1. INTERVENTIONAL STUDY ON SELF MEDICATION IN COMMONLY OCCURRING ILLNESSES IN NONMEDICAL STAFF OF A TERTIARY CARE TEACHING HOSPITAL Dr Smita Sontakke*, Dr Vijay Thawani**, Dr. Sachi Bang* *Govt. Medical College, Nagpur India; **VCSGGMSRI, Srinagar, Pauri-Garhwal, Uttarakhand, India Abstract Interventional Study on Self Medication in Commonly Occurring Illnesses in Nonmedical Staff of a Tertiary Care Teaching Hospital Smita dipak Sontakke1, Vijay Thawani2, Sachi Bang1 1Government Medical College, India; 2Department of Pharmacology, VCSGGMSRI, Srinagar, Pauri-Garhwal, Uttarakhand, India Problem statement: Self medication with prescription medicines is known to occur in developing economies since prescription medicines are freely sold over the counter (OTC) because regulations are not implemented. Self medication may result in health hazards resulting from failure to recognize warning symptoms of a disease, missed diagnosis, incorrect therapy, failure to follow precautions, failure to recognize drug interactions and ADRs, use of an inadequate or excessive dose, use of the same medicine under different brand names, and failure to seek subsequent medical advice. Objective: To study patterns of self medication among nonmedical staff of tertiary care teaching hospital in 5 common illnesses (i.e., diarrhea, constipation, sore throat, common cold, and insomnia) and to evaluate the impact of information, education, communication (IEC) intervention Design: This was a randomized, self-control, interventional, pre-post intervention design. A pretested, semi-structured, open-ended questionnaire was used to assess existing knowledge of 100 randomly selected, nonmedical staff members of a tertiary care teaching hospital of Nagpur, India, about treatment of the specified 5 illnesses. Information was sought about medicines used, dose, and ADRs. Respondents‘ awareness of the warning symptoms of the disease and knowledge about nonpharmacological measures and precautions to be taken while using medicines were recorded. IEC Interventions: Based on the baseline data obtained after analyzing the pre-intervention questionnaire, small group discussions were conducted. These were followed by distribution of handouts containing information about all issues addressed in the questionnaire. A month after this IEC intervention, the pre-intervention questionnaire was re-administered to see the change. Results: The number of respondents was the same after the intervention. Positive outcomes after intervention included increased awareness about ADRs and knowledge of warning symptoms of disease, non-pharmacological measures, and precautions to be taken while using medicines. Significant positive change in the type of medicine used for constipation was observed after intervention. There was no improvement in the pattern of antimicrobials used, and no reduction in the number of respondents who used prescription medicines OTC. Positive outcomes were observed in the age group of 25–40 years and in graduate respondents. Statistical analysis was done by Fischer‘s exact test. Conclusions: Patterns of self medication improved after IEC interventions, but some aspects were resistant to change. The problems of using prescription medicines OTC and of inappropriate use of antimicrobials can be controlled only with strict implementation of regulations to prevent their availability OTC. Funding source(s): This study was not funded, and there is no conflict of interest. Study Background  Self medication → treatment of common health problems with medicines approved as safe and effective for use without medical supervision  Nonprescription medicines or ‘over the counter’ medicines  Self medication with prescription medicines is common  Self medication has advantages  Optimal therapy with OTC medicines requires that consumers have basic knowledge about the medicine  Knowledge about seeking further medical attention and when not to self medicate  Need to provide adequate information to consumers so that they choose right medicine for a particular illness to gain benefits from self medication Objectives Material and Methods Information Recorded IEC Interventions Results Conclusion Implications  Study the prevalence