Experiences of self-medication among people: a qualitative meta-synthesis.

BACKGROUND: Self-medication is one of the major health-related problems in the world, which causes many problems for people and health systems. No comprehensive qualitative meta-synthesis has been done to understand the perceptions and experiences of self-medication among people. OBJECTIVES: This study aimed to analyze, re-interpret, and synthesize the existing qualitative studies on perceptions and experiences of self-medication among people around the world. METHODS: In this meta-synthesis, all published qualitative studies in PubMed, Scopus, CINAHL, and Web of Science databases were searched in May 2018. A total of 543 articles were screened in the primary stage and finally five articles that met the inclusion criteria were included in the meta-synthesis. The included studies were analyzed using Noblit & Hare approach. RESULTS: Initially, 115 codes were identified. In the second stage, the codes were merged based on similarity and shared meanings. Finally, after checking by two authors, the following five themes were emerged: cost-effectiveness, affectivity, inefficiency of the healthcare system, previous experiences, and oversimplification. CONCLUSION: The findings of this first meta-synthesis provided a comprehensive understanding of the perceptions and experiences of self-medication around the world. The findings showed that the experiences of self-medication could be classified into personal, social, organizational, and cultural categories. These findings could help policymakers address these perceptions and experiences in effective health planning.

Attitudes towards sales and use of over-the-counter drugs in Sweden in a reregulated pharmacy market: a population-based study.

OBJECTIVES: To analyse attitudes towards sales and use of over-the-counter (OTC) drugs in the Swedish adult population. METHODS: Data were collected through the web-based Citizen Panel comprising 21 000 Swedes. A stratified sample of 4058 participants was emailed a survey invitation. Questions concerned use of OTC drugs, and attitudes towards sales and use of OTC drugs. Correlations between the attitudinal statements were assessed using Spearman's rank correlation. Associations between attitudes and participant characteristics were analysed using multinomial logistic regression. KEY FINDINGS: Participation rate was 64%. Altogether 87% reported use of OTC drugs in the last 6 months. Approximately 10% of participants stated that they used OTC drugs at the first sign of illness, and 9% stated that they used more OTC drugs compared with previously, due to increased availability. The statement on use of OTC drugs at first sign of illness correlated with the statement about using more OTC drugs with increased availability. Socio-demographic factors (age, sex and education) and frequent use of OTC drugs were associated with attitudes to sales and use of OTC drugs. CONCLUSIONS: Increased use due to greater availability, in combination with OTC drug use at first sign of illness illustrates the need for continuous education of the population about self-care with OTC drugs. Increased awareness of the incautious views on OTC drugs in part of the population is important. Swedish policy-makers may use such knowledge in their continuous evaluation of the 2009 pharmacy reform to review the impact of sales of OTC drugs in retail outlets on patient safety and public health. Pharmacy and healthcare staff could be more proactive in asking customers and patients about their use of OTC drugs and offering them advice.

Using machine learning to investigate self-medication purchasing in England via high street retailer loyalty card data.

The availability alongside growing awareness of medicine has led to increased self-treatment of minor ailments. Self-medication is where one 'self' diagnoses and prescribes over the counter medicines for treatment. The self-care movement has important policy implications, perceived to relieve the National Health Service (NHS) burden, increasing patient subsistence and freeing resources for more serious ailments. However, there has been little research exploring how self-medication behaviours vary between population groups due to a lack of available data. The aim of our study is to evaluate how high street retailer loyalty card data can help inform our understanding of how individuals self-medicate in England. Transaction level loyalty card data was acquired from a national high street retailer for England for 2012-2014. We calculated the proportion of loyalty card customers (n ~ 10 million) within Lower Super Output Areas who purchased the following medicines: 'coughs and colds', 'Hayfever', 'pain relief' and 'sun preps'. Machine learning was used to explore how 50 sociodemographic and health accessibility features were associated towards explaining purchasing of each product group. Random Forests are used as a baseline and Gradient Boosting as our final model. Our results showed that pain relief was the most common medicine purchased. There was little difference in purchasing behaviours by sex other than for sun preps. The gradient boosting models demonstrated that socioeconomic status of areas, as well as air pollution, were important predictors of each medicine. Our study adds to the self-medication literature through demonstrating the usefulness of loyalty card records for producing insights about how self-medication varies at the national level. Big data offer novel insights that add to and address issues that traditional studies are unable to consider. New forms of data through data linkage may offer opportunities to improve current public health decision making surrounding at risk population groups within self-medication behaviours.

