DRPs were detected in four indications: pain, respiratory tract, gastrointestinal tract, and skin disorders. Four DRPs were responsible for almost 75% of all DRPs identified: self-medication inappropriate (29.7%), requested product inappropriate (20.5%), intended duration of drug use too long including drug abuse (17.1%), and wrong dosage (6.8%). If a drug history was available in the pharmacy, significantly more cases with wrong dosage (p<0.05) and drug-drug interactions (p<0.001) were detected, whereas wrong use of drugs was less frequent (p<0.05). In all cases, patients with identified DRPs were counselled accordingly. Furthermore, most frequent interventions were referral to a physician (39.5%), and switching patients to a more appropriate drug product (28.1%).

Overall, more than 90% of all DRPs were partly or completely solved in the pharmacy (45.3% and 44.9%, respectively).

Conclusions: In almost one out of five encounters, direct pharmacist-patient interaction in self-medication revealed relevant DRPs in German community pharmacies. About 80% of all DRPs were observed in cases where patients requested a product. Therefore, special attention has to be given to these patients especially since they often do not ask for advice. Having access to the patient file including data on both prescription-only and OTC products seem to increase patient safety.