What Do Young Adults Think about the Safety of Over-the-Counter Analgesics? Findings from a Cross-Sectional Survey.

Analgesics are commonly used over-the-counter (OTC) medicines readily available for purchase, sometimes without advice of a health professional. However, analgesics can cause harm even when taken according to dosing recommendations. Young adults may be more vulnerable to harm if they perceive low risk with OTC analgesic use, or struggle to interpret dosing instructions. This study aimed to explore factors affecting how young adults use OTC analgesics and associated perceptions of safety. An online survey was distributed to school-leavers and university students (17 to 25 years), in South-East Queensland, Australia, in the period November-December 2019. Most of the 302 respondents (school-leavers n = 147, university students n = 155) did not use analgesics frequently. School-leavers deferred to parents for analgesic information, while university students preferred the internet. The majority of respondents appeared safety conscious and did not take outside indicated use or instructions. However, a small proportion reported taking analgesics for an inappropriate indication. The difference in preferred source of analgesic information may reflect experience with analgesic use, increasing autonomy or decreased parental influence. Whilst it is encouraging that the majority of young adults appeared safety conscious, greater insight is needed into factors influencing decision making on OTC use, e.g., medicines knowledge, and changes with increasing age.

Australian pharmacists: ready for increased non-prescription medicines reclassification.

OBJECTIVES: Reclassification of medicines from prescription to non-prescription increases timely access to treatment, promotes self-management of minor ailments and relieves healthcare system burden. Previous research identified that Australia lagged behind the United Kingdom and New Zealand in medicines reclassification. This study aimed to identify Australian pharmacists' opinions on the current state of medicines reclassification; the prescription medicines consumers requested without prescription; the medicines pharmacists believed should and should not be considered for reclassification; and perceived barriers to reclassification. METHODS: A 2016 national online survey that sought pharmacists' opinions on the state of reclassification, perceived barriers to reclassification and readiness of the profession for further reclassification. Pharmacists' comments were invited through open-ended questions. KEY FINDINGS: Two hundred and thirty-five valid surveys were completed. Respondents practised in community, hospital, consultant and academic contexts, and the majority were female (58.7%, n = 138). More than two thirds (70.66%, n = 166) of pharmacists reported receiving daily or weekly requests for non-prescription access to prescription medicines. The majority of pharmacists (71.7%) agreed that the Australian pharmacy profession is ready for further medicines reclassification, guided by patient safety, harm minimisation and medication continuance. The most prominent barrier to further reclassification was opposition from other healthcare professionals. CONCLUSIONS: Australian pharmacists believe that their profession has the capacity to safely and effectively manage a wider range of non-prescription medicines through increased reclassification in the contexts of patient safety and risk mitigation. This study has contributed to the global conversation on non-prescription medicines access, providing momentum for practice and policy change.

Medicines reclassification from a pharmaceutical industry perspective: An international qualitative study.

BACKGROUND: Widening access to medicines through reclassification ('switching') of medicines from prescription to non-prescription is an international trend generally welcomed by community pharmacists. Research has focused on scheduling and committee deliberations affecting reclassification, rather than industry aspects, despite industry's role in driving reclassifications. The research aimed to identify how pharmaceutical industry and product-related factors influence reclassification, and to explore stakeholder acceptability of government or third-party driven reclassifications. METHODS: Sixty-five in-depth, semi-structured interviews were conducted with 80 key informants (including representatives from regulatory bodies, industry, pharmacy and medicine) in developed countries including the United States, the United Kingdom, Japan, Australia, and New Zealand. The questions explored barriers and enablers to reclassification at the local (micro-), regional (meso-) and global (macro-) levels. Analysis of transcribed interviews entailed descriptive and thematic approaches. RESULTS: Pharmaceutical industry decisions to drive medicine reclassification reflect characteristics of the company, product, and external environment at all levels. For the company, financial factors, company focus (e.g. on prescription business versus non-prescription business), and capability in non-prescription medicines and reclassification were common influences. Products with significant non-prescription market potential and a well-known prescription medicine brand name most suited reclassification, usually near patent expiry. Barriers included immediate generic entry post-reclassification, and a short-term profitability and/or prescription business focus. Some countries allow government or a third-party (including pharmacy) to drive reclassifications, with examples of successful reclassifications ensuing. Some industry and other participants held concerns about this practice, particularly in the United States. Concerns included insufficient resourcing, and the pharmaceutical company's business, potentially encouraging product withdrawal or legal challenge. CONCLUSIONS: This study is the first to explore both pharmaceutical industry factors affecting reclassification and acceptability of alternate drivers of reclassification. Factors beyond clinical safety and efficacy and the local reclassification environment can influence reclassification. Pharmacy-driven reclassification might be one alternative.

Turning Pain into Gain: Evaluation of a Multidisciplinary Chronic Pain Management Program in Primary Care.

OBJECTIVE: To measure the impact of the multidisciplinary Turning Pain Into Gain program in people experiencing chronic pain of any etiology. METHODS: A mixed-methods observational study of 252 participants was used to explore the impact of Turning Pain Into Gain on medication use; quality of life and functioning, as measured by the Pain Self-Efficacy Questionnaire; and self-reported hospitalizations between 2015 and 2016. RESULTS: Responses from 178 participants showed an increased alignment with Australian pain medication guidelines (e.g., a 7.3% reduction in paracetamol duplication was reported with a concurrent 5.1% rise in the administration of sustained-release paracetamol formulations); improved Pain Self-Efficacy Questionnaire scores from 23.1 (out of a possible score of 60) preprogram to 35.3 postprogram; and a reduction in self-reported hospitalizations from 50 cases in the 12 months preprogram to 11 cases in the 12 months postprogram. CONCLUSIONS: Positive medication, Pain Self-Efficacy Questionnaire, and hospitalization changes provide evidence for the broader implementation of similar patient-centered programs to promote more holistic management of diverse types of chronic pain in primary care. Reduced hospitalization reflects potential for this intervention to be cost-effective, which could be investigated further.

