Diss. (sammanfattning) Uppsala : Uppsala universitet, 2006. / Härtill 4 uppsatser.

Följande uppsats analyserar utvecklingen av läkemedelsreklam i Sverige under perioden från sekelskiftet 1900 till nutiden. Under denna period har läkemedelsreklam gått genom många förändringar. Regelverken som styr marknadsföring av läkemedel har konstant växt och medfört att läkemedelsreklamens innehåll, form och målgrupp har blivit tydligt definierade. Det ledde till minskning av ”kvacksalveri” och ”humbugreklam”, som var ett stort problem i början för läkemedelsreklamen i Sverige. Etiska standarder inom branschen har ökat under de senaste hundra åren. Förutom detta har reklamens innehåll och marknasföringssätt förändrats parallellt med medieutvecklingen. Läkemedelsreklam utvecklades från enkla utomhusaffischer till moderna digitala former, som används för nutidens marknadsföring. Även om utvecklingen av läkemedelsreklam har varit beständig och effektiv, finns fortfarande utrymme för ”polering” av både regelverket och etiska standarder inom verksamheten. Denna uppsats försöker erbjuda svaret på frågan: ”Hur har marknadsföring av läkemedel utvecklats under perioden mellan 1900 till nutid i Sverige?”. Förutom detta diskuteras positiva och negativa aspekter av marknadsföringen av läkemedel i Sverige, samt vilka åtgärder som skulle bidra till en saklig, balanserad och icke vilseledande läkemedelsreklam. Metoden som användes att svara på examensarbetets frågeställning var litteraturöversikt över kvalitativa studier och publikationer. Källor som användes i den här litteraturstudien omfattade bland annat böcker, statliga dokument, websidor, akademiska uppsatser och populär litteratur, som var publicerade inom området marknadsföring, medicin, farmacia, läkemedelsreklam etc. Analysen av litteratur som behandlar problematiken kring svensk läkemdelsreklam, från 1900 till 2018, ledde till slutsatsen att svensk läkemdelsreklam utvecklades inom följande tre kategorier: regelverket, etiken och mediaformer. Utvecklingen av regelverket omfattar antagandet av sju nya rättsliga lagar och fyra utomrättsliga regler, som under den analyserade perioden har satt normen för svensk läkemedelsreklam. Etiska standarder höjdes parallellt med utvecklingen av regelverket inom branschen, men också på grund av ett självreglerande system, som idag omfattar utomrättsliga regler och institutioner, som t.ex. Läkemedelsindustriföreningen (LIF), Nämnden för bedömning av läkemedelsinformation (NBL) och liknande, vars funktion är att bevaka och vägleda läkemdelesföretags marknadsaktiviteter. Mediautvecklingen omfattar uppkomsten av sex nya mediakanaler som har använts för läkemdelsreklamens syfte. Analysen visade också att det fortfande finns utryme för förbättring inom området med avseende på konroll av marknadsföringsmaterialet innan publicering, höjning av böterna för ”osund” marknadsföring, samt ökning av transparens av forskningsresultat. / Advertising has always been a powerful tool for the pharmaceutical industry. The history of pharma marketing in Sweden dates to the beginning of the 20th century. That was the time of “miraculous” drugs that could, according to advertisements, treat any kind of disease. Back then, marketing activities didn´t imply more than using empty promises, which were in combination with an alluring illustration, placed in a newspaper or an attractive public place. Consequently, negative perceptions have been plaguing the pharmaceutical marketing from the very beginning. In the years to come, medico-marketing in Sweden was struggling to rebuild its image. Marketing activities got strictly regulated at the national level via numerous laws, rules or procedures. Many authorities have been established to control the market and provide guideline for socially responsible, honest, respectful and up-to-date pharma marketing. As the result, up to the end of the 20th century conditions in pharmaceutical industry in Sweden have radically changed. Frivolous marketing of pharmaceutical drugs is today a matter of the past. However, there are still examples where pharmaceutical companies are breaking the law and are being accused of inappropriate marketing of drugs or lack of transparency in reporting results from negative clinical trials. Those examples are the warning signs for authorities that there is still a lot of space for further regulation of the market. Following thesis has an aim to answer to the question: “ How did pharma marketing in Sweden develop in the period between the beginning of the 20th century until today?”. Methodology used in this thesis include a qualitative method literature review, which is a survey of important articles, books and other sources relevant to the research question. A review of litterature published in Swedish language in period between the beginning of 20th century and today, showed that development of medico-marketing in Sweden took place within three following categories: regulatory law, ethics and media marketing. Apart from the progress in the analysed fields, there is still space for improvement. Some proposals for rasing the quality of marketing activities in the pharmaceutical industry include following: control of marketing materials before publishing, increasing the fees for marketing that is inconssistent with the regulatory laws and move toward greater transparency for clinical trial data.

