Guest guest Posted August 11, 2007 Report Share Posted August 11, 2007 Hi, Justification for sale of OTCs: News like a celebrity’s marriage or honeymoon, cricket, riots, elections… occupy the top page. On TV, serials of the ‘Saas-bahu’ type, singing contests are the most watched. What about the worthy issues and policies that rock the nation? Wonder why barring a handful, nobody even cares to think of them! Sale of OTCs is one such issue. For the last few days, we have been talking on this topic. To add to it, a few suggestions that could be applied at various levels: Prescriber: Doctors should be available-on duty or on call duty at all levels of health care (govt). Where not available, private general practioners can charge a minimal fee, the maximum level of which should be fixed by the govt. so that patients have access to doctor at all times, for any type of ailment. Quacks should not be allowed to practice and RMPs should undergo regular medical orientation course on the latest in medicine. Pharmacist: Pharmacist should be only a dispenser, not a prescriber. Should dispense drugs only with prescription and issue a bill. Ask for two prescriptions for Schedule X drugs. Limit the issue to a maximum of 10 doses or even less for drugs with low Therapeutic index. List of OTCs should be very short and displayed in large bold letters (fluorescent ones for night) outside the pharmacy. No selling of single doses of antibiotics No dispensing on orders over phone/ Internet. Regular training of pharmacists for dispensing medicines and also for selling OTCs. Pharmaceuticals: Package inserts (in all state languages of India) should be enclosed along with OTC drugs so that patient can go through them. Patient: Consult a doctor, take a prescription and then get the drugs prescribed. Demand a bill for the drugs purchased. No purchase of drugs over phone or Internet- you could be cheated. Government: Policy on sale and purchase of medicines- Schedule H, X; OTCs Limit OTCs. Surprise inspections of pharmacies and canceling licenses of unqualified pharmacists or those who violate policies. Regular updates on drug sale and purchase on health websites/ bulletins. Anupama. Did you know? You can CHAT without downloading messenger. Click here Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 18, 2011 Report Share Posted January 18, 2011 Hello again Rob,  Some of this made me smile at your style but on the matter of educating the population I think Mao had it right with his, " shoot one, teach a hundred' policy...(just kidding)..though sometimes...!  On the matter of the patient choosing his preferred OTCs then if you are the one stocking the box of pills then the patient has no choice him/herself and it would be better if you then saw them to give them the most suitable not best marketed and if what you have put in the box is not suitable then the consequences come back on you, again the self service thing does not ask the required questions re medicine dispensing as even in a pharmacy I have found that the nice young thing with the OTC stuff does ask if you have taken this before and if you have any problems with asthma or stomach...well they do in places I have been..maybe not everywhere.  P. From: rob.davis@... <rob.davis@...> Subject: Re: First Aid Boxes Date: Wednesday, 19 January, 2011, 14:14  On Tuesday, January 18, 2011 12:57, " gerry keenan " <gkeenanpa@...> said: > I for one , old dog that i am would love to > read it...and I am not to old to learn new tricks. Old dogs, old bears, old swamp donkeys... Wilf Knows a thing or two about them all, and has the bite marks (and dung piles) to prove it. There are even rumours about his prowess with Kangaroo, but I've been too afraid to confirm them. His wisdom is questionable only when he speaks of women, or those who appear to be women at first glance. An observation I have made about OTCs in first aid cabinets is that, you have to solidly establish that you either are, or are not going to provide them, and make that known to the population you are serving. If you don't let them know that they will remain stocked, then your people tend to start hoarding them. Consequently, every time you re-stock the boxes, they are ransacked within 24 hours by men (and women) who don't want to worry about whether they'll be there next time they need them. If you educate the population, and keep them well stocked, use tends to decrease significantly after the first couple of months, because hoarding stops. Of course, there are multiple legal issues surrounding the dispensing of OTCs in the first aid environment. And these will obviously vary by jurisdiction. I certainly was not aware of the legal restriction in Kanuckistan. But, in the US at least, it is generally accepted that OTCs are not a legal problem, so long as they are left to the patient to choose, and not specifically " prescribed " by the first aid provider. That means, if someone wants something for a headache, you point them towards the box and tell them to take whatever they need, and not tell them to " take two aspirin " . It is also in US OSHA literature that such medications should be individually wrapped and labelled dosages, not a big community bottle for people to pour pills out of. Obviously, reasons of sanitation and product safety are prime factors in this requirement, among other good practices. I'm a big fan of the breakable seal method. It definitely makes your job easier, and gives at least some users cause to stop and think twice before opening that door. Of course, it goes