Self-Care Introduction PDF

# Self-care: An Introduction Prepared by Sara T. Taeb MSc. P522PT, Fall 2023 ## Community Pharmacists - Are the most accessible healthcare professionals. - No appointment is needed to consult a pharmacist. - Patients can receive free unbiased advice almost anywhere. - Community pharmacists are of...

# Self-care: An Introduction Prepared by Sara T. Taeb MSc. P522PT, Fall 2023 ## Community Pharmacists - Are the most accessible healthcare professionals. - No appointment is needed to consult a pharmacist. - Patients can receive free unbiased advice almost anywhere. - Community pharmacists are often the first health professional patients seek advice from, providing a filtering mechanism to refer patients with more serious pathology to an appropriate practitioner for further investigation. ## Self-care ### History and Evolving Definition - Self-care has been common practice among centuries of human history. - There is no single definition of self-care that is universally accepted in the literature, as definitions vary depending on the setting and stakeholders' perspectives. - The World Self-Medication Industry (WSMI) defines self-care as "a life-long habit and culture. It is the action individuals take for themselves and their families to stay healthy and take care of minor and long term conditions, based on their knowledge and the information available, and working in collaboration with health and social care professionals where necessary." - Treatment of minor ailments and self-management of long-term conditions are found towards the middle of this scale. ### Self-Care: An Independent Act - Self-care is the independent act of preventing diagnosing and treating one's illness without seeking professional advice. - The World Health Organization defines self-care as 'the ability of individuals, families and communities to promote health, prevent disease, and maintain health and to cope with illness and disability with or without the support of a health-care provider'. - Self-care is characterized by individuals who take proactive roles for themselves, on behalf of and with others in order to develop, protect, maintain, and improve their physical and psychological health. - Promotion of self-care is a means to empower individuals, families and communities for informed health decision-making. - Self-care has the potential of improving the efficiency of health systems and contributing towards health equity. ### Impetus for Continued Growth - Two main trends have contributed greatly to the expanding self-care market: - Growing consumerism. - Increased healthcare costs and demands. - Various social and health trends have also altered individuals' outlook on health and the way in which they perceive their own health status. - Increased access to almost limitless health information via the Internet and mobile, coupled with improved educational levels and subsequent health literacy, has caused a shift towards informed, empowered consumers wishing to become more active to their healthcare. ### Self-Care Products - Self-care products provide individuals with the opportunity to take more responsibility for, and become more involved in, their health. - The spike in digital health technology has also engaged patients by supporting more personalized and tailored health care. For examples, mobile phone applications that monitor daily habits, weight fluctuations, steps taken, and calories burned are trending. ## Self-Medication - Self-medication is a key component of self-care and is defined as the selection and use of medications - legally classified as drugs specifically designed and labeled for use without medical supervision and approved as safe and effective if used as directed for such use - by individuals to treat self-recognized illnesses or symptoms. - Self-medication products are those not requiring a medical prescription and which are produced, distributed and sold to consumers for use on their own initiative. - Self-care medications are often called 'nonprescription' or 'OTC' and are available without a prescription. - Nonprescription products are also available in other retail outlets (e.g., supermarkets, gas stations) and are commonly self-selected by the public. - Three general categories of products are available for self-medication: - Nonprescription medications. - Dietary supplements. - Complementary and alternative medicines (CAMs). - The term nonprescription replaces over-the-counter (OTC), reflecting formal usage in pharmacy practice - however, these designations are often used interchangeably. ### Responsible Self-Medication - Responsible self-medication can be used to prevent and treat symptoms and ailments that do not need medical consultation or oversight. - This reduces pressure on medical services, especially when these are limited. - For those populations living in rural or remote areas, where access to medical services may be difficult, patients are able to control their own conditions to a greater extent. - Only if the condition fails to respond, persists, or becomes more severe will the patient need to seek professional medical care. - Medicines are made available to the public vary from country to country, but all have been approved by regulatory agencies as being safe and effective for people to select and use without the need for medical supervision or intervention. ## Minor Ailments - Minor ailments, also known as (common ailments, common conditions, minor illnesses, self-limiting conditions, self-treatable conditions and ambulatory conditions) are defined as "common or self-limiting or uncomplicated conditions which can be diagnosed and managed without medical intervention". - These conditions represent an important aspect of self-care, given that the public is more apt to self-treat such ailments. - The most prevalent