Under de senaste åren har farmaceutens roll på apoteket ändrats. Från att fokus tidigare legat på läkemedel läggs det nu främst på omsorg om kunden. Målet är att sträva efter en aktiv dialog med hjälp av god kommunikation för att ta reda på kundens behov. Men inom kommunikationsprocessen förekommer en del hinder som kan försvåra och reducera möjligheten att förmedla ett budskap. För att uppnå en god och effektiv kommunikation mellan farmaceut och kund är det viktigt att finna olika åtgärder för att förhindra att dessa hinder påverkar kommunikationen. Syftet med den här studien var att studera kommunikationen mellan kunder och farmaceuter med fokus på förekomsten av kommunikationsbarriärer.  Hur ofta uppstår kommunikationsbarriärer på apoteket? Hur bemöter och åtgärdar farmaceuten kommunikationsbarriärer? Hur kan farmaceuten bemöta och åtgärda kommunikationsbarriärer för att kundmötet ska avslutas positivt? Insamling av data gjordes med hjälp av strukturerade observationer som genomfördes på apotek runt om i Sverige. Ett tydligt utformat observationsschema fylldes i, samtidigt som det skedde ett möte mellan farmaceut och kund som handlade om förskrivningar. Av 422 kundmöten med farmaceuter på 11 apotek visades  förekomst av kommunikationsbarriärer vid 164 (39%) av observationerna. De tre vanligaste kommunikationsbarriärerna var farmaceutrelaterade vid  12% av observationerna, språkrelaterade 10%, och tidsbrist hos kunden 8 %. Övriga kommunikationsbarriärer var kundrelaterade 8% och relaterade till apoteksmiljön 3%.  96 (59%)  av ovan 164 observerade kundbarriärer åtgärdades under expeditionen av recepten. Gemensamt för dess åtgärder var att de resulterade i att kunden blev nöjd.

Abstract Medicines are substances used to prevent, alleviate or cure diseases which is an important part of health care. The role of the pharmacist in the healthcare chain is important because they are the patients last contact with healthcare professionals. After this contact they must assume responsibility over their own treatment. The pharmacist's responsibility is to make sure that the patient has received essential information about their drugs and to check that the prescribed dose is correct. The increased digitalization of society brings an opportunity for the patients to increase participation and understanding of their drug treatment. Decision support systems are different methods used to obtain a basis for decision making. Pharmacists use these systems to check if prescriptions are correct, for example by ensuring that the right medication, in the correct dose, has been prescribed to the right patient at the right time. In Sweden there is a decision support system called elektroniskt expertstöd (EES). This system offers pharmacy customers further drug control in addition to other controls that are available through the pharmacy's other systems. The benefit of this system is that the pharmacist has better support in detecting incorrect doses, interactions, duplicate medications and if the drug is inappropriate for the patient's gender or age. When the system alerts, the pharmacist makes an assessment which may be discussed with the patient or the physician if needed. Purpose The purpose of this survey study was to investigate what the pharmacy customers knows about EES and the pharmacists use of the system. Method Before the study started, approval from the southeast ethic committee was obtained which said that there were no ethical barriers for the performance of the study. The surveys were handed out to anyone who would receive prescriptions at different pharmacies in Luleå, Grängesberg, Värnamo, Kalmar and Torsås. The common goal was to spend 20 hours of handing out surveys per student. The results were put together and analyzed in IBM SPSS Statistics with descriptive statistics.  Results and discussion The results show that most of the respondents did not know about EES and did not know if the pharmacists are using this support system. The results also show that most of the respondents had not given their consent to EES and did not know if EES could support the pharmacists work. More than half of the survey population answered “do not know” on a question asking if they wanted the pharmacist to use EES when dispensing drugs. Almost a quarter of the total population wanted the pharmacist to use EES and close to three quarters of the total population had no knowledge of the system. This could mean that the customers who have knowledge wants the system to be used. A reason for wanting the system to be used without having knowledge of it could be that customers trust it is beneficial for themselves and for the pharmacists. Building trust and showing care in each customer meeting is important to make the customer susceptible to information. Sufficient information can lead to better compliance in drug treatments. Before the pharmacist can use EES for the first time the customer must consent. Although it was a few years since the introduction of EES into pharmacies, some pharmacists find it difficult to connect customers to the system. It is a relatively new way of working with drug analysis at the pharmacies in Sweden. More practice in the system could provide increased use of it and help the pharmacists decision making.   Conclusion Only a small proportion of the pharmacy customers have knowledge of EES. But even so, one fourth of them wanted the system to be used to analyze their medication which is considered positive.

