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Self­Care Self­care is the independent act of preventing, diagnosing, and treating one’s illnesses without seeking professional advice. Preventive self­care involves maintaining well­being and appearance through exercise and a healthy lifestyle. For many individuals, a healthy lifestyle includes controlling their diet; taking vitamins, minerals, and herbal supplements; participating in regular exercise and keeping fit; and maintaining their appearance by using dental, skin, and hair care products. However, sickness self­care for individuals involves diagnosing their conditions and obtaining products for the goal of mitigating illness and relieving symptoms. Examples of sickness self­care include use of dietary options (e.g., warm soup for a cold); use of devices for both disease assessment (e.g., home blood glucose meters and pregnancy tests) and treatment (e.g., ice packs, first­aid bandages, vaporizers, and nasal strips); and use of nonprescription medications. The use of sickness self­care products is limited to mild illness or short­term management of illness, and most products warn users to contact a health care provider if conditions do not improve within a short period of time. For the provision of sickness self­care, one individual from each household usually plays a leading role in adopting a course of action. This individual must determine whether a health care provider should be consulted or whether the use of home remedies and self­care will suffice. Furthermore, the number of individuals involved in choosing the most appropriate self­care option is increasing because of the growth of the U.S. geriatric population, whose members are known as high users of nonprescription medications. 1 Individuals responsible for providing self­care for themselves or family members rely on knowledge and experience to guide their decisions. For better or worse, there is no shortage of information, given the wealth of health­related self­help books, newspaper feature articles, magazine and television advertisements, magazine articles, radio programs, instructional tapes and CDs, DVDs, and Internet sites—all of which provide self­care advice. The availability of coupons indirectly provides information and encourages cost savings for trying a product. The abundance of available health­related information, especially from the Internet, helps individuals become more “selfempowered” to address their health care issues and leads to aggressive marketing and use of self­care alternatives. The quality of the information ranges from excellent to very poor. Although it is more accepted today for individuals to attempt to manage their health­related issues rather than to consult a health care provider, the concern is whether they are making appropriate and informed decisions. Furthermore, all this health information can become overwhelming, driving some individuals to seek advice from family and friends. This well­intentioned advice can be problematic because it is often biased, and most individuals are not sufficiently informed or qualified to consider another’s health conditions or medications before making a recommendation. They simply state what has worked best for them and fail to consider how their approach might apply to someone else. Commercial products used for preventive or sickness self­care are often classified together as health and beauty care (HBC) products. Staggering numbers of HBC products are available. Although access to quality HBC products is crucial to the goal of self­care, the vast number of similar, competing products makes appropriate selection difficult. Yet, in one consumer poll in which 66% of adults believed that the wide range of competing products made selection difficult, less than half (43%) said they consulted a pharmacist before making a purchase. 2 The pharmacist plays a crucial role in assisting patients who are seeking both preventive and sickness self­care products. The practicing pharmacist has the expertise to screen patient health information and apply his or her knowledge and training to select products according to individual health care needs. Therefore, for pharmacies to provide pharmacist­assisted self­care, only quality HBC products should be stocked, and a pharmacist should be readily available for patients seeking assistance. More and more pharmacies are changing their floor layout and design and staffing to ensure that a pharmacist is available and easily accessible to patients seeking advice in the nonprescription drug aisles. At times, this change coincides with the implementation of a retail clinic staffed by a nurse practitioner or a physician assistant as a primary care provider. Self­Medication Self­medication is often the most sought­after first level of self­care. As self­care has increased, so has the practice of self­medication with vitamins (i.e., nutritional dietary supplements), natural products (i.e., herbal/botanical and nonherbal dietary supplements [e.g., glucosamine]), and nonprescription medications. Factors that help drive reliance on self­medication include (1) growth of the aging population, (2) decreased availability of primary care providers, (3) increased costs of health care, and (4) high proportion of underinsured or uninsured people in the United States. Easy accessibility, convenience, and cost­effectiveness of self­medication products ensure their essential role in the U.S. health care system.