Pattern of medication selling and self-medication practices: A study from Punjab, Pakistan.

BACKGROUND: Access to medicines without prescription is a major contributing factor for self-medication practices. This study was designed to examine the ratio of non-prescribed medicines sales and self-medication practices in Punjab, Pakistan. This study also evaluates the reasons for self-medication within its communities. METHODS: An observational study was conducted in 272 systemically selected pharmacies to analyze medicines-related sales, with or without prescription. A cross-sectional survey was performed between June 2015 and November 2016. Consumers were interviewed about their self-medication practices. RESULTS: Of the pharmacies surveyed, 65.3% participated in the study. A total of 4348 medicines were purchased for self-medication by 3037 consumers (15.2% of all study participants), of which 873 (28.7%) participated in an interview. Majority (81.2%) medicine purchaser, (90.9%) interview participants, and (59.4%) drug users were male. On average, each community pharmacy sold 7.9 medicines without prescription each day, to an average of 5.5 customers. Many participants (28.9%) had matriculation in their formal education. The medicines most often sold for self-medication were analgesics and antipyretics(39.4%). More than 25% of participants reported fever symptoms and 47.8% assumed their illness was too trivial to consult a doctor. Media advertisements were the most common source of information for participants (46.7%). CONCLUSION: Many types of medicines were often sold without prescription from community pharmacies. Self-medication was common practice for a wide range of illnesses. Pakistan also needs effective implementation of policies to monitor medication sales. Public education about rational medication and limits to advertising medicine are very necessary.

The value of self-medication: summary of existing evidence.

AIM: The aim of this review was to identify the international evidence that is currently available on the economic value of self-care through responsible self-medication, in terms of the measures related to access to treatment, time, and productivity. METHODS: A targeted literature search was conducted for 1990-2016, including data gathered from members of the World Self-Medication Industry and searches on PubMed, EBSCOHost, and Google Scholar. Specific searches of individual drug classes known to be switched to non-prescription status in this period were also conducted. RESULTS: A total of 71 articles were identified, of which 17 (11 modeling studies, six retrospective analyses) were included in the review. Evidence from modeling studies and retrospective analyses of grouped data across a range of common conditions for which non-prescription medications are available in different countries/regions showed that the use of non-prescription products for the treatment of common conditions or for symptom management (e.g. allergies, chronic pain, migraine, vaginitis, gastrointestinal symptoms, or common cold symptoms) had considerable value to patients, payers, and employers alike in terms of cost savings and improved productivity. Potential benefits of self-medication were also identified in preventative healthcare strategies, such as those for cardiovascular health and osteoporosis. LIMITATIONS: This review was limited by a targeted, but non-systematic approach to literature retrieval, as well as the inclusion of unpublished reports/white papers and patient self-reported data. CONCLUSIONS: The evidence identified in this literature review shows that responsible, appropriate self-medication with non-prescription products can provide significant economic benefits for patients, employers, and healthcare systems worldwide.

Rules for improving pharmacotherapy in older adult patients: part 1 (rules 1-5).

The population of older adult patients in the United States is growing each year. Appropriate pharmacotherapy has allowed many older patients to live longer and maintain healthy lives. Unfortunately, the inappropriate utilization of medications can be harmful to older adult patients. Inappropriate pharmacotherapy may lead to overusing medications and polypharmacy. Polypharmacy can contribute to a higher incidence of adverse effects, increase the risk of dangerous drug interactions, cause noncompliance with appropriate medication use, and significantly increase the cost of health care. The polypharmacy issue with geriatric patients has been described as an epidemic and this issue must be addressed. This review provides objective rules that may help prevent polypharmacy. Consideration of these rules when prescribing, dispensing, and caring for older adult patients will improve the overall pharmacotherapy regimens instituted by healthcare providers.

Social, cultural and economic factors associated with self-medication.