Abstract Background and Objective: An accurate medication history list is an integral part of the patient assessment at hospital admission. The objective of the study was to describe the frequency, type, and predictors of unintentional medication errors and to evaluate the quality of the clinical pharmacy services focusing on the acceptance of the recommendations made by the clinical pharmacist. Setting and methods: A descriptive study was conducted at two internal medicine wards at Baghdad Teaching Hospital in Iraq using Lund Integrated Medicines Management (LIMM)-based medication reconciliation. The study pharmacist conducted medication interviews for patients shortly after hospital admission to obtain the most accurate pre-admission medication history list. This list was compared with the medication list in the patient’s medical chart. Intended addition, withdrawal of a drug, or changes to the dose/ dosage form in the patient’s medical list was considered as medication discrepancies. However, medication discrepancies were considered as medication errors based on no identified clinical reason. Results: A total of 114 patients were included in this study. Over two-thirds of the study patients (73.7%) experienced 215 medication errors identified by a clinical pharmacist conducting medication reconciliation. Most errors were omission (87.9%). Cardiovascular agents followed by NSAID were commonly in error (53%) and (10.2%) respectively. In a logistic regression model, age (odds ratio (OR), 1.055: 95% confidence interval (CI) 1.010 - 1.102), female gender (OR, 3.468: 95% CI 1.232- 9.761) and number of medications at admission (OR, 0.810: 95% CI 0.681-0.963) were predictors for medication history errors at admission. Conclusions: Medication errors at the time of hospital admission are common and undetected.  A structured approach like the LIMM-based medication reconciliation at Iraqi hospital is needed to detect these errors.

The origin of the word ‘communication’ is the Latin word communicare, meaning to make common. The reason for our communication is to share thoughts, feelings and information, we want to affect and confirm. We are used to interpersonal communication, but even if we have had a lot of practice at it during our lives, we still find our selves facing misunderstandings and conflicts. The more people we meet during a day, the greater the chance is for interruptions in the communication. In pharmacy practice, good communication is vital for the client’s health and quality of life. In recent years, there has been a change of focus in pharmacy practice, from the medication to the clients. To be able to provide care for the client and to reduce drug related problems, a good relationship has to be built between staff and client. The tool for building this relationship is good communication. The aim of this study was to observe the communication between clients and pharmacy employees. How many of the encounters involve communication problems? What is causing the communication problems? What can the pharmacist do to improve the encounter? How do pharmacists handle communication problems, and how does this affect the outcome of the encounter? The data was collected using structured observations at pharmacies using a coding scheme, defined with rules and procedures. The encounters studied were those involving a client, an employee with the title ‘Leg. Apotekare’ or ‘Leg. Receptarie’ and a conversation about prescriptions. Different kinds of communication problems or potential communication problems were identified, but more specific categorisations were needed. Two systems to identify different types of communication problems were developed. One identified different levels of communication problems, not taking in to account what or who caused them. The other system identified the communication problems caused by circumstances or the client, but not by the pharmacist. This was used to compare pharmacist behaviour in connection to the communication problems. The results show that communication problems were found in almost a third of the 343 valid observations, according to the levels of communication problem previously described. The most common potential communication problems were lack of eye contact, not expressing positivity, the client helping someone else to get their medicine and that the client’s medicine was not in store at the pharmacy. In spite of all the communication problems, 95,9 % of the clients were perceived as satisfied at the end of the encounter. What the pharmacist can do to prevent the potential communication problem from causing an actual communication problem is to reinforce positive behaviour. For example to maintain eye contact, be a good listener, act with concern for the client and be specific and clear while communicating. When comparing the pharmacists’ behaviour in problematical encounters that ended well and those who did not, the usage of positive behaviour was generally more common in the encounters that ended well. Therefore, the conclusion is, that a reduction in the number of problematical encounters could be reached by intentional use of positive reinforcement by the pharmacists.