without saying that actual locks are a huge no-no, legality wise. US OSHA doesn't even allow first aid kits to have a means of attaching a lock to. All that said, in a remote environment -- with me as the provider -- I am more inclined to leave the medication dispensing in the dispensary. In most populations, there are plenty of workers who carry their own bottles of ibuprofen or APAP. Those who have the intelligence to come prepared should be rewarded for doing so. And those who do not, should get a clue and be prepared on their next trip, not expecting someone to wipe their arse for them like an infant. If they don't, then they get to receive medical care from me (which is not necessarily a bad thing, although time consuming). I am a medical practitioner, not a vending machine. Which brings us to yet another good solution. Vending machines. They make vending machines specifically for OTC medication selections, and they're not terribly expensive. In fact, at a busy site, they will quickly pay for themselves, while reassuring your population that their OTC needs will always be available without hassle. Rob Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 18, 2011 Report Share Posted January 18, 2011 Hello again Rob,  Some of this made me smile at your style but on the matter of educating the population I think Mao had it right with his, " shoot one, teach a hundred' policy...(just kidding)..though sometimes...!  On the matter of the patient choosing his preferred OTCs then if you are the one stocking the box of pills then the patient has no choice him/herself and it would be better if you then saw them to give them the most suitable not best marketed and if what you have put in the box is not suitable then the consequences come back on you, again the self service thing does not ask the required questions re medicine dispensing as even in a pharmacy I have found that the nice young thing with the OTC stuff does ask if you have taken this before and if you have any problems with asthma or stomach...well they do in places I have been..maybe not everywhere.  P. From: rob.davis@... <rob.davis@...> Subject: Re: First Aid Boxes Date: Wednesday, 19 January, 2011, 14:14  On Tuesday, January 18, 2011 12:57, " gerry keenan " <gkeenanpa@...> said: > I for one , old dog that i am would love to > read it...and I am not to old to learn new tricks. Old dogs, old bears, old swamp donkeys... Wilf Knows a thing or two about them all, and has the bite marks (and dung piles) to prove it. There are even rumours about his prowess with Kangaroo, but I've been too afraid to confirm them. His wisdom is questionable only when he speaks of women, or those who appear to be women at first glance. An observation I have made about OTCs in first aid cabinets is that, you have to solidly establish that you either are, or are not going to provide them, and make that known to the population you are serving. If you don't let them know that they will remain stocked, then your people tend to start hoarding them. Consequently, every time you re-stock the boxes, they are ransacked within 24 hours by men (and women) who don't want to worry about whether they'll be there next time they need them. If you educate the population, and keep them well stocked, use tends to decrease significantly after the first couple of months, because hoarding stops. Of course, there are multiple legal issues surrounding the dispensing of OTCs in the first aid environment. And these will obviously vary by jurisdiction. I certainly was not aware of the legal restriction in Kanuckistan. But, in the US at least, it is generally accepted that OTCs are not a legal problem, so long as they are left to the patient to choose, and not specifically " prescribed " by the first aid provider. That means, if someone wants something for a headache, you point them towards the box and tell them to take whatever they need, and not tell them to " take two aspirin " . It is also in US OSHA literature that such medications should be individually wrapped and labelled dosages, not a big community bottle for people to pour pills out of. Obviously, reasons of sanitation and product safety are prime factors in this requirement, among other good practices. I'm a big fan of the breakable seal method. It definitely makes your job easier, and gives at least some users cause to stop and think twice before opening that door. Of course, it goes without saying that actual locks are a huge no-no, legality wise. US OSHA doesn't even allow first aid kits to have a means of attaching a lock to. All that said, in a remote environment -- with me as the provider -- I am more inclined to leave the medication dispensing in the dispensary. In most populations, there are plenty of workers who carry their own bottles of ibuprofen or APAP. Those who have the intelligence to come prepared should be rewarded for doing so. And those who do not, should get a clue and be prepared on their next trip, not expecting someone to wipe their arse for them like an infant. If they don't, then they get to receive medical care from me (which is not necessarily a bad thing, although time consuming). I am a medical practitioner, not a vending machine. Which brings us to yet another good solution. Vending machines. They make vending machines specifically for OTC medication selections, and they're not terribly expensive. In fact, at a busy site, they will quickly pay for themselves, while reassuring your population that their OTC needs will always be available without hassle. Rob Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 19, 2011 Report Share Posted January 19, 2011 On Tuesday, January 18, 2011 22:42, " peter mitchell " <treetop_bay@...