INTRODUCTION: Self-medication is an increasingly frequent phenomenon worldwide; some studies suggest that there is a relationship with socio-economic and cultural factors. OBJECTIVE: To determine the prevalence of self-medication and its related factors in a Colombian city. MATERIALS AND METHODS: Cross-sectional descriptive study, in Pereira, Colombia. We selected 414 adults using simple randomization sampling with houses used as the observational unit. The IRIS-AM instrument was used to collect the information required. RESULTS: Four hundred and fourteen (414) people were interviewed, 62.6% were females, and mean age was 44 years; 77.5% of the sample had self-medicated at least once in their life and 31.9% during the last month. The most commonly used medications were: analgesics and antipyretics (44.3%), non-steroidal anti-inflammatory drugs and anti-rheumatic medication (36.4%), and anti-histamine medication (8.5%). The most commonly self-medicated symptoms were: headache (55.7%), cold (16.2%) and muscular pain (13.2%). Multivariate analysis revealed an association between self-medication throughout life and storing medications at home, and between a high level of education and having a favorable opinion of self-medication. Storing medications at home and recommending them to others were associated with self-medication during the previous 30 days. CONCLUSION: Self-medication rates were found to be similar to those reported globally, but there is not an established pattern for this practice. Associations were found between social and demographic variables and self-medication, which require further characterization. Intention to self-medicate has not been well-described in other studies, and may be an important indicator which will contribute to future understanding of this phenomenon.

Social, cultural and economic factors associated with self-medication / Factores económicos, sociales y culturales asociados con la automedicación

Introduction: Self-medication is an increasingly frequent phenomenon worldwide; some studies suggest that there is a relationship with socio-economic and cultural factors. Objective: To determine the prevalence of self-medication and its related factors in a Colombian city. Materials and methods: Cross-sectional descriptive study, in Pereira, Colombia. We selected 414 adults using simple randomization sampling with houses used as the observational unit. The IRIS-AM instrument was used to collect the information required. Results: Four hundred and fourteen (414) people were interviewed, 62.6% were females, and mean age was 44 years; 77.5% of the sample had self-medicated at least once in their life and 31.9% during the last month. The most commonly used medications were: analgesics and antipyretics (44.3%), non-steroidal anti-inflammatory drugs and anti-rheumatic medication (36.4%), and anti-histamine medication (8.5%). The most commonly self-medicated symptoms were: headache (55.7%), cold (16.2%) and muscular pain (13.2%). Multivariate analysis revealed an association between self-medication throughout life and storing medications at home, and between a high level of education and having a favorable opinion of self-medication. Storing medications at home and recommending them to others were associated with self-medication during the previous 30 days. Conclusion: Self-medication rates were found to be similar to those reported globally, but there is not an established pattern for this practice. Associations were found between social and demographic variables and self-medication, which require further characterization. Intention to self-medicate has not been well-described in other studies, and may be an important indicator which will contribute to future understanding of this phenomenon.

Introducción. La automedicación es un fenómeno cada vez más frecuente a nivel mundial. Los estudios en este campo sugieren que hay una relación entre la automedicación y diversos factores sociodemográficos y económicos. Objetivo. Determinar la prevalencia de la automedicación y los factores relacionados en Pereira, Colombia. Materiales y métodos. Estudio descriptivo de corte transversal llevado a cabo en la población de Pereira. Se hizo un muestreo aleatorio por afijación proporcional en 414 adultos, y se desarrolló y aplicó la encuesta IRIS-AM ( Instrument for Systematic Data Collection of Self-Medication ). Resultados. Se encuestaron 414 personas, 62,6 % de las cuales eran mujeres; el promedio de edad fue de 44 años. La prevalencia de la automedicación fue de 77,5 % a lo largo de la vida y de 31,9 % en los 30 días previos. Los medicamentos más comúnmente utilizados fueron los analgésicos y antipiréticos (44,3 %), los antiinflamatorios no esteroideos (36,4 %), y los antihistamínicos (8,5 %). Los síntomas que llevaron a la automedicación con mayor frecuencia fueron la cefalea (55,7 %), el resfriado (16,2 %) y el dolor muscular (13,2 %). Los análisis multivariados mostraron asociación entre la automedicación a lo largo de la vida y guardar medicamentos en casa, así como entre tener un nivel superior de escolaridad y estar a favor de la automedicación. Los factores referentes a almacenar medicamentos y recomendarlos a otros se asociaron con la automedicación en los 30 días previos. Conclusiones. La prevalencia de la automedicación hallada en este estudio fue similar a la reportada previamente a nivel mundial; aun así, no existe un patrón establecido para esta práctica. Se evidenciaron las variables sociodemográficas asociadas con la automedicación, las cuales requieren una mejor caracterización. La intención de recurrir a la automedicación ha sido poco estudiada y podría ser un indicador importante para la medición y comprensión de este fenómeno.

