Key Findings
According to the results of WP2, 2,459 medicines were consumed by the 932 PATs in all countries, subdivided in 819 (33.3%) non-prescribed medicines and 1,640 (66.7%) prescribed medicines, 2.,455 medicines were consumed by the 853 CLs in all countries, subdivided in 1,278 (52.1%) non-prescribed medicines and 1,177 (47/9%) prescribed medicines, 2,864 medicines were provided by the 565 GPs in all countries, subdivided in 956 non-prescribed medicines and 1,908 prescribed medicines and 3,524 medicines were provided by the 701 PHs in all countries, subdivided in 1,468 non-prescribed medicines and 2,056 prescribed medicines. This WP achieved to identify the various categories of factors included in the conceptual model of health and illness related behaviour (Slikkerveer, 1995) that play a potential role in PATs and CLs’ medicine consuming behaviour as well as GPs’ and PHs’ medicine providing behaviour, as illustrated clearly in the Deliverable 2.1 prepared by the WP2 leader Prof. Slikkerveer in collaboration with members of the LEAD programme and the UNPAD team. A remarkable overall conclusion was that in both the GPs and the PHs, the intervening determinants show a strong dominance over all other independent categories of determinants – including the psycho-social determinants – which open up a new focal point for behaviour change in the arena of the classical doctor-patient relations and interactions. Another remarkable conclusion is that in both the PATs and CLs by contrast the independent socio-demographic and psycho-social determinants show a strong dominance over all other intervening categories of determinants – including the intervening GP- and PH-specific determinants – opens up a new focal point for behaviour change at the individual and community level.
Based on the results of WP3 and WP4, Mediterranean countries were found to have the highest rate of OTC drug consumption compared to countries from Central and Northern Europe. Women tended to consume both non-prescribed and prescribed medications to a higher extent than males. The majority of physicians declared that they had prescribed medications to more than 60% of their patients during the previous month and expected to prescribe at least one medication to the two thirds of the chronic patients visiting them. Physicians’ gender was found to affect their intention to prescribe medicines with female physicians expecting to prescribe/recommend more medications without well documented evidence than their male counterparts especially in Czech Republic, Greece and Malta. In Czech Republic, Malta and Turkey, physicians’ positive attitude towards medicines was significantly associated with their intention to prescribe/recommend medicines. Social pressure was found to affect physicians’ intention to prescribe medicines in Mediterranean countries only and particularly in Greece, Malta and Turkey. Finally, in Malta and Sweden, physicians’ age was found to affect their intention to prescribe/recommend medicines with younger physicians expected to issue a prescription without well documented evidence at a higher extent than their older colleagues.
According to the results of WP5, the intervention met moderate to high acceptability and was found to be practical for general practice in most participating countries. As for its efficacy, certain trends emerged based on the responses to the three study questionnaires. Overall, changes in GPs’ intention to provide medicines tended to be positive in the intervention group whilst no changes were found in the control group. This pattern was seen across all 5 countries. There was no apparent change in the number of prescribed medicines (before - after the intervention) in Cyprus and Greece. In France there was a small increase in the number of prescribed medicines at post intervention level, which may be due to coincidence with the season of vaccination. In Malta and Turkey, a small decrease in the number of prescribed medicines was observed in both the intervention and the control group, without this change being statistically significant. There was a change towards a more rational prescription found in the intervention group comparing to the control group. For instance in Cyprus, after the intervention, 60% of the GPs (in intervention group) stated that that they would not prescribe medicines already purchased from the pharmacy without prescription while that percentage was zero prior to the intervention. In Greece the percentage of the GPs who would not prescribe a medicine already bought from the pharmacy was also 60% after the intervention whilst it was 20% at baseline. A positive change was also found regarding prescribing of medicines to third persons (relatives, friends etc.). To be more specific, in Cyprus 80% of GPs stated that they would not prescribe a medicine to a third person while that percentage was 40% before the intervention. In Greece, 60% of the GPs stated that they would not prescribe a medicine to a third person after the intervention, while that percentage was 40% before the intervention. In Cyprus and Greece there was an increase of 20% at the number of GPs stating that they would always discuss the prescribed medicines with patients suffering from chronic disease (baseline percentage was 40% in Cyprus and 60% in Greece). Finally, in Cyprus 80% of GPs stated that they would not prescribe medicines suggested by another physician after the intervention, while the baseline percentage of GPs was initially zero. In Greece, 100% of GPs said that in such occasion they would contact the physician who suggested this medicine to their patient while the baseline percentage of GPs stating this response was 60%.
As regards to the results of WP6, a number of statements were developed, conveying key messages to GPs in Southern European countries, policy makers and other stakeholders. These statements were based on consensus methods and collective decision making and reflected the latest trends in OTC prescribing and consumption based on the results of the multi-country survey and the multi-centre intervention implemented within the OTC SOCIOMED project.
In WP7 a set of recommendations/ practical guidelines was developed on the basis of the project’s outcomes and distributed via e-mail to all the stakeholders engaged in medicine distribution, monitoring and evaluation that were identified through a mapping process. The aim of this action was to inform all stakeholders about the knowledge gained through the project and ensure the transfer of knowledge into everyday clinical and pharmaceutical practice as well as the introduction of key and missing issues in the agenda of policy makers.