Cross‐sectional survey of medication used for headache in a general population

Objective To determine the level and types of medication used to treat headache in the general population and to compare this with current recommendations. Methods Cross‐sectional survey to an adult general population sample. A questionnaire gathered information on occurrence, characteristics of, and medication use for headaches in the previous three months. Setting Patients aged 18 years and over registered with five general practices in North Staffordshire, England. Key findings The response rate was 56%. Eighty‐five per cent of headache sufferers (60% of all questionnaire respondents) reported using medication for their headaches in the three months prior to the survey. Medication use was more likely to be reported by women, respondents aged 36 to 50 years, those reporting more painful and more disabling headaches, those experiencing at least five associated symptoms, and those whose untreated headaches lasted 4 to 24 hours. Paracetamol was by far the most widely used medication, with 74% of medication users taking it in the three‐month period. Fifty‐eight per cent of acute medication users took only one single therapy for their headaches. Only a small number of medication users (3%) took their headache medication before the pain began, with most (63%) taking it when the pain started and the remainder waiting until the pain was unbearable. Half of medication users (47%) reported that the medication completely relieved their headache, 51% obtained partial relief and 2% did not obtain relief. Conclusion Medication use for headache appears to be appropriate for most patients. Although only a minority used combination therapy, the high prevalence of headache means that this translates to substantial numbers in the population as a whole. Some headache sufferers might benefit from advice to make better use of the treatments available.     

Satisfaction with information and its relationship with adherence in patients with chronic pain

□ Due to the nature of chronic pain it would be expected that patients are highly adherent to their pain medication. However, results from this study have shown that 23 per cent of patients often or always avoid using their pain medication, 13.4 per cent often or always alter dosages, and 10.3 per cent often or always stop taking their medication for a while. This suggests intentional non‐adherence to pain medication □ Less than 50 per cent of respondents were satisfied with information provided on side effects, what to do if side effects occur, and possible interactions with other medication □ Patients' satisfaction with information about their medication was related to self‐reported adherence; greater satisfaction was associated with higher self‐reported adherence     

Patient self‐eports of potential adverse drug reactions

□ A systematic questionnaire was found to be a feasible method of facilitating patients to report symptoms they perceived to be potential adverse effects of drugs □ Although 89 per cent of patients who had taken tramadol and venlafaxine reported at least one symptom in questionnaires, only 58 per cent of these claimed to have reported their symptoms to their doctor □ Only 22 per cent of symptoms reported by a sample of patients were found to be recorded in medical records and only 23 yellow card reports were submitted to the CSM for the same period □ Low reporting rates to GPs and low recording rates would appear to be contributory factors to low rates of reporting to the CSM.     

A patient‐held medication record and a patient medication profile to support the continuity of acute cancer care

□ The sharing of care of patients receiving medical oncology care is vulnerable to errors in their documented drug history □ A patient‐held medication record identified over 90 per cent of patients' medications but was ‘forgotten’ by the patient in a third of contacts with a pharmacist □ Discrepancies between the medication records of GPs, community pharmacists and the medical oncology clinic were highly prevalent □ A posted patient medication profile issued by the hospital pharmacist to both the patient's GP and their community pharmacist was associated with a significant convergence in their records (discrepancies reduced from 17 to 6 % P<0.001) □ The patient‐held record had little impact on the accuracy of practitioners' records and its value lies more in facilitating patient education than rectifying errors in documentation     

Identification of psychosocial factors which influence patient adherence with antihypertensive medication

□ It is estimated that only 50 per cent of hypertensive patients adhere to medication regimens □ In this study evaluation of self‐efficacy and the theory of planned behaviour was used to identify psychosocial factors which impact on patient adherence to antihypertensives □ High self‐efficacy, intentions to comply with the medication regimen, possessing a positive attitude towards taking medication, perceiving pressure from significant others to take medication as prescribed, and perceiving control over taking medication were determinants of good adherence □ The successful identification of factors which influence adherence will allow health‐care providers to implement interventions, aimed at enhancing adherence with antihypertensive medication.     

SIGN guidelines and the management of sore throat in community pharmacy

□ Scottish Intercollegiate Guidelines Network guidance on the management of sore throat recommends analgesia and refer to the role of the community pharmacist in advising symptomatic relief □ Advice given to 749 patients from 65 community pharmacies; 49 patients (6.5 per cent) were referred to their general practitioner □ Paracetamol, drug of choice from SIGN guideline, was recommended to 219 patients (29 per cent); a preparation for symptomatic relief either alone or in combination with an analgesic was advised for 590 patients (79 per cent) and of these, 315 patients (42 per cent) were recommended lozenges with anaesthetic and antibacterial action □ Compliance with SIGN guidelines was observed regarding choice of analgesic □ Evidence is required for choice of symptomatic relief.     