Impact of a program to reduce the dispensing of antibiotics without a prescription in Spain / Impacto de un programa para reducir la dispensación de antibióticos sin receta en España

Background: In 1999, the Pharmacists Association of Gipuzkoa, a Spanish province with a population of 700,000, initiated a campaign to reduce the common practice in community pharmacies of dispensing antibiotics without prescription. Objective: The study was designed to assess the ongoing effectiveness of this program in reducing nonprescription dispensing of antibiotics. Methods: In March 2009, 2 young women posed as simulated patients and visited each of the 280 operating community pharmacies in Gipuzkoa. In 139 of these pharmacies, randomly selected, the simulated patients feigned the symptoms of an uncomplicated urinary tract infection and requested an unspecified antibiotic. In the remaining 141, the actress requested a specific antibiotic, only describing her symptoms upon request by the dispensing staff. The rate of nonprescription dispensing had previously been estimated at 70.5% in 2000 and 42.2% in 2004. Univariate and multivariate analyses were performed, based on a number of variables related to the pharmacy and staff. Results: In the current study, antibiotics were dispensed without prescription by 49 of 280 pharmacies (17.5%). The product- and symptombased scenarios had similar rates of 16.3% and 18.7%, respectively. The only variables which appeared to affect the nonprescription dispensing rate were the gender of the dispenser, being males more likely to dispense (OR=3.135, 95%CI [1.286, 7.646]), and the number of previous antibioticawareness campaigns in which the pharmacy had participated (OR=1.057, 95% CI [1.008, 1.107]). The community population, its number of pharmacies, the years in business of each pharmacy, or its revenue, did not appear to influence the nonprescription dispensing rate. Conclusion: A long-term multifactorial program set up by the pharmacists association of Gipuzkoa, Spain, appears to have been effective in reducing the rate at which antibiotics are dispensed without aprescription in community pharmacies (AU)

Antecedentes: En 1999, el Colegio de Farmacéuticos de Gipuzkoa, una provincia española con una población de 700.000 habitantes, inició una campaña para reducir la práctica común de dispensar antibióticos sin receta. Objetivo: Este estudio fue diseñado para evaluar la efectividad de este programa en la reducción de la dispensación de antibióticos. Métodos: En marzo 2009, 2 mujeres jóvenes actuaron como pacientes simuladas y visitaron todas las 280 farmacias comunitarias en ejercicio en Gipuzkoa. En 139 farmacias aleatoriamente seleccionadas, las pacientes simuladas fingieron síntomas de una infección urinaria no complicada y solicitaron un antibiótico sin especificar. En las restantes 141, las actrices solicitaron un antibiótico específico, describiendo sus síntomas solo si se lo solicitaba el personal dispensador. La tasa de dispensación sin receta había sido establecida previamente en el 70,5% en 2000 y 42.2% en 2004.Se realizaron análisis univariados y multivariados basados en algunas variables relacionadas con el personal de la farmacia. Resultados: En el presente estudio 49 de las 280 farmacias (17,5%) dispensaron antibióticos sin receta. Los escenarios de producto y de síntomas tuvieron tasas similares de 16,3% y 18,7%, respectivamente. Las únicas variables que parecían influir en la tasa de dispensación sin receta fueron el género del dispensador, siendo los hombres más proclives a dispensar (OR=3,135, IC95% [1,286, 7,646]), y el número de campañas de concienciación en las que había participado la farmacia previamente (OR=1,057, CI95% [1,008, 1,107]). La población de la localidad, su número de farmacias, la antigüedad de la farmacia o su cifra de negocios no parecieron influir en la tasa de dispensación sin receta. Conclusión: El programa multifactorial a largo plazo del Colegio de Farmacéuticos de Gipuzkoa, España, parece que fue efectivo en la reducción de la tasa de antibióticos dispensados sin receta en farmacias comunitarias (AU)

The other side of medicalization: self-medicalization and self-medication.