> said:  > Some of this made me smile at your style but on the matter of educating > the population I think Mao had it right with his, " shoot one, teach a hundred' > policy...(just kidding)..though sometimes...! I certainly agree in theory. But when dealing with Aussies, I hear that discretion is the better part of valour. I'll just lock myself in my quarters and let them take whatever they want! > On the matter of the patient choosing his preferred OTCs then if you are the one > stocking the box of pills then the patient has no choice him/herself and it would > be better if you then saw them to give them the most suitable not best marketed > and if what you have put in the box is not suitable then the consequences come > back on you, again the self service thing does not ask the required questions re > medicine dispensing as even in a pharmacy I have found that the nice young thing > with the OTC stuff does ask if you have taken this before and if you have any > problems with asthma or stomach... I completely agree with you. Maintaining personal control is always the preferred choice. But it's all going to depend upon your atmosphere. What I do on a vessel may well vary from what I do on a gas site, on a firebase, or in a large manufacturing facility or office complex. I just wanted to bring several options to light for the original question. Rob Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 27, 2011 Report Share Posted January 27, 2011 I think this just boils down to " libertarianism " v. whatever category you'd prefer to put yourself in (as I'm not trying to be insulting). While I have often been amazed at the immaturity of some of the workers offshore, I choose to treat them as adults until they have been proven otherwise. There are no " required questions " regarding the dispensing of over the counter medications--at least in the U.S.--though obviously some education in the matter is useful. The risks of these medications, while they do exist, are being overhyped and are statistically insignificant relative to population (that being: most of these people have already used all of the OTCs, have their preferences, and believe they " know what works " ). If you recommended another OTC (and refused to give them what they preferred) odds are they would just go hunting among the crew for what they want while badmouthing you anyway--both negative outcomes for the patient, crew, and yourself and only reduces your ability to be effective in your job. While awareness (both as a medic and patient) of some of the issues surrounding OTC meds is appropriate, there are many other things that should be addressed regarding health and safety before I would spent too much time worrying about a guy being allowed to pick up his own ibuprofen or not. With all that said, so long as the people get treated, I don't think you're wrong for choosing the method that works best for you, as I didn't realize that this topic would be as polarizing as it is. At the very least, it has been educational and made me consider some of the differences that constitute the cultural norms. Austin On Jan 19, 2011, at 12:23 AM, peter mitchell wrote: > Hello again Rob, > > Some of this made me smile at your style but on the matter of educating the population I think Mao had it right with his, " shoot one, teach a hundred' policy...(just kidding)..though sometimes...! > > On the matter of the patient choosing his preferred OTCs then if you are the one stocking the box of pills then the patient has no choice him/herself and it would be better if you then saw them to give them the most suitable not best marketed and if what you have put in the box is not suitable then the consequences come back on you, again the self service thing does not ask the required questions re medicine dispensing as even in a pharmacy I have found that the nice young thing with the OTC stuff does ask if you have taken this before and if you have any problems with asthma or stomach...well they do in places I have been..maybe not everywhere. > > P. > > > > From: rob.davis@... <rob.davis@...> > Subject: Re: First Aid Boxes > > Date: Wednesday, 19 January, 2011, 14:14 > > > > On Tuesday, January 18, 2011 12:57, " gerry keenan " <gkeenanpa@...> said: > > > I for one , old dog that i am would love to > > read it...and I am not to old to learn new tricks. > > Old dogs, old bears, old swamp donkeys... Wilf Knows a thing or two about them all, and has the bite marks (and dung piles) to prove it. There are even rumours about his prowess with Kangaroo, but I've been too afraid to confirm them. His wisdom is questionable only when he speaks of women, or those who appear to be women at first glance. > > An observation I have made about OTCs in first aid cabinets is that, you have to solidly establish that you either are, or are not going to provide them, and make that known to the population you are serving. If you don't let them know that they will remain stocked, then your people tend to start hoarding them. Consequently, every time you re-stock the boxes, they are ransacked within 24 hours by men (and women) who don't want to worry about whether they'll be there next time they need them. If you educate the population, and keep them well stocked, use tends to decrease significantly after the first couple of months, because hoarding stops. > > Of course, there are multiple legal issues surrounding the