Over the counter medication
June 2005
Influences on OTC use
Unlike prescription products OTC medicines can be advertised directly to the public. While there is a formal system in place to approve the content of advertisements, their content can nonetheless appear to overstate benefits, and omit mentioning other points such as price (Rallapalli and Smith 1994). This will inevitably influence purchasers in favour of the product. A study from the USA concluded that the advertisements lacked the information necessary for consumers to make informed choices (Sansgiry et al 1999). There is no similar published research on UK advertisements for OTC medicines.
The extent, however, to which doctors and patients discuss OTC treatments is less clear. In a US study 58 per cent of patients discussed OTC medicines with their doctors (Sleath 2001). The participating patients were those attending primary care consultations and so had the opportunity for such discussion. Doctors asked questions about OTC medication in 37 per cent of consultations. The authors concluded that physician-patient communication about OTC medications should be encouraged so that the patient becomes a collaborative partner in medication management. Health professionals may or may not perceive a need to know what OTC medicines patients are taking. While this may change if patient-held records, or smart cards are introduced, we know little about how patients themselves might view discussion with health professionals about self-medication. Little is known about the extent to which prescribers (medical, nursing or pharmacist) routinely enquire about OTC medicines use in their consultations with patients. In one UK study 45 per cent of people consulting their GP reported using OTC medicines in the previous week, but only 13 per cent were asked about this by the doctor (Urquhart et al 2004). Patients were generally positive about the idea that doctors might enquire about prior OTC use, as well as doctors making OTC recommendations (Bradley 1998) but there is also evidence that patients feel inhibited from volunteering information about prior treatment with OTCs (Stevenson et al 2003).
Branstad et al studied the effects of OTC availability of topical hydrocortisone (via pharmacy-only sales) in Sweden (Branstad et al 1994). Magazine articles were found to be the most frequently cited source of information around the time of the switch. Six years after the switch, however, pharmacy staff and nurses had become the most important sources. Research suggests that doctors may be more highly rated than pharmacists as sources of information about OTC medicines (Lefterova and Getov 2004, Gore and Madhavan 1993).