The concept of medicalization has given rise to considerable discussion in the social sciences, focusing especially on the extension of medicine's jurisdiction and its hold over our bodies through the reduction of social phenomena to individual biological pathologies. However, the process leading to medical treatment may start when individuals engage in self-medication and thus practice "self-medicalization." But, can we apply to this concept the same type of analysis as the first and see merely the individual's replication of the social control mechanisms to which he/she usually falls victim? This article aims to demonstrate that the medicalization individuals practice on themselves takes on a completely different meaning to that practiced by the medical profession. Empirical data collected in France show that self-medicalization, which may involve treating a problem medically when doctors believe it to be of a non-medical nature, can be an attempt by individuals to furnish a social explanation for their somatic problems and experiences. In this article, I examine the social and political significance of this phenomenon.

Prevalence and related factors for choosing self-medication among pharmacies visitors based on health belief model in Hamadan Province, west of Iran.

BACKGROUND: Self-medication has increased in the last decade in Iran; can be followed several complications. The aim of this study was to determine the prevalence and factors influencing self-medication based on health belief model. METHODS: A cross-sectional study was conducted among 1400 Hamadan Province pharmacies visitors, during spring and summer 2012 which was randomly selected with the proportional to size among different pharmacy at Hamadan for participation in this study. A structured questionnaire was applied for collecting data, which were analyzed by SPSS version 16 using bivariate correlations and logistic regression statistical tests. RESULTS: 35.4% of the participants had self-medication. Pain medication (10.6%), antibiotics (7.3%) and anti-cough and cold medications (4.5%) had the largest consumption. The main reasons of self-medication among participants were previous use of medication, symptoms improve and similar prescribed. The best predictor for self-medication was perceived severity with odds ratio estimate of 0.790 [95% CI: 0.694, 0.900]. CONCLUSION: It seems that designing and implementation of educational programs to increase seriousness about side effect of self-medication may be usefulness of the results in order to prevent of self-medication.

Assessing student pharmacist impact on patient over-the-counter medication selection.

OBJECTIVE: To evaluate the financial and clinical outcomes of an over-the-counter (OTC) medication consultation performed by doctorate of pharmacy student pharmacists in a community pharmacy. DESIGN: Cross-sectional survey. SETTING: Independent and chain community pharmacy locations in Pittsburgh, Pennsylvania. PARTICIPANTS: Fourth professional year (PY4) advanced experiential student pharmacists on community rotations at the designated settings who performed OTC consultations and the participants of these encounters. MAIN OUTCOME MEASURED: Financial and clinical impact of an OTC consultation performed by student pharmacists on rotation. RESULTS: A total of 559 OTC consultations were offered in 5 participating community pharmacy settings over a period of 1 year. Student pharmacists initiated 62.4% of all documented interactions and 60.5% of all participants accepted the consultation offer. The student pharmacists' OTC recommendations resulted in significant cost savings to the participant. Those participants accepting consultation reported being more likely to consult with a pharmacist in the future. PY4 students were also able to demonstrate capability in impacting clinical outcomes on several occasions by implementing OTC medication changes due to patient safety concerns. CONCLUSION: Student pharmacist OTC consultations have the potential to positively impact both financial and clinical outcomes associated with the use of OTC medications.

Determinants socio-economiques de l'automedication aux antimalariens a Kisangani/RD Congo