Preliminary investigation of the problems associated with supply of palliative care medicines in primary care

□ Fax‐back was a cost effective method for administration of a self‐completion questionnaire which produced a high (76 per cent) response rate □ Problems with supply of palliative care medicines were reported by 58.5 per cent of health authorities responding to the survey □ Supply of medicines out of hours was the most common problem reported (93 per cent), with stock levels held in pharmacies and problems with specialist medicines also causing problems in over 50 per cent of respondents □ Some health authorities reported that protocols for supply of palliative medicines, or the existence of designated community pharmacies for their provision, reduced the problems reported □ Further research into effectiveness of protocols and designated palliative care pharmacies is indicated, and our study has identified those health authorities where such research could be targeted     

A postal survey to assess the views of community pharmacists on the deregulation of emergency hormonal contraception

□ This was a postal survey undertaken before EHC was available nationally in UK community pharmacies □ The survey aimed to assess attitudes of UK community pharmacists towards the deregulation of EHC □ A response rate of 66 per cent was attained and the consensus was that community pharmacists broadly agreed with the deregulation of EHC □ Pharmacists believed that the supply of EHC through pharmacies would increase their professional status, and there would be need for GP collaboration □ Although pharmacists welcomed EHC deregulation, they had reservations about legal implications     

Medication overuse headache from antimigraine therapy: clinical features, pathogenesis and management

Medication overuse headache (MOH) is being recognised more often in headache, neurology and primary care clinics, but is still frequently overlooked. The most significant factor in the development of MOH is the lack of widespread awareness and understanding on the part of clinicians and patients. While the diagnosis of MOH may be suspected clinically, it can only be confirmed in retrospect. Diagnosis may take > or =3 months because of the need for prolonged observation after cessation of medication. Diagnosis must be based on observation of patterns of headaches and medication use, remembering that MOH is only seen in patients with migraine and not in those without. MOH should be viewed as an entity that is caused or propagated by frequently used medication taken for headache symptomatic relief. Because of easy availability and low expense, the greatest problem appears to be associated with barbiturate-containing combination analgesics and over-the-counter caffeine-containing combination analgesics. Even though triptan overuse headache is not encountered with great frequency, all triptans should be considered potential inducers of MOH. There are several different theories regarding the aetiology of MOH, including: (i) central sensitisation from repetitive activation of nociceptive pathways; (ii) a direct effect of the medication on the capacity of the brain to inhibit pain; (iii) a decrease in blood serotonin due to repetitive medication administration with attendant upregulation of serotonin receptors; (iv) cellular adaptation in the brain; and (v) changes in the periaqueductal grey matter. The principal approach to management of MOH is built around cessation of overused medication. Without discontinuation of the offending medication, improvement is almost impossible to attain. A three-step approach to treating patients with analgesic rebound headaches includes: (i) a bridging or transition programme; (ii) nonpharmacological measures; and (iii) prophylactic medication started early in the course of treatment (after offending medication is successfully discontinued). The best management advice is to raise awareness and strive for prevention. Prophylactic medications should be initiated for patients having > or =2 headache days per week. Anticipatory medication use should be discouraged and migraine-specific therapy should be considered as early as possible in the natural history of patients' headaches. Reduction in headache risk factors should include behavioural modification approaches to headache control earlier in the natural history of migraine.     

Supplying emergency hormonal contraception in the pharmacy: the perspectives of service users

□ Pharmacists have been supplying emergency hormonal contraception via patient group direction in Manchester, Salford and Trafford health action zone since late 1999 □ This paper presents preliminary results of a questionnaire survey of users experiences of obtaining emergency contraception from this source □ Four hundred and thirty out of a total of 5,020 questionnaires distributed by pharmacists were completed □ Ninety‐nine per cent of service users were either very satisfied or satisfied with the manner in which their request for emergency contraception was dealt with □ Ninety‐one per cent of respondents felt either comfortable or very comfortable discussing emergency contraception with the pharmacist     

Use of health information touchscreens by community pharmacy users in six local community pharmacies

□ Considerable update of touchscreen availability □ Wide variety of information accessed □ Number of accesses broadly comparable with NHS Direct call figures □ Sixty‐four per cent of touchscreen users are under the age of 35 years □ Supermarket pharmacy had most accesses     

A methodological study of some factors influencing the reporting of symptoms.