Widening consumer access to medicines: a comparison of prescription to non-prescription medicine switch in Australia and New Zealand.

BACKGROUND: Despite similarities in health systems and Trans-Tasman Harmonization of medicines scheduling, New Zealand is more active than Australia in 'switching' (reclassifying) medicines from prescription to non-prescription. OBJECTIVES: To identify and compare enablers and barriers to switch in New Zealand and Australia. METHODS: We conducted and analyzed 27 in-depth personal interviews with key participants in NZ and Australia and international participants previously located in Australia, and analyzed records of meetings considering switches (2000-2013). Analysis of both sets of data entailed a heuristic qualitative approach that embraced the lead researcher's knowledge and experience. RESULTS: The key themes identified were conservatism and political influences in Australia, and an open attitude, proactivity and flexibility in NZ. Pharmacist-only medicine schedules and individuals holding a progressive attitude were proposed to facilitate switch in both countries. A pharmacy retail group drove many switches in NZ ('third-party switch'), unlike Australia. Barriers to switch in both countries included small market sizes, funding of prescription medicines and cost of doctor visits, and lack of market exclusivity. In Australia, advertising limitations for pharmacist-only medicines reportedly discouraged industry from submitting switch applications. Perceptions of pharmacy performance could help or hinder switches. CONCLUSION: Committee and regulator openness to switch, and confidence in pharmacy appear to influence consumer access to medicines. The pharmacist-only medicine schedule in Australasia and the rise of third-party switch and flexibility in switch in NZ could be considered elsewhere to enable switch.

Widening consumer access to medicines through switching medicines to non-prescription: a six country comparison.

BACKGROUND: Switching or reclassifying medicines with established safety profiles from prescription to non-prescription aims to increase timely consumer access to medicines, reduce under-treatment and enhance self-management. However, risks include suboptimal therapy and adverse effects. With a long-standing government policy supporting switching or reclassifying medicines from prescription to non-prescription, the United Kingdom is believed to lead the world in switch, but evidence for this is inconclusive. Interest in switching medicines for certain long-term conditions has arisen in the United Kingdom, United States, and Europe, but such switches have been contentious. The objective of this study was then to provide a comprehensive comparison of progress in switch for medicines across six developed countries: the United States; the United Kingdom; Australia; Japan; the Netherlands; and New Zealand. METHODS: A list of prescription-to-non-prescription medicine switches was systematically compiled. Three measures were used to compare switch activity across the countries: "progressive" switches from 2003 to 2013 (indicating incremental consumer benefit over current non-prescription medicines); "first-in-world" switches from 2003 to 2013; and switch date comparisons for selected medicines. RESULTS: New Zealand was the most active in progressive switches from 2003 to 2013, with the United Kingdom and Japan not far behind. The United States, Australia and the Netherlands showed the least activity in this period. Few medicines for long-term conditions were switched, even in the United Kingdom and New Zealand where first-in-world switches were most likely. Switch of certain medicines took considerably longer in some countries than others. For example, a consumer in the United Kingdom could self-medicate with a non-sedating antihistamine 19 years earlier than a consumer in the United States. CONCLUSION: Proactivity in medicines switching, most notably in New Zealand and the United Kingdom, questions missed opportunities to enhance consumers' self-management in countries such as the United States.

Does advice from pharmacy staff vary according to the nonprescription medicine requested?

BACKGROUND: Community pharmacy has long been advocated as an appropriate gateway of supply for nonprescription medicines and health-related advice. Consumers sometimes self-treat the symptoms of minor illness, yet there is conflicting evidence over their ability to do so properly. Emerging trends also suggest a variable approach to nonprescription medicine supply by pharmacy staff. Understanding of this is limited and more structured exploration is needed. OBJECTIVE: To explore variation in pharmacy staff response to requests for nonprescription medicines from different legislative schedules through analysis of data collected using pseudo-patient methods. METHODS: Consumers posed as pharmacy patrons (ie, pseudo-patients, simulated patients) and requested 1 of 3 specific nonprescription medicines by name. Two of these, ibuprofen and a branded cold and flu medication, could be sold by any pharmacy staff member (these were considered Pharmacy Medicine). The third, a combination analgesic containing paracetamol (acetaminophen), codeine, and doxylamine, required pharmacist involvement in the sale (considered Pharmacist Only Medicine). Pseudo-patient visits measured the service provided in each pharmacy by observing whether staff performed particular behaviors such as providing advice regarding the drugs. RESULTS: Staff response was generally superior when pseudo-patients requested the combination analgesic that required pharmacist intervention. Medicine advice was provided verbally to 84.9% of pseudo-patients requesting this analgesic compared with 51.1% of those requesting the cold and flu medication. Similar trends were observed for other behaviors. CONCLUSIONS: Emerging patterns imply that pharmacy staff response may vary according to the medicine requested. It may be that pharmacists and their staff prioritize drugs or behaviors that they consider critically relevant as part of a risk management approach. This has possible implications for future scheduling policy. Further research using a range of scenarios would more fully explore the breadth of such behavior. This would aid identification of medicines that trigger professional intervention and inform development of targeted training programs.