Objectif de l'etude : evaluer l'importance et les determinants socio-economiques de l'automedication aux anti-malariens dans la commune de la Tshopo a Kisangani Materiel et methodes : Nous avons realise une etude transversale utilisant un questionnaire d'enquete pour collecter les donnees. Par un echantillonnage systematique; 384 menages au minimum ont ete enquetes. Resultats : Au total 386 responsables de menage ont participe a l'enquete. 346 (89;6) de responsables avaient reconnu pratiquer l'automedication aux anti-malariens. Deux facteurs socio-economiques etaient significativement lies a l'automedication dans l'analyse classique : le revenu mensuel des responsables (p=0;0013) et la charge familiale en terme de nombre d'enfants (p=0;0034). L'age; le sexe; l'occupation des responsables; le niveau d'instruction et la religion des responsables n'etaient pas associes a la pratique. A l'analyse multi variee; les deux facteurs sont restes significatifs : les revenus superieurs a 100 dollars americains previennent la pratique [ORaj=0;25 (0;11-0;58); p=0;001] et le nombre eleve d'enfants dans le menage la favorise [ORaj=3;94(1;62-9;55); p=0;0024] entre 3-4 enfants et ORaj=3;34(1;067-10;46); p=0;038); a partir de 7 enfants) Conclusion : La prevalence de l'automedication aux anti-malariens est alarmante dans la commune de la Tshopo a Kisangani. La menace de la resistance; la circulation possible de medicaments de qualite douteuse et le contexte local de controle de qualite fait de cette pratique un probleme important de sante publique. Une evaluation serieuse de cette pratique serait donc utile dans le futur

Uso de hierro en forma de medicamento en gestantes colombianas / Pregnant Colombian females' iron in take in drug form

Objetivo Caracterizar el consumo de hierro en forma de medicamento en un grupo de embarazadas colombianas. Metodología Estudio observacional descriptivo, se obtuvo información de mujeres en control prenatal y/o atención del parto en 4 ciudades de Colombia. Las fuentes de información fueron entrevistas a gestantes y registros de historia clínica. Resultados La muestra fue de 1 637 mujeres en 15 instituciones. A 1 396 mujeres (85,3 %) les recomendaron consumir hierro, recomendación realizada por médico al 85,3 % de ellas, el 86,8 % tuvo adherencia al tratamiento. Al 84,7 % el hierro fue suministrado por la empresa aseguradora de salud, el 11,9 % lo compró a sus expensas. El 90,0 % de gestantes anémicas y el 82,8 % de las no anémicas consumieron hierro en forma de medicamento, en conjunto, en el 37,2 % de las gestantes el consumo de suplencia de hierro fue pertinente (es decir, lo necesitaban, se les recomendó y lo consumieron o no le necesitaban, no se recomendó y/o no lo consumieron). Discusión Se recomienda y se consume hierro independientemente de presentar anemia. Se invita a reflexionar sobre la utilidad de los programas que promueven el consumo masivo de esta sustancia en forma de medicamento durante el embarazo, programas que parecen desconocer las causas fundamentales de los problemas nutricionales que aquejan a la población.

Objective Describing a group of pregnant Colombian females' iron intake, in drug form. Methodology This was an observational descriptive study; information was collected in 4 Colombian cities regarding pregnant females during antenatal control or when giving birth. Information sources consisted of interviews with pregnant women and their clinical records. Results The sample consisted of 1,637 female sat tending 15 institutions. An iron intake was recommended for1, 396 women (85.3 %); a doctor made such recommendation in 85.3 % of cases and adherence was 86.8 %. Health insurance was used by 84.7 % of the females for supplying iron; 11.9 % of them bought it themselves. Iron intake as medication for anemic pregnant females was 90.0 % and 82.8 % in non-anemic ones. Iron intake supply was appropriate in 37.2 % of the pregnant females (i.e. they needed it, someone recommended it for them and they consumed it, or they didn't need it, someone didn't recommend it to them and/or they did not take it). Discussion Iron intake was recommended and consumed regardless of anemia status. The results invite to think on the usefulness of programs promoting the mass intake of iron as a medication during pregnancy. Such programs seem to be unaware of the fundamental causes of people's nutritional problems.

The concentration of out-of-pocket expenditures on complementary and alternative medicine in the United States.

