In surveys of individuals who have had recent upper respiratory infections, the majority of respondents recall self treatment with OTC healthcare products (Labrie, 2001, Mclsaac et al., 1998, Metzger et al., 2004). Importantly, fewer individuals recall seeking medical attention and those that did seek medical attention rarely did so as their first response to their illness.
In a random-digit-dialing survey of 1505 adults, 77% of those who reported an illness in the past six months had self-treated with an OTC medication, in contrast to 43% who said they visited a physician for their illness (Labrie, 2001). Of those reporting headache symptoms, 81% self-treated; of those reporting cold, cough, flu, or sore throat symptoms, 72% self-treated.
This survey did not determine the time between OTC use and first contact with the healthcare system. However, it did ascertain whether OTC use was an individual's first action after the onset of symptoms. Of the individuals reporting headache symptoms, 54% said their first course of action was to take an OTC medication (34% said their first course of action was to wait and see if the symptoms would go away, and only 4% said their first course of action was to consult a physician). For individuals with cold, cough, flu, and sore throat symptoms, the first course of action was self-treatment with an OTC product in 42%, watchful waiting in 34%, using a dietary supplement in 9%, and consulting a physician in less than 9%.
Another survey found that 76% of individuals who reported an upper respiratory tract infection in the last two weeks self-treated with an OTC medication; only 14% visited a physician (McIsaac et al., 1998). This survey did not assess the timing of OTC use relative to the timing of visits to physicians, but it did assess the timing of visits to physicians in the course of illness. The study found that nearly two-thirds of sick individuals who visited a physician did not do so until after the second day of illness and one-third did not do so until after the fourth day of illness. This survey was extensive. The researchers interviewed
42,223 adults 20 years of age or older in Canada over a period of 11 months.
Corso et al. (2003) surveyed usage of diarrhea remedies during a 1993 Milwaukee outbreak of cryptosporiosis by retrospective review of medical records of approximately 2000 patients. In the records of 378 patients who met their definition of moderate or severe cryptosporidiosis, they found evidence of self-treatment with OTC medications in approximately 30%.
A limitation of the above surveys is that they did not ascertain whether individuals purchased an OTC product or used one that was already in the medicine cabinet at home. Thus, these studies simply suggest the potential of monitoring of OTC medications for detection of outbreaks. They leave unanswered the question of how many unit sales might occur per sick individual during an outbreak and when these purchases might occur relative to the onset of the patient's symptoms.
A survey that Metzger et al. (2004) conducted in New York City partially addressed one of these limitations: they asked about OTC purchase as opposed to use. However, they did not determine how many OTC products each individual purchased or the relative timing of OTC purchase with respect to onset of illness.
Of the 2433 residents of New York City that Metzger and colleagues interviewed, 460 (18.9%) reported having a flu-like illness in 30 days prior to the interview. Of the 460 who reported a flu-like illness, 53.2% purchased one or more OTC products. OTC purchase was the most common action: 32.6% missed work or school,29.1% visited a physician, 21.4% called a physician, 8.8% visited an emergency department, and 3.8% called a nurse or health advice line. Of the 108 individuals who took two or more of these actions, 36.6% purchased an OTC product as their first action in response to their symptoms. This was the most common first action: 30.3% missed work or school first, 16.2% visited a physician first, 11.8% called a physician first, 3.3% visited the emergency department first, and 0.7% called a nurse or health advice line first.
A study by Johnson et al. (2005) measured purchase (versus use) of an OTC product and the timing of purchase. In a survey of the caregivers for 78 children visiting an emergency department (ED) for an acute infectious illness, they found that caregivers purchased an OTC product for 32 (41%) of the children prior to the visit. On average, the caregivers made the purchase 1.88 (95% confidence interval [CI], 1.4-2.3) days prior to bringing their child to the ED. Of 29 children with cough and fever, caregivers purchased an OTC medication for 18 (62.1%). Of 30 children with vomiting or diarrhea with fever, caregivers purchased an OTC medication for 19 (63.3%). A limitation of this study is that it examined only children who presented to an emergency department, as opposed to the other surveys we have discussed, which conducted telephone interviews of a more representative sample of the population. The Walter Reed Army Institute of Research is conducting a similar study in adults (Pavlin, 2005).
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