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Results of a 2002 survey conducted for the National Council on Patient Information and Education (NCPIE) 3 illustrate how ubiquitous the use of nonprescription medications has become. According to the survey, 59% of Americans had taken at least one nonprescription medication in the preceding 6 months. Table 1­1 illustrates some of the conditions that are self­treatable with nonprescription medications. Conditions and symptoms commonly treated with nonprescription medications include the following: Pain (78%) Cough/cold/flu/sore throat (52%) Allergy/sinus problems (45%) Heartburn/indigestion (37%) Constipation/diarrhea/gas (21%) Minor infections (12%) Skin problems (10%) Approximately 20% of Americans believe that they are consuming more nonprescription medications and taking them more frequently than they did 5 years earlier. 3 This increase in nonprescription drug use may reflect a consumer belief that self­medication is safe. Additional data collected in the survey “Your Health at Hand: Perceptions of Over­the­Counter Medicine in the U.S.” supports the view that consumers and physicians are confident in their use of nonprescription medications. 4 These survey results show the following: 93% of physicians believe it is important that medications for minor ailments be available over the counter. 96% of consumers believe nonprescription medications make it easy to care for minor medical ailments. 87% of physicians and 89% of consumers believe nonprescription medications are an important part of overall and family health care. 93% of adults prefer to treat minor ailments with nonprescription medications before seeking professional care. 88% of physicians recommend patients address minor ailments with self­care, including nonprescription medications before seeking professional care. TABLE 1­1 Selected Medical Disorders Amenable to Nonprescription Drug Therapy a Abrasions Aches and pains (general, mildmoderate) Acidity, stomach Acne Allergic reactions (mild) Allergic rhinitis Anemia (after diagnosis by a health care provider) Arthralgia Asthma (after diagnosis by a health care provider) Athlete’s foot Bacterial infection (dermatologic, mild) Blisters Blood pressure monitoring Boils Bowel preparation (diagnostic) Burns (minor, thermal) Calluses Candidal vaginitis Canker sores Carbuncles Chapped skin Cold sores Colds (viral upper respiratory infection) Congestion (chest, nasal) Constipation Contact lens care Contraception Corns Cough Cuts (superficial) Dandruff Decongestant, nasal Dental care Dermatitis (contact) Diabetes mellitus (insulin, monitoring equipment, supplies) Diaper rash Diarrhea Dry skin Dyslipidemia Dysmenorrhea Dyspepsia Fever Flatulence Gastritis Gingivitis Hair loss Halitosis Hangover relief, morning Head lice Headache Heartburn Hemorrhoids Herpes Impetigo Indigestion Ingrown toenails Insect bites and stings Insomnia Jet lag Jock itch Migraine Motion sickness Myalgia Nausea Nutrition (infant) Obesity Occult blood, fecal (detection) Ostomy care Ovulation prediction Periodontal disease Pharyngitis Pinworm infestation Premenstrual syndrome Prickly heat Psoriasis Ringworm Seborrhea Sinusitis Smoking cessation Sprains Strains Stye (hordeolum) Sunburn Teething Thrush Toothache Vomiting Warts (common and plantar) Xerostomia Wound careDownload pdf

The pertinent nonprescription medication(s) for a particular disorder may serve as primary or major adjunctive therapy. Source: U.S. Food and Drug Administration. Status of OTC rulemaking. February 17, 2011. Accessed at http://www.fda.gov/Drugs/DevelopmentApprovalProcess/DevelopmentResources/Over­theCounterOTCDrugs/StatusofOTCRulemakings/default.htm, June 2014. A major 2012 survey of more than 3200 individuals provides information regarding the value of nonprescription medications and their contribution to cost savings and quality care in our health care system. 5 These data showed the following: Availability of nonprescription products provides $102 billion in annual savings relative to alternatives and increased access to medications. Each dollar spent on nonprescription medications saves $6­$7 for the health care system. In the previous 12 months, 79% of consumers (or approximately 240 million people) took a nonprescription drug in the categories of allergy, analgesics, antifungals, cough/cold/flu, lower gastrointestinal, upper gastrointestinal, and medicated skin. 180 million individuals would seek treatment from a primary care provider if nonprescription medications were not available. Self­medication plays an increasing role as adjunctive therapy for chronic diseases that are managed with prescription medications. Examples include low­dose aspirin for reducing heart attack risk, fish oil (omega­3 fatty acids) to help manage certain dyslipidemias, and glucosamine with chondroitin to help relieve symptoms of osteoarthritis. However, the use of nonprescription products as adjunctive therapy comes with potential risks associated with incorrect product selection. For example, many patients who require daily low­dose aspirin do not fully understand the differences between the many aspirin products. There are various strengths (low dose, regular, and extra strength) and products (chewable, buffered, and enteric coated). Selection of the wrong product could result in adverse reactions (e.g., gastritis or ulcer) or drug­drug interactions (e.g., warfarin and blood pressure medications). The pharmacist plays an important role in helping patients select the correct products for their condition. Options for Self­Medication Three general categories of products are available for self­medication: (1) nonprescription medications, (2) nutritional