Alzheimers sjukdom (AS) är den vanligaste demenssjukdomen som primärt drabbar äldre ³ 65 år. Sjukdomsmekanismerna är inte helt klarlagda dock finns det vetenskapligt bevis som visar att β-amyloid och tau-protein har en avgörande roll i uppkomsten av AS, vilket leder successivt till utveckling av nervcellsdegeneration i hjärnan. Vanliga symtom är minnesbesvär, försämrat språk och tidsuppfattning. Idag finns det ingen behandling som botar sjukdomen utan befintliga läkemedel, acetylkolinesterashämmare (indikation mild/måttlig demens) och memantin (indikation medelsvår/svår demens) används endast som symtomlindrande mediciner. Syfte: Avsikten med litteraturstudien var att undersöka effekten av kolinesterashämmare på patienter med indikation svår Alzheimers sjukdom. Olika databaser och artiklar har använts för att få information om AS och svar på min frågeställning. Resultat: Granskade artiklar visar att kolinesterashämmare kan användas med säkerhet och har god effekt på kognitiva förmågan, ADL-funktioner (”activities of daily living”) och globala funktioner för behandling av patienter med ett svårt stadium av Alzheimers sjukdom under minst 6 månader. Donepezil visar bättre effekt på kognitiva förmågan jämfört med galantamin och rivastigmin. Biverkningarnas svårighetsgrad var generellt mild eller måttlig i form av gastrotintinala besvär. Slutsats: Kolinesterashämmare gynnar patienter med en MMSE poäng 4-12 jämfört med placebobehandling. Fler studier krävs för att utvärdera effekten av galantamin och rivastigmin. / Alzheimer’s disease (AD) is the most common dementia disorder that primarily affects older people age ³ 65 years. The disease mechanisms are not entirely understood, but there is some scientific evidence that describes how Β-amyloid and tau protein play an important role in the pathogenesis of AD, which gradually leads to the development of neurodegeneration in the brain. The disease is characterized by cognitive dysfunction and typical symptoms include memory loss, problems with language and behavioral issues. Currently there is no cure for dementia but acetylcholinesterase inhibitors and memantine can temporarily slow down the decline of symptoms.      The purpose of this literature study was to investigate the effect of cholinesterase inhibitors on patients with severe Alzheimer's disease. Different databases and articles have been used to search information about AD and answer to my question. Results: Examined articles showed that cholinesterase inhibitors could be used safely and have some effect on cognitive ability in patients with a severe stage of Alzheimer's disease for at least 6 months. Donepezil gives rise to a better effect on cognitive ability compared to galantamine and rivastigmine. The most common adverse effects were mild or moderate in severity. Conclusion: Cholinesterase inhibitors provide important benefits in patients with an MMSE score of 4-12 compared with placebo treatment. More studies are required to evaluate the effect of galantamine and rivastigmine

Bakgrund: Många kunder tycker det är svårt att dela tabletter när de blir ordinerade att göra det och en orsak kan vara att tabletterna smulas sönder vid delning. Följsamheten kan påverkas negativt av att tabletterna smulas sönder. Cirka 10 % av kunderna i tidigare studier har fått kassera tabletter på grund av delningsproblem. Syftet med studien är att ta reda på i vilken utsträckning kunder upplever att tabletterna smulas sönder när de försöker dela dem samt vad kunden gör med smulorna. Metod: Intervjuer med apotekskunder, 18 år och äldre som har fått ett recept med dosering på delade tabletter expedierat. Resultat: Totalt intervjuades 475 av 572 tillfrågade apotekskunder. Det visade det sig att 174 apotekskunder har upplevt att tabletterna smular vid delning och att 29 apotekskunder upplever smulning som ett problem. 