problems can be categorized into four therapeutic areas: - Pain disorders (e.g., headaches, musculoskeletal). - Respiratory issues (e.g., coughs, colds). - Skin conditions (e.g., acne). - Gastrointestinal disturbances (e.g., indigestion). ## Nonprescription Medications OTC (Over the Counter) - OTC drug products are medicines especially designed and labeled for use without a prescriber's direction and supervision and deemed as safe and effective when they are used in self-medication. - OTC drugs are regulated by the same agencies that regulate prescription medicines. Therefore OTC meds are held to the same drug product formulation(e.g.purity and stability (labeling and safety) benefits outweigh risks) ### Characteristics of OTC Drugs - Their benefits outweigh their risks. - The potential for misuse and abuse is low. - Consumers can use them for self-diagnosed conditions. - They can be adequately labeled. - Health practitioners are not needed for the safe and effective use of the product (accessibility and convenience). ## The Benefits of Self-Care and Self-Medication - Self-care products play an increasingly important role in the healthcare of millions as they offer symptom relief and disease prevention while providing convenience and affordability to patients. - The added convenience of OTC medicines is the primary reason why consumers prefer these products to prescription medicines for the treatment of common health conditions, such as headache, heartburn, and allergies. - This accessibility eliminates the stress and inconvenience of GP visits, saving time and money, and reducing lost work productivity. - Utilizing self-care can enhance patients' self-care confidence by improving their skill set and empowering them to care for certain conditions on their own, such that GPs are only visited when necessary. - This gives the public greater control over their own health and encourages healthy behaviors that help prevent future illnesses. - With other HCPs, namely pharmacists, guiding patients in the self-management of ailments, GPs are able to focus on caring for higher risk patients and managing long-term conditions. - Canadian industry data shows that if only 16% of Canadians who see the doctor for mild symptoms practiced self-care instead, an additional 500,000 Canadians could have access to a family doctor. - Furthermore, increased personal responsibility around healthcare has been shown to improve people's health and wellbeing. - Direct, rapid access to effective medicines. - Wide availability. - Decreased healthcare system utilization (fewer physician visits, lower healthcare system costs). ### Facilitating Safe and Appropriate Self-care and Self-Medication - Inappropriate use of nonprescription products can increase morbidity, mortality, and related healthcare costs. - One reason for this is that these medications have the potential to interact with prescription products, causing adverse events, especially in vulnerable patient populations (e.g., older adults, immunocompromised individuals). - The increased risk of adverse outcomes secondary to self-medication in these groups may be related to the presence of multiple disease states, higher prescription drug use, and/or impairments in activities of daily living. - Other vulnerable patient populations include infants, children, and women who are pregnant or lactating. - Pharmacists should ensure patients understand that self-care products are not without safety concerns and emphasize the importance of using these products as directed. ### Safety Concerns Related to Nonprescription Drugs - Incorrect self-diagnosis. - Drug-drug interactions. - Increased risk of adverse events when not used appropriately. - Substandard and falsified products. - A substandard product is one that fails to meet quality standards and/or specifications. - Falsified products, the identity, composition, or source is deliberately misrepresented. - These products may contain the wrong active ingredient (AI), no Al, or the wrong amount of the correct Al. - Substandard and falsified products commonly contain unknown impurities as they are often compounded in unsanitary conditions, by unqualified personnel. - The growing risk of substandard and falsified medications may be related to increased internet connectivity, as those responsible for manufacturing and distributing such products have gained access to a global market. - Consequences related to the use of substandard and falsified medications can be far reaching, from the failure to prevent or cure disease to serious patient harm or death. - Potential for misuse and abuse. - Nonprescription drug use and abuse includes using these products for reasons other than those intended, and exceeding recommended dosages. - Factors that may contribute to inappropriate nonprescription drug use include: - Public perception that these medications are without safety concerns. - The ease of procurement. - Rates of nonprescription drug abuse have increased over time. - In the US, for example, dextromethorphan abuse increased 15-fold from 1999 to 2004 among adolescents aged 9-17. - Nonprescription drug abuse can occur in all patient population, however, those with mental health issues, pain disorders, and diseases of aging may be more susceptible. - Although abused products vary worldwide, a 2013 systematic review identified codeine products, laxatives, sedating antihistamines, cough products, and decongestants as the most commonly abused drug classes worldwide ## Drug Classification System - Drugs are universally classified into two major categories: prescription drugs and non-prescription drugs. ### Prescription Drugs - To access prescription drugs, physicians must diagnose a disease before providing prescriptions to patients. - They are called prescription drugs in the USA, prescription-only