of self-medication in five commonly occurring illnesses- common cold, sore throat, diarrhea, constipation and insomnia  Study the knowledge of the medicines used  Education regarding the non-prescription medicine and its appropriate use  Study the effect of IEC intervention on pattern of self medication  Randomized, self control, interventional, pre-post intervention design  Study Participants: 100 randomly selected nonmedical staff members of a tertiary care teaching hospital  Study instrument: Pretested, semi structured, open ended, questionnaire  Demographic characteristics  Medicines used for each of the five illnesses by self-medication  On whose advice  Duration of use  Dose of the medicine  Whether aware of: adverse effects, drug interactions, precautions  Use of medicines in children and pregnant women  When to consult a doctor  Non-pharmacological treatment for these illnesses  Small group discussions: planned based on the data obtained after analysing the pre- intervention questionnaire  Distribution of hand outs: containing information about all the issues addressed in the questionnaire  Pre intervention questionnaire re-administered one month after IEC intervention to see the change. Pre and Post intervention data compared using Chi-square test Table 1: Pre and post –intervention knowledge about 5 diseases in the study participants (n=100) Parameter Disease Diarrhoea Common cold Sore throatConstipationInsomnia PrePostPrePostPrePostPrePostPre Post Taking Medicines70639392 7574717231 30 Type of medicineSymptomatic403187901628868***31 30 Antimicrobial28305025645200 0 Both02 01000301000 0 Others000000614***0 0 Prescription medicine obtained OTC655971676965575128 29 Aware ofDose1621121510190510 19 Adverse Effects1839*293414 32* 724*11 33* Aware of warning symptoms of the disease 2143*1435**1939*1736*7 25* Practice non-pharmacological measures7188768367815189*29 74* Aware of precautions to be taken in children & pregnant women 0735***0629***0724*225**3 19** Figures indicate number of participants out of 100 *p<0.01, **p<0.001, ***p<0.0001 when compared to pre-intervention by Chi-square test with level of significance 5% SymptomaticOthersAntimicrobial Table 2: List of medicines used in the three diseases by the study participants Diarrhoea Loperamide (12,6) Diphenoxylate(6,1) Metronidazole(16,16) Ciprofloxacin (4,4) Tinidazole (6,7) Furazolidone (2,2) Ofloxacin (1,1) Norfloxacin + Tinidazole (1, 2) None Triprolidine+ Paracetamol+ Phenylpropanola- mine (10,10) Cetrizine (45,47) Nimesulide (7,5) Paracetamol (5,8) Aspirin (4,3) Diclofenac (2,1) Amoxycillin (5,2) Zandubalm (1,1) Vicks vaporub (8,10) D-cold (5,4) Common cold Sore throat Diphenhydramine (5,6) Povidone-iodine Gargles (7,18) Homeopathy(1,1) Ranitidine(1,0) Vicks action 500(7,8) Ampicillin (3,1) Amoxycillin (8,6) Erythromycin(35,30) Azithromycin(10,7) Methylcellulose (2, 14) Ispaghula husk (2,9) Bisacodyl (4,45) Alprazolam (12,12) Diazepam (13,13) Pheniramine maleate (6,5) Metronidazole (2,0) None Eno(6,1) Omeprazole(8,0) Ranitidine(22,0) Gellucil(18,0) Kayamchurna(7,3) Constipation Insomnia  Use of prescription medicines OTC  Use of antimicrobials  Awareness about dose of medicines Intervention resulted in No change inPositive change in  Awareness about adverse effects of medicines  Knowledge of warning symptoms of the disease, non-pharmacological measures and precautions to be taken in children and pregnant women  Type of medicines used in constipation For changing the pattern of antimicrobial use in these illnesses, interventions merely aimed at educating consumers may not be very effective, and more vigorous interventions including strict regulation of OTC sale of antimicrobials need to be employed Inappropriate self-medication is responsible for serious ADRs, drug- interactions and inadequate treatment This results in development of resistance in case of anti-microbials and various complications of the disease if inadequately treated Appropriate IEC intervention will enhance knowledge of the respondents about self-medication of common illnesses and the same will be propagated to friends and relatives This will serve to reduce the problems associated with inappropriate self-medication