93 apotekskunder samlar ihop smulorna och använder dem medan 80 apotekskunder slänger smulorna och delar en ny tablett. Konklusion: En stor andel, mer än 40 % av apotekskunder som talar svenska i hemmet och som delar tabletter, upplever att tabletterna smular men bara 7 % tycker att smulning är ett problem. Det som utmärker dem som upplevt att tabletterna smular är att en större andel använder verktyg för att dela tabletterna. Många samlar ihop och använder smulorna trots att osäkerheten kring hur mycket läkemedel de får i sig är stor. / In Sweden, about 10 percent of the prescriptions have a dosage with split tablets. Many patients have problems with breaking tablets into two or more parts as the tablet may crumble or break into many small pieces. The aim with this work is to examine to which extent patients experience crumbled tablets when trying to split tablets and what the patient does with the crumbles. In order to examine patients experience with crumbled tablets, interviews with patients who collected a prescription with a dosage with divided tablets in one of twelve pharmacies, were done. Included patients had to be 18 years or older. Of the 416 included patients with experience of splitting tablets, 123 had problems with tablet splitting and out of these 29 found the issue with tablets crumbling to be a problem. Overall, 174 patients experienced crumbled tablets. Patients, who didn’t experience crumbled tablets, were less likely to split tablets with a tool than patients who did experience crumbled tablets. 93 of 380 patients collected crumbles equivalent to half a tablet and consumed the crumbles while 80 patients discarded the crumbles (threw them away). Many patients use the crumbles instead of throwing them away even though it is difficult to tell how much of the drug you obtain with the crumbles. It seems as if the way you choose to divide the tablet (with or with out a tool) is affecting whether you experience crumbling or not. Most people don’t experience crumbling and of those who do only one out of six considers it to be a problem. In Sweden in whole the interviews give a slight estimate for how many patients the problem is persistent. In rough numbers it is estimated that 37- 47.000 had experienced crumbled tablets whereas 4.500-10.500 found it be a problem.

Abstract Elective urological patients’ medication usage at the time of admission Author: Nygren. J. Supervisor: Gillespie. U. Examiner: Nielsen. E. Department of Pharmaceutical Biosciences, division of pharmacokinetics and drug therapy. Faculty of pharmacy. Uppsala University, Sweden.   Background and Objective: Information about the patient’s current medication treatment before elective urologic surgery has been based upon a prefilled self-reported health declaration or a patient provided medication list. A new work procedure has recently been adopted where a pharmacist performs a medication reconciliation in order to increase the patient safety, receive deeper insight into the patients ongoing treatment and to reduce the physician’s workload. The objective of the study was to map out how well the patients could account for their medication usage at the time of admission and to identify discrepancies between the health declaration/patient’s medication list and the medication list after medication reconciliation. Design: The study population consisted of adult men and women scheduled for elective urological surgery.  A clinical pharmacist performed a medication reconciliation and stored appurtenant patient data and medication lists in anonymised forma. Data was then analysed by a student undertaking his degree project (MSc Clinical pharmacy). The population and discrepancies were divided into sub-groups and a t-test was performed to identify any statistical difference between selected sub-groups of the population. Setting: Urology department, Uppsala University Hospital Main outcome measures: The proportion of patients having at least one discrepancy were studied. Distribution of discrepancies per patient was compared between sub-groups; number of medications, age and county of residence. Results: At least one discrepancy (range 1-7) was observed in 51 (66%) out of the 77 patients included in the study. Patients using >5 medications at the time of admission had more discrepancies per patient than those using 0-5 medications (3.2 vs 1.0; p=5.6x10-6) and there was a trend towards Uppsala patients having more discrepancies per patient than those residing outside the region (2.4 vs 1.5; p=0.057). There was no significant difference observed between the age groups. Conclusion: The health declaration/medication list presented at the time of admission did not provide enough information to determine the patient’s complete medication usage.

