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ORIGINAL ARTICLE
Year : 2021  |  Volume : 14  |  Issue : 1  |  Page : 36-39  

Use of internet for practice of self-medication: We are heading toward an era of internet pharmacy


1 Medical Student Final Year, DY Patil Medical College, Pune, Maharashtra, India
2 Department of Surgery, NSCB Government Medical College, Jabalpur, MP, India

Date of Submission09-May-2020
Date of Decision25-Jun-2020
Date of Acceptance30-Jun-2020
Date of Web Publication22-Jan-2021

Correspondence Address:
Pawan Agarwal
292/293, Napier Town, Jabalpur - 482 003, Madhya Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mjdrdypu.mjdrdypu_242_20

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  Abstract 


Background: Internet has become the major source of health-related information, leading to a growing trend toward unsupervised self-medication using internet. This survey was conducted to assess the extent of internet use to obtain health information/self-medication, their perception regarding side effects of drug used, types/quality of information, and which site was commonly surfed for information. Materials and Methods: A web-based tool (Google Forms) was used to develop a questionnaire to obtain information about extent and impact of internet on self-medication by general population. The questionnaire included 9 questions along with demographic details of participants. The questionnaire was sent to participants by WhatsApp and E-mail and their responses were analyzed. Results: Four hundred and forty-eight (56%) persons responded to survey. There were 226 (50.4%) males and 222 (49.6%) females. The average age of responders was 35.10 years. Overall, 59.8% of responders used internet to obtain health information and self-medication. Out of these, 54.47% took allopathic medications without consulting the doctors. The majority of persons self-medicated for minor illnesses, but 11.6% of persons self-diagnosed and self-medicated for serious illnesses such as heart disease, diabetes, cancers, and psychological problems. 23.2% of peoples think that information on internet carries no risk for self-medication and 21% think that internet use can be a substitute for consulting a doctor. Google was the most common site (93.8%) surfed by participants. The health information provided on net was perceived as very good by 43.7%. Conclusions: There are growing trends toward the self-medication using internet. The health information on internet should be made easier, simpler, and safer to achieve positive health outcomes, but patients should be discouraged for self-medication. To support the safe and appropriate use of nonprescription medicines, minimum practice standards should be set by the governing medical bodies in each country.</ABS>

Keywords: Drugs, internet, self-care, self-medication, side effects


How to cite this article:
Agarwal T, Agarwal V, Agarwal P, Sharma D. Use of internet for practice of self-medication: We are heading toward an era of internet pharmacy. Med J DY Patil Vidyapeeth 2021;14:36-9

How to cite this URL:
Agarwal T, Agarwal V, Agarwal P, Sharma D. Use of internet for practice of self-medication: We are heading toward an era of internet pharmacy. Med J DY Patil Vidyapeeth [serial online] 2021 [cited 2021 Mar 7];14:36-9. Available from: https://www.mjdrdypv.org/text.asp?2021/14/1/36/307669




  Introduction Top


Self-medication is a global phenomenon though its prevalence varies from country to country. Traditionally, people procure drugs for self-medication by recalling or using previous prescription past experience, advice from peers, and by taking over-the-counter (OTC) drugs from pharmacists.[1] However, with the advent and easy availability of internet, it has become a major source of health-related information. The internet is widely used in medicine and had a significant impact on research, training, and patient care. The rapid proliferation of internet has led to availability of health-related information even to lay public who are using internet to self-diagnose and self-medicate to a large extent. There is a concern among doctors regarding the use of the internet by general population to diagnose and treat health issues by self-medication since they can misinterpret and use information wrongly. It could be due to inadequate health literacy, complicated, and poor quality technical information.[2],[3] This survey was conducted to assess the extent of internet use to obtain health information/self-medication, their perception regarding side effects of drug used, types/quality of information, and which site was commonly surfed for information.


  Materials and Methods Top


Ethical approval for the study was accorded by the Institutional Ethical Committee (Letter number IEC/2020/4220 dated 12-05-2020). A web-based tool (Google Forms) was used to develop a questionnaire to obtain information about impact of internet on self-medication by general population. The questionnaire was sent to 800 participants by WhatsApp and E-mail messages and their responses were analyzed. The questionnaire included 9 questions which required multiple-choice/dichotomous answers: yes or no. Questionnaire was validated based on judgment including face validity, content validity, and consensual validity. The questions are shown in [Table 1].
Table 1: Questionnaire for survey

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The questionnaire also collected data on demographics details such as age, gender, occupation, type of family, marital status, and residence. This survey was made available online from August 1, 2019, to August 30, 2019. Link to the survey was sent by E-mails, Facebook, and WhatsApp messages to general population and they were asked to respond. The self-medication was defined as the use of over-the-counter drugs or any allopathic drug for self-treatment, without prior consultation with a certified medical graduate. Responders' consent was implied as all the participants volunteered to fill the Google Forms. Ethical committee approval was taken before starting the study.