drugs in the UK, and schedule 1 in Canada. ### Non-Prescription Drugs - On the other hand, the numbers of sub-categories of non-prescription drugs ranged from one in the US (over-the-counter drugs OTC), two in UK (Pharmacy drugs and General sale list drugs) and three in Canada (schedule 2, schedule 3 and unscheduled) #### Behind-the-Counter (BTC) Drug Category - BTC drugs do not require prescriptions but do require dispensing under pharmacists' supervision, and, as a result, these drugs are kept behind the pharmacy counters. - Pharmacists must ask for patients' symptoms before dispensing any drugs. - Detailed instructions are also required to ensure that patients understand how to use the drug safely. - Many countries have implemented BTC as an official drug category, though the official name of the category differs in each: - Pharmacy drugs (UK). - Schedule 2 (Canada). #### Open-Shelf (OPS) Drug Category - OPS drugs have been deemed safe for consumers to practice self-medication; although drugs are still confined to distribution only in healthcare settings, and not in non-pharmacy retailers. - This implies that patients could seek pharmacist advice if needed. - Canada has implemented the OPS drug category, which is called schedule 3. - OPS drugs are permitted to be sold via online pharmacies in Canada. #### General Sale List (GSL) Drug Category - GSL drugs have been declared safe for self-medication. They can be sold in non-pharmacy retailers and over the internet. - The GSL drug category has a different nomenclature across the countries: - Over-the-counter drugs (the US). - General sale list drugs (the UK) and - Unscheduled drugs (Canada). - Nowadays there over 80 therapeutic categories of OTC meds which can be grouped in 12 broad therapeutic classes: 1. Analgesics and antipyretics. 2. Cold cough and allergy products. 3. Night time sleep-aids. 4. Gastrointestinal products. 5. Dermatological products. 6. Other topical products (including dermal and vaginal antifungal anorectal medications, head lice products, hair loss products and otics.) 7. Ophthalmic products. 8. Oral health care products. 9. Menstrual products. 10. Nicotine replacement products. 11. Weight loss aids. 12. Vaginal contraceptives and emergency contraceptives. ## The Pharmacist's Role in Self-care and Minor Ailments - Pharmacists have a crucial role to play in self-care and minor ailment management as they are one of the most accessible HCPs worldwide and are among the best trained to advise patients on the selection and manner of use of nonprescription medications. - In fact, supporting self-care is recognized as being a core activity of the profession in many countries. - Based on their knowledge, assessment skills, experience, location, and availability, pharmacists are ideally placed to assist a patient in their self-care journey to ensure safe and effective therapies are recommended to optimize health outcomes. - Another important role for pharmacists in self-care and self-medication is ensuring symptoms perceived to be minor are not the result of an undetected, more serious condition. - This requires that pharmacists exercise enhanced clinical judgment, with particular attention to the presence of alarm features, previous treatment attempts, and behaviors suggesting avoidance of care. - Accurately identifying the need for further medical assessment is crucial for avoiding delays in the treatment of more serious ailments. ### The World Health Organization (WHO) - Based on these functions and findings, the World Health Organization (WHO) describes pharmacists as being communicators, drug suppliers, collaborators, and health promoters in self-care and self-medication. - As communicators, pharmacists initiate dialogue with patients, formulate questions to gather pertinent information, and provide objective education on therapies using a variety of modalities based on patient-specific factors. - As drug suppliers, pharmacists provide access to nonprescription medications and ensure products are from reputable sources and are of good quality. - As collaborators, pharmacists establish relationships with patients, other HCPs, and various stakeholder groups. - Finally, as health promoters, pharmacists screen patients in the community to identify those at risk of health problems, advise patients on disease prevention and other health related practices, and participate in campaigns to raise awareness of public health issues. - The WHO suggests additional roles for pharmacists in self-care and self-medication include managing minor ailments and ensuring safe and appropriate self-medication practices. ### Switching Process of OTC Drugs - The process of transferring FDA-approved prescription medications to nonprescription status is known as "Rx-to-OTC switch". - An ingredient, before is introduced as an OTC medicine, it typically has been marketed by a manufacturer as a prescription medicine first. - Then, after a sufficient amount of time has passed to enable the manufacturer to gather appropriate scientific information on the product, the manufacturer then may elect to submit a New Drug Application) NDA) - The switch process also works in reverse. - Although specific regulations for nonprescription drugs differ between countries, the underlying goals are same - ensure the quality, safety and efficacy of products, improve public health, and encourage competition in the nonprescription sector. - With appropriate regulation of nonprescription products, patients can be empowered to engage in self-care without potential compromises in safety. ### Approval of Nonprescription Drugs - In most countries, there is a formal means of approving nonprescription products. - In the US and India, these activities are governed by the Food and Drug Administration (FDA) and Central Drugs Standard Control