CONTEXT: The most intense spenders on health services are considerably less healthy.49% report fair or poor health status compared to 15% of the general adult population and are elderly. Such findings have important implications for addressing national health-care spending because interventions targeting those people who are in poor health could theoretically generate dramatic cost savings. Although the popularity of complementary and alternative medicine (CAM) in the United States is well recognized, little is known about the distribution of out-of-pocket expenditures on CAM services. OBJECTIVE: This study examined the distribution of out-of-pocket expenditures on CAM health services in the United States. DESIGN: The research team used data from the 2007 National Health Interview Survey to examine the distribution in the United States of out-of-pocket expenditures on CAM services and the characteristics of adult (age ≥ 18 years) CAM users (n = 2972) according to spending. OUTCOME MEASURES: Using complex survey-design methods, the research team generated national estimates of expenditures on CAM services and used linear regression adjusted for covariates to determine whether self-reported health status predicted CAM spending. RESULTS: According to our estimates, in 2007, over 30 million adults reported out-of-pocket expenditures on CAM services, and of these individuals, 7.2 million were heavy CAM spenders with a mean annual expenditure of $1385. The highest quartile of CAM spenders accounted for $10 billion of the $13.9 billion spent nationally on CAM in 2007. Self-reported health status did not differ among groups with differing levels of CAM spending, ß = 1.00 (95% CI, 0.8-1.2). CONCLUSIONS: Out-of-pocket spending on CAM is concentrated. Just a quarter of CAM users account for over 70% of all expenditures on CAM services, and health status does not appear to be associated with level of CAM spending.

Reasons for self-medication and perceptions of risk among Mexican migrant farm workers.

Although the frequency of self-medication among Mexican migrants has been well-documented in the public health literature, the multiple reasons for this practice are poorly understood. Most studies point to migrants' cultural preferences for Mexican medications, their prior experiences in countries where antibiotics are loosely regulated, and their lack of access to health care as the primary factors behind their self-medication. Based on participant observation and in-depth interviews with 23 Mexican migrants in a farm working community in the interior of California, we argue that occupational vulnerability is an equally important factor that encourages self-medication. All 23 of our interviewees reported having engaged in some degree of self-medication, notable in this location 8 h from the US-Mexico border. Among interviewees, occupational vulnerability represented an even more important factor influencing self-medication than lack of health insurance or lack of legal documentation. While interviewees did express a preference for Mexican medications as more potent and effective, this did not necessarily translate to a preference for using them without a doctor's supervision. Finally, we show that rather than remaining unaware of the risks of following this custom "transported from Latin America", Mexican migrants devised an elaborate hierarchy of resort of the safest self-medication practices to follow.

Irrational use of antibiotics and role of the pharmacist: an insight from a qualitative study in New Delhi, India.

WHAT IS KNOWN AND OBJECTIVE: The overall volume of antibiotic consumption in the community is one of the foremost causes of antimicrobial resistance. In developing countries like India, pharmacists often dispense 'prescription-only' drugs, like antibiotics, to patients who do not have a prescription. Not much data is available regarding detailed information on behaviour of antibiotic use by community pharmacists which is of particular significance to develop a suitable and sustainable intervention programme to promote rational use of antibiotics. A qualitative study was conducted to understand the dispensing practices and behaviour of community pharmacists to develop policy interventions that would improve the use of antibiotics at the community level. METHODS: Focus group discussions (FGDs) were held for five municipal wards of Delhi with retail pharmacists, public sector pharmacists and the office bearers of pharmacists' associations. Data on antibiotic use and resistance were collected earlier from these five wards. FGDs (n = 3 with 40 pharmacists) were analysed through grounded theory. RESULTS AND DISCUSSION: Four broad themes identified were as follows: prescribing and dispensing behaviour; commercial interests; advisory role; and intervention strategies for rational use of antibiotics. FGDs with pharmacists working in the public sector revealed that, besides the factors listed above, overstock and near-expiry, and under-supply of antibiotics promoted antibiotic misuse. Suggestions for interventions from pharmacists were the following: (i) education to increase awareness of rational use and resistance to antibiotics; (ii) involving pharmacists as partners for creating awareness among communities for rational use and resistance to antibiotics; (iii) developing an easy return policy for near-expiry antibiotics in public sector facilities; and (iv) motivating and showing appreciation for community pharmacists who participate in intervention programmes. WHAT IS NEW AND CONCLUSIONS: Inappropriate antibiotic dispensing and use owing to commercial interests and lack of knowledge about the rational use of antibiotics and antibiotic resistance were the main findings of this in-depth qualitative study. Community pharmacists were willing to participate in educational programme aimed at improving use of antibiotics. Such programmes should be initiated within a multidisciplinary framework including doctors, pharmacists, social scientists, government agencies and non-profit organizations.