dietary supplements, and (3) natural products and homeopathic remedies. Nonprescription Medications Nonprescription medications are regulated by the Center for Drug Evaluation and Research, a division of the U.S. Food and Drug Administration (FDA)—the same agency that regulates prescription drug products. As such, nonprescription medications are held to the same drug product formulation (e.g., purity and stability), labeling, and safety (benefits outweigh risks) standards as those for prescription medications. A complete discussion of the monograph system can be found in Chapter 4. It is worth noting that, although nonprescription medications are regulated in a manner equivalent to that of prescription medications, the sales of nonprescription medications are not limited to pharmacies. They are also available in retail establishments such as discount stores, supermarkets, and gas station quick stops and on a plethora of Internet sites. The provisions of the 1951 Durham­Humphrey Amendment to the Food, Drug, and Cosmetic Act of 1938 gives FDA the final authority to categorize a medication as prescription or nonprescription. FDA deems nonprescription medications safe and effective when they are used without a prescriber’s directive and oversight. In addition, these products have the following characteristics: they have a low potential for misuse and abuse; patients can use them for self­diagnosed conditions; they are adequately labeled; and they do not require access to a health care provider for safe and effective use. 6 The estimated number of available FDA­approved nonprescription drug products is 100,000, including more than 1000 active ingredients that cover more than 80 therapeutic categories. Your Health at Hand Book: Guide to OTC Active Ingredients in the United States provides an extensive list of active ingredients, therapeutic categories, and examples of brand name products. 7 Sales of nonprescription medications in 2011 were estimated at $17.4 billion dollars. 8 Sales of the top 15 therapeutic categories of nonprescription medications for 2011 are shown in Figure 1­1. 9 Not surprisingly, the dollars spent, as shown in this figure, correspond to what consumer surveys have reported as the most common conditions managed with self­care. For example, in a survey in which consumers were asked what health problems they had experienced in the preceding 6 months, the most frequent responses were muscle/back/joint pain and cough/cold/flu/sore throat (both categories at 48%), with headache and 6/1/2015 PharmacyLibrary | Print: Chapter 1. Self­Care and Nonprescription Pharmacotherapy http://www.pharmacylibrary.com.ezproxy.roosevelt.edu:2048/popup.aspx?aID=785002&print=yes_chapter 4/16 heartburn/indigestion trailing at 43% and 32%, respectively. 10 The correlation between common types of illnesses and dollars spent implies that many Americans provide self­care for those conditions using nonprescription medications. Nutritional Dietary Supplements The Dietary Supplement Health and Education Act of 1994 amended the 1983 Food, Drug, and Cosmetic Act to establish standards with respect to dietary supplements. The amendment defined dietary supplements as products that are intended to supplement the diet and that bear or contain one or more of the following dietary ingredients: (1) a vitamin, (2) a mineral, (3) an herb, or (4) an amino acid. Results from a recent National Health and Nutrition Survey indicate that more than 50% of adults used one or more dietary supplements between 2003 and 2006. 11 A survey of college students found that almost three­quarters (71%) had used an herbal or nutritional supplement and that 61% had used both a nonprescription product and a nutritional or herbal supplement within the past year. 12 (See Chapters 50, 51, and 52 for further information on dietary supplements.) Natural Products and Homeopathic Remedies Because of factors such as high health care costs and restricted access to conventional health care providers, many patients seek care from providers of complementary and alternative medicine (CAM). The National Center for Complementary and Alternative Medicine and the National Center for Health Statistics reported survey results on Americans’ use of CAM. 13 Approximately 38% of adults and 12% of children reported receiving some form of CAM therapy in 2007. Some of the most common forms of CAM therapy were natural products (18%), deep breathing (13%), meditation (9%), chiropractic and osteopathic care (9%), massage (8%), and yoga (6%). Adults spent approximately $34 billion out of pocket to visit CAM providers and purchase products. 14 Self­care is a component of many CAM therapies. By definition, the term dietary supplement includes both herbal and natural products. In 2011, the total estimated sales of herbal products were $5.03 billion, with the top­selling supplements being cranberry, soy, saw palmetto, garlic, and echinacea. 15 A 2002 National Health Survey indicated that about 13% of elderly patients had used an herbal supplement during the preceding year. 16 The use of combined herbal and conventional therapy raises safety concerns because 51% of patients failed to inform their health care provider about their herbal therapy. 11 These safety concerns include the potential for herbal supplement­drug interactions. Lexi­Comp’s Lexi­Interact database (Hudson, Ohio, Lexi­Comp, Inc., 2013) lists several hundred herbdrug interactions, with garlic, St. John’s wort, the various ginseng products, and Ginkgo biloba leading the way. Therefore, individuals who take prescription or nonprescription medications should consult with a pharmacist or other health care provider before self­medicating with herbal supplements.