Organization, respectively. - Products generally obtain nonprescription status by one of two ways: - They are classified as nonprescription with initial market authorization, or - They become nonprescription after initial approval as a prescription product. - Regardless of the route to nonprescription status, approval requires that the safety, efficacy, pharmacokinetics, pharmacodynamics, and indications of a drug be well established and documented. - For novel drugs, initial evidence of safety and efficacy is primarily from animal studies. - Several countries have adopted an accelerated approval process for prescription drugs seeking nonprescription status, as safety and efficacy were established with initial authorization. ### Prescription-to-Nonprescription Switches - Prescription-to-nonprescription switches are currently the most common means by which products obtain nonprescription status. - These switches are thought to be motivated by three factors: - The desire to extend product viability by pharmaceutical companies. - Attempts to contain costs by healthcare payers. - An increasing interest in self-care from the public. ### Labeling, Packaging, and Advertising - Labeling - Although labeling, packaging and advertising regulations vary by country, overarching themes exist. - For example, most, if not all, countries require that information necessary for the correct and unsupervised use of nonprescription drugs be included on the product label or package insert (Drug Facts Label). - Furthermore, regulations require that information be provided in easily understandable and patient-friendly language. #### OTC "Drug Facts "Label - The label tells what the medicine is supposed to do, who should or shouldn't take it, and how to use it. - The labeling of OTC medicines has always contained usage and safety information for consumers. - With the introduction of the "Drug Fact "label, the information is more uniform and easier to read and understand. - Any self-medication product should be safe for use. - This implies the availability of appropriate consumer information and avoidance of any delay in diagnosis and treatment of diseases not suitable for self-medication. - Furthermore, self-medication drugs are known to interact with many prescription-only drugs, alcohol and foods. - The following information must appear in this order on OTC drug facts label: - The product's active ingredients, including the amount in each dosage unit. - The purpose of the product. - Warnings. - Dosage instructions - when, how, and how often to take the product. - The product's inactive ingredients, important information to help consumers avoid ingredients that may cause an allergic reaction. - Other Information. This section tells you how to store the drug. Some drugs may be sensitive to heat or moisture. - Questions or Comments. This section includes contact information available to consumers with questions about the product. It may not exist on all Drug Facts labels. ### Packaging - Regulations are typically aimed at: - Reducing the risk of accidental drug exposure by children. - Facilitating recognition of product tampering. - Deterring the misuse of nonprescription drugs. ### Advertising - Regulations pertaining to drug advertising ensure information communicated to consumers is truthful and not misleading. - This is important, as misinformation regarding the use of nonprescription products can have significant implications on patient safety and wellbeing. ### Adverse Drug Reaction Reporting - Several countries have systems in place for reporting adverse reactions (serious and nonserious) related to nonprescription drug use, allowing for ongoing monitoring of drug safety. ### OTC COUNSELING - OTC Counseling refers to a pharmacist's full working knowledge of OTC drugs as well as initiating an assessment of the patient's self-care concerns and drug-related needs. - The involvement of pharmacists in nonprescription medication counseling will increase the public's ability to understand the risks and benefits of OTC remedies. ### The Pharmacist's Role in OTC Counseling - Pharmacists are trained to help patients determine when and how to treat themselves. - The pharmacist plays a key role in ensuring that the balance of OTC use tips toward benefit rather than risk. - The pharmacist is available at the point of purchase to help the patient select an appropriate OTC product, suggest non-pharmacologic therapy, or refer the patient to a physician when necessary. ### Potential Barriers to Patient Counseling - Pharmacy Environment - Pharmacist Barriers. - Patient Barriers. #### Pharmacy Environment - The design of a pharmacy has a major impact on how patients view pharmacists and react to their consultation efforts. - The presence of a high counter prevents easy eye contact and makes a pharmacist seem unfriendly and even uncaring. - The lack of semiprivate space prevents patients from asking questions of their pharmacist or describing problems. #### Pharmacist Barriers - Inappropriate use of interpersonal space by the pharmacist. - Inappropriate body language. - Inappropriate vocal characteristics. #### Patient Barriers - Patients also can create barriers that pharmacists must recognize. - Functional barriers hinder the patient's ability to understand information that is being communicated by the pharmacist. - Sensory deficits - Language problems - Illiteracy - Low health literacy - Comprehension difficulties - Alternative health beliefs - Personal health beliefs - Cultural influences #### Overcoming Barriers - The Pharmacists should keep the following tips in mind: - Be an active listener - Use clear, unambiguous language appropriate to the knowledge of the patient - Be aware of nonverbal cues (signs) - Ask for feedback so as to clarify any misunderstandings - Provide feedback outlining the message.