The spontaneous occurrence of symptoms that are often regarded as adverse drug reactions was studied by means of open questionnaires or by a 38-item checklist of symptoms. Of the 416 respondents who returned an analyzable questionnaire, only 233 (56 per cent) were healthy (defined as having had no illness and/or having taken no medication in the previous three days). Using the open questionnaires, one or more symptoms were reported by 15 per cent of healthy persons (N equals 155) and by 69 per cent of a group of 118 persons who had been ill and/or who had taken medication in the previous three days. In contrast, using the checklist questionnaires 82 per cent of healthy persons (N equals 78) and 97 percent of persons who had been ill and/or who had taken medication in the previous three days (N equals 65) reported one or more symptoms. The total number of symptoms reported by any one person was three with the open questionnaire and 22 with the checklist. In addition, a greater severity of symptoms was associated with the open questionnaire. Sex, educational level, or presence or absence of previous exposure to clinical trials did not influence the nature and incidence of symptoms reported. However, the severity of symptoms reported was significantly different for the latter two factors. Differences in the frequency with which certain symptoms were reported and the relevance of these and other observations to the design of clinical trial record forms are discussed.     

Analgesic use for headache treatment by schoolchildren of southern Brazil

The importance of the use of analgesic medication for the symptomatic relief of pain has been underestimated in medical practice. The objective of this study was to determine the prevalence of tension-type and migraine-type headaches and the associated analgesic consumption for its treatment within elementary school students from Porto Alegre (Brazil). A systematic random sample of 538 students from 5th to 8th grades was produced to complete the cross-sectional delineation. Subjects were individually submitted to a structured interview on headache and to general physical and neurological examination. Lifetime prevalence for headaches was 93.3%, 82.9% of the students recalled having headaches during the last year and 31.4% reported headaches in the last week. The prevalence for headaches in the previous 24 h was 8.9%. There was a significant prevalence of headache in females. The prevalence of analgesic consumption was 84.1% throughout life, 85.7% in the last year, and 54% in the last 3 months. A significantly higher prevalence of headache medication consumption was also depicted for females. However, the small age differences within the sample did not appear to be an important factor in influencing analgesic use for headaches. Different agents composed the individual treatment of headaches, with predominant use of over-the-counter preparations. Acetylsalicylic acid, consumed by 58.3% of the children, was the drug most frequently used for both tension-type and migraine-type headache treatments. In spite of the verification that headache was very frequently experienced by the children composing this sample accompanied by a consequent use of analgesics, no medication abuse was diagnosed.     

The use of sublingual glyceryl trinitrate and aspirin in angina patients and enhancement of coronary heart disease databases

□ Audit involving 95 per cent of community pharmacists in one LHCC □ Data were gathered using a semi‐structured questionnaire □ A list of all participating patients was sent to each GP surgery in the locality to enhance their CHD database □ Not all appropriate angina patients are receiving aspirin □ Patients' knowledge of GTN management was poor and should be improved upon by input from healthcare professionals     

Factors related to medication adherence among homeless women and children

Objective The primary objective of this study was to examine factors related to medication adherence among homeless women and children. A secondary purpose was to describe the medication informational needs of homeless women. Method Fifty‐seven women at six different shelters for homeless women in Wake County, North Carolina were interviewed during the summer of 2001. Key findings Fifty‐eight per cent of women reported having at least one medical condition and 84% of the women had taken at least one medication during the past week. Twenty‐six per cent of women said that during the last week they had not taken a medication on purpose and 30% purposively cut back on a medication. A woman with a substance abuse problem was five times more likely to purposively not take a medication. Almost half of the women who had children living with them had a child that had taken medication during the past week. The primary reasons cited for not using medications as directed were access issues. Fifty‐eight per cent of the women wanted to learn more about their or their children's medications. The majority of women preferred to receive more verbal and written drug information. Conclusions Pharmacists need to work with local homeless shelters and the women in these shelters to help make sure that they receive needed medications and information for themselves and their children.     

Developing an R&D agenda for pharmacy workforce research

□ A consultation exercise was conducted to identify and prioritise the research agenda on the pharmacy workforce □ A two‐ound Delphi technique was employed for the main study □ People from all sectors of the profession were invited to contribute their views on what research should be carried out □ Ninety per cent of respondents agreed that the top priority for research was to “identify the levels, causes and implications of turnover among different cohorts of pharmacists” □ The need to take forward aspects of the proposed programme is now a matter of some urgency for the profession and the National Health Service     

Futile and inappropriate prescribing: an assessment of the issue in a series of patients admitted to a specialist palliative care unit

□ Palliative care patients are often subjected to polypharmacy, some of which is futile or inappropriate □ Rationalisation of medication does not occur due to patients being seen by several specialists and prescribers fearing the reaction of a patient whose drug rationalisation may remind the patient of his/her own mortality □ Patients raised no objections to having medication withdrawn after the reasons why had been carefully communicated to them □ Health care professionals need to do regular medication review as part of their role to achieve favourable outcomes for patients