dispensing of OTCs in the first aid environment. And these will obviously vary by jurisdiction. I certainly was not aware of the legal restriction in Kanuckistan. But, in the US at least, it is generally accepted that OTCs are not a legal problem, so long as they are left to the patient to choose, and not specifically " prescribed " by the first aid provider. That means, if someone wants something for a headache, you point them towards the box and tell them to take whatever they need, and not tell them to " take two aspirin " . > > It is also in US OSHA literature that such medications should be individually wrapped and labelled dosages, not a big community bottle for people to pour pills out of. Obviously, reasons of sanitation and product safety are prime factors in this requirement, among other good practices. > > I'm a big fan of the breakable seal method. It definitely makes your job easier, and gives at least some users cause to stop and think twice before opening that door. Of course, it goes without saying that actual locks are a huge no-no, legality wise. US OSHA doesn't even allow first aid kits to have a means of attaching a lock to. > > All that said, in a remote environment -- with me as the provider -- I am more inclined to leave the medication dispensing in the dispensary. In most populations, there are plenty of workers who carry their own bottles of ibuprofen or APAP. Those who have the intelligence to come prepared should be rewarded for doing so. And those who do not, should get a clue and be prepared on their next trip, not expecting someone to wipe their arse for them like an infant. If they don't, then they get to receive medical care from me (which is not necessarily a bad thing, although time consuming). I am a medical practitioner, not a vending machine. > > Which brings us to yet another good solution. Vending machines. They make vending machines specifically for OTC medication selections, and they're not terribly expensive. In fact, at a busy site, they will quickly pay for themselves, while reassuring your population that their OTC needs will always be available without hassle. > > Rob > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 28, 2011 Report Share Posted January 28, 2011 On 1/27/2011 8:40 PM, B. Austin wrote: > > ...The risks of these medications, while they do exist, are being > overhyped and are statistically insignificant relative to population... The U.S. CDC reports an estimated 16,500 deaths per year from NSAIDs, and alcoholism is a co-morbid factor. LT Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 28, 2011 Report Share Posted January 28, 2011 Are all of those NSAIDs OTC, though? And how many were suicides? Either way, it's an interesting statistic. Regards, Alyssa Woods, NREMT-B (210) 842-6428 Sent from the itty bitty keyboard on my iPhone On Jan 28, 2011, at 9:25 AM, Larry Torrey <ltorrey@...> wrote: > On 1/27/2011 8:40 PM, B. Austin wrote: > > > > ...The risks of these medications, while they do exist, are being > > overhyped and are statistically insignificant relative to population... > > The U.S. CDC reports an estimated 16,500 deaths per year from NSAIDs, > and alcoholism is a co-morbid factor. > > LT > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 28, 2011 Report Share Posted January 28, 2011 Your number comes from thirteen+ year old research by Gurkipal Singh who popularized this number. There is no reference in any of his articles to any CDC report, it's just an estimate from what I can tell. Another estimate is 3,200 deaths/year (Tarone, 2004) while Cryer states " The lack of good estimates regarding these problems with NSAIDs is largely a reflection of the inadequate surveillance systems to capture rare events " (2005). Do I deny there is a problem with NSAIDs particularly in patients with co-morbid factors or those abusing the medication? No. Do ERs frequently see (stupid) people trying to OD on them and messing their liver and GI tract up? Sure. Does that make it less of a zebra in the offshore/remote environment? Nope, unless you're regularly dealing with the suicidal on your vessel or site, in which case you -certainly- have larger problems to deal with. Again, it simply comes down to personal preference or legal responsibilities. You may have to do it one way by law, or you may choose another way by preference, but there is no evidence that doing otherwise is risky or unsafe. Austin Cryer, B. (2005). NSAID-associated deaths: the rise and fall of NSAID-associated GI mortality. The American Journal Of Gastroenterology, 100(8), 1694-1695. Retrieved from EBSCOhost. Singh, G. (1998). Recent considerations in nonsteroidal anti-inflammatory drug gastropathy. The American Journal Of Medicine, 105(1B), 31S-38S. Retrieved from EBSCOhost. Tarone, R., Blot, W., & McLaughlin, J. (2004). Nonselective nonaspirin nonsteroidal anti-inflammatory drugs and gastrointestinal bleeding: relative and absolute risk estimates from recent epidemiologic studies. American Journal Of Therapeutics, 11(1), 17-25. Retrieved from EBSCOhost. On Jan 28, 2011, at 10:25 AM, Larry Torrey wrote: > On 1/27/2011 8:40 PM, B. Austin wrote: > > > > ...The risks of these medications, while they do exist, are being > > overhyped and are statistically insignificant relative to population... > > The U.S. CDC reports an estimated 16,500 deaths per year from NSAIDs, > and alcoholism is a co-morbid factor. > > LT > Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You are posting as a guest. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.