Bakgrund: Användning av läkemedel ökar och därmed ökar också läkemedelsrelaterade problem. För att patienter ska kunna ha en säker läkemedelsbehandling krävs bland annat korrekt och fullständig läkemedelsinformation. I dagsläget finns det olika informationskällor som patienter använder för att hålla koll på sin läkemedelsbehandling men i många av dem förekommer avvikelser som gör att risken för felmedicinering eller överdosering ökar. Syfte: Syftet med det här arbetet var att undersöka prevalensen av avvikelser i läkemedelslista ”Mina sparade recept på apotek” (MSR), samt att se om vissa läkemedelsgrupper skulle förekomma oftare än andra bland avvikelserna. Även andra variabler, såsom informationskällor som patienter använder för att hålla reda på sin läkemedelsbehandling, avsaknad av receptbelagda läkemedel i MSR och användning av receptfria läkemedel mättes. Metod: Data for studien samlades in genom speciellt utformade läkemedelsintervjuer med patienter på ett öppenvårdsapotek i Sverige under veckorna 3–5 i början av 2021. Patienterna som inkluderades var vuxna patienter som hade åtminstone tre receptbelagda läkemedel i sin MSR och som hämtade ut läkemedel åt sig själva. Innan läkemedelsintervjuerna påbörjade erhölls också ett skriftligt samtycke från alla deltagare. Resultat: Nästan 70 procent av 69 intervjuade patienter hade minst en typ av avvikelse i MSR, därav dubbla och inaktuella recept var vanligaste. Bland avvikelserna var de vanligaste läkemedel för behandling av sjukdomar som rör nervsystemet, hjärta och kretslopp samt matsmältningsorgan och ämnesomsättning. En del av patienterna (35 procent) saknade receptbelagda läkemedel i sin MSR, medan 30 procent av dem uppgav att de använde receptfria läkemedel. Informationskällan som användes av de flesta patienterna för att hålla koll på deras läkemedelsbehandling var just MSR.  Slutsats: Avvikelser i MSR förekommer hos nästan 7 av 10 patienter och de läkemedelsgrupperna som var vanligare bland avvikelser är också läkemedelsgrupper som orsakar mest läkemedelsrelaterade problem. Dessa avvikelser måste åtgärdas eftersom de påverkar patienternas säkerhet och förhoppningsvis kommer implementering av den nya nationella läkemedelslistan (NLL) kunna förbättra situationen för både patienten och hälso- och sjukvårdspersonalen. / Background: The use of medicines has increased in the past few years, which has also led to increased amount of drug-related problems (DRP), such as drug-drug interactions and serious adverse effects which lead to hospitalization. In order to decrease the amount of DRP, the medication lists of individual patients need to be accurate and updated. The most used medication list among those available is the one that is printed out at a pharmacy “My stored prescriptions at pharmacy”.  It is also called “Prescription List” (PL). Even though a lot of patients use the PL, there are a lot of discrepancies in it, such as noncurrent and missing prescriptions, but also prescription duplicates. Aim: The aim of this study was to study the prevalence of discrepancies in the PL, such as noncurrent or duplicate prescriptions, wrong dosage or other unclarities, but also to see if there are some particular drug groups which are more common among the discrepancies. Secondary outcomes that were measured included the amount of missing prescriptions in the PL, as well as the usage of over-the-counter (OTC) medicines and primary information sources that patients use to keep track of their prescriptions. Methods: Data needed for the study was collected by interviewing patients at a local pharmacy. The interview was specially designed to answer to all the outcomes and the patient’s individual PL was also used to identify the discrepancies. In order to be included in the study patients needed to be at least 18 years old, have three or more prescriptions in the national prescription repository (NPR) and pick up their own medication, as well as provide a written consent to participate. Pharmacists that were dispensing patient’s prescriptions were also in charge of the recruitment of patients. Result: Out of the 103 patients that were informed about the study, 69 patients were included. Almost 70 percent of them had at least one type of discrepancy in the PL. The most common discrepancy was prescription duplicates (46 percent), followed by noncurrent prescriptions (44 percent). Drug groups which were common among the discrepancies were the drugs used to treat diseases in the nervous system, cardiovascular system and digestive system (including metabolism). Secondary outcomes showed that 35 percent of the patients had at least one missing prescription in the PL, but also that 30 percent of the patients used OTC medicines, the most common being paracetamol (acetaminophen). The most used information source was the PL with 32 percent of patients using it as their primary information source for their medication therapy. Conclusions: Prescription duplicates and noncurrent prescriptions are frequent in the PL and are a major source of medication errors for patients and health-care workers. Drug groups which where the most common among the discrepancies are also the ones responsible for half of the hospitalizations in Sweden. This implies that they could probably be prevented by improving the PL. The number of the missing prescriptions was quite low. The usage of OTC medicines showed that most of patients used painkillers. These are the drugs that Swedes often overuse and therefore, for future safety, monitoring of OTC sales should be implemented. Although it had 21 percent of inaccuracies, the PL was the most used information source for the patients, which gives the conclusion that the improvement of it is needed as soon as possible in order to prevent and decrease the frequency of DRP.