The inappropriate provision and consumption of non-prescribed medicines consists a public health problem of outmost importance for developed as well as for developing countries. The problem has been shown to be widespread in Mediterranean countries with enormous health risks. Although abuse of non-prescribed medicines is steadily rising and concerns about inappropriate treatment and adverse drug reactions have been raised, this subject does not appear to have received the attention it deserves in general practice/family practice research. In Europe, particularly in the Southern European region, countries have neither a full national programme to promote better use of medicines nor a multidisciplinary national body under mandate to monitor medicine consumption or even to develop and coordinate the implementation of such a programme.
The OTC SOCIOMED project aimed at assessing the extent of inappropriate provision and consumption of non-prescribed medicines in certain Southern European countries and identifying factors that influence these behaviours in four primary care groups [general practitioners (GPs) – pharmacists (PHs) – patients –clients]. The project further aimed to implement theory-guided interventions, addressing physicians’ training needs and behavioural components playing an influential role in the inappropriate provision of non-prescribed medicines.
Work package 1 involved tasks related to project monitoring and coordination. Work package 2 described the consumption of non-prescribed medicines by patients and pharmacy clients and the provision of non-prescribed medicines by GPs and PHs. It further made regional and geographical comparisons in the consumption and provision of non-prescribed medicines (Northern-Central-Southern Europe, rural-urban settings).
Work package 3 assessed GPs’ and PHs’ beliefs, attitudes and perceived behaviour control based on Theory of Planned Behaviour (TPB) and explored the role of TPB in explaining GPs’ and PHs’ intention to provide medicines in patients without well documented evidence.
Work package 4 assessed patients’ and clients’ beliefs, attitudes and perceived behaviour control based on TPB and explored the role of TPB in explaining patients’ and clients’ intention to consume medicines.
Work package 5 involved the design, implementation and evaluation of a multifaceted intervention addressing GPs’ beliefs and attitudes towards medicines and aiming to test the feasibility of a pilot intervention as well as change GPs’ intention to provide medicines to patients without well documented evidence.
Work package 6 reviewed and evaluated the project results and interventions using a nominal group process.
Finally, work package 7 involved the dissemination of the project’s results through a variety of dissemination channels as well as developed a set of recommendations/practical guidelines, summarizing the knowledge gained from the project.
These recommendations were distributed to a number of stakeholders identified through a mapping process, including public and private organizations/bodies involved in medical research and education, health care planning, drug industry distribution and monitoring.
Two conceptual frameworks have been tested and theory-based evidence has been delivered to the participating countries for future implementation into their local settings. Certain pilot interventions have been tested in local settings and a proposed intervention frame has been evaluated as feasible, relevant and practical in the busy health care environment.
Evidence has been generated and delivered to stakeholders on future policy actions targeting physicians’ skills and prescribing behaviour in primary health care. Guidance on how to manage physicians’ behavioural change and how to prevent irrational prescribing of medicines at primary care settings has been developed, on the basis of theoretical constructs borrowed from behavioural sciences.
These constructs could be fertilized in undergraduate, postgraduate and continuous medical education to improve medical practice. The collaboration between academic departments, colleges of GPs and primary care networks has been tested and capacity has been built to enable future collaborative efforts in this area of research. This study is expected to enable multi-country, multi-stakeholder consultations in medicine provision and consumption.