Three questions required dichotomous answer: yes/no and other three question's responses were coded in Likert's scale[4] with the responses such as strongly disagree, disagree, agree, and strongly agree. The remaining three questions were open ended required answers from participants.

Data analysis

The prevalence of self-medication was analyzed as percentages.


  Results Top


The survey link was sent to 800 people and 448 (56%) responded to survey. There were 226 (50.4%) males and 222 (49.6%) females. The average age of responders was 35.10 years and it ranged from 18 years to 66 years. 67.9% of responders were professionals, 11.2% were skilled workers, 13.8% were semiskilled, and 7.1% were unskilled. According to the types of family, 55.4% were nuclear family and 44.6% were joint family. 61.2% of responders were married and the remaining 38.8% were single. Majority of the responders (87.5%) were from urban area and only 12.5% from rural area. All questions were answered by all participants.

Overall 59.8% of responders use internet to obtain health-related information and self-medication. Out of these, 54.47% took medications without consulting the doctors. Only 25% of doctors asked their patients regarding use of internet and self-medication [Table 2].
Table 2: Dichotomous response by participants

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The majority of persons self-medicated for common symptoms such as acidity, allergy, body ache, cold, fever, limb pain, migraine, sexual health, stomach disorders, and minor gynecological problems. Google was the most common site (93.8%) surfed by participants, followed by WebMd, Mayo Clinic, Practo, Medscape, and YouTube which were in the range of <1% each.

11.6% of persons self-diagnosed and self-medicated for serious illnesses such as heart disease, diabetes, cancers, and psychological problems. 23.2% of peoples think that information on internet carries no risk for self-medication and 21% think that internet use can be a substitute for consulting a doctor. Majority of responders (77.6%) believe that internet use for self-medication can increase the risk of side effects of drugs [Table 3]. Health information provided on net was perceived as “very good” by 43.7% of responders.
Table 3: Responses on Likert's scale

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  Discussion Top


Conventionally, patients were given the information regarding disease, its progression, and treatment by the physician. With the proliferation of the internet, the doctor–patient dynamic has changed. Now, there are growing tends toward self-medication using the internet. Self-medication is an important health issue, especially in developing countries like India where access to health care may not be optimal for majority of the population.[5]

In the 1990s, the internet users were only 1% all over the world, but today, this has escalated to 90% across the globe.[6] India's internet user numbers will reach 627 million (40% of total population) by the end of 2019 and most of these persons will be using internet for self-medication and to read information on health-related issues.[7]

Self-medication occurs throughout the world and its extent varies from 53% to 75% in different countries.[8],[9] The prevalence of self-medication in India increased from 31% to 71% in the last decade.[10]

Many studies in the past showed use of internet for self-medication to be in the range of 15%–19%.[11],[12] However, due to rapid growth and accessibility of internet to lay public, it has become a major source of health-related information and a way for self-medication. Our study shows that the use of internet for self-medication rises to 60%.

Self-medication is a universal phenomenon and not determined by education, cultural, and social background. Self-medication is associated with risks such as misdiagnosis, wrong dosage, drug interactions, prolonged duration of use, and increased resistance to pathogens.[13] The main reasons for self-medication are mild illness, lack of time to visit the doctor, longer waiting period at clinics, failing public health systems, high consultation fee, and increased reliance on internet-based solutions. There is a culture of home remedies rooted in traditional Indian systems, which is also responsible for the practice of self-medication.

We found that almost 60% people self-medicate using the internet as a source and majority of them (54.47%) took medications without consulting the doctors. Majority of the peoples used internet to self-medicate for minor ailments, but alarmingly around 12% of responders were taking medicines for major illness such as chest pain, diabetes, and cancers. Twenty-one percent think that internet use can be a substitute for consulting a doctor, which may compromise patient's safety and may lead to morbidity and mortality and paradoxical economic loss due to delay in the diagnosis of underlying conditions and appropriate treatment. Majority of responders (77.6%) believe that internet use for self-medication can increase the risk of side effects of drugs still they are using it. As per drug laws applicable to India, self-medication is permitted for OTC drugs, but in India, there is no specific list of OTC drugs.[14] The self-medication is more common among medical/pharmacy students, which ranges from ~ 60%–80% in different studies.[15],[16] However, in general population, self-medication is reported to be almost 30%–35% and for mild illness only.[17]

Proponents of self-medication argue that they practice responsible self-medication. However, there is a difference in responsible self-medication and self-care. Self-care like smoking cessation and prevention of heart disease is very much acceptable, but responsible self-medication requires a certain level of knowledge and health orientation.[18] The advantages of responsible self-medication include reduced load on the medical services, saving on time/cost for patients, and reduced insurance costs. It also includes the patient in decision-making who has the liberty to choose the best available treatment options and manage their own health. However, responsible self-medication is not totally free of risk and may result in adverse health effects that require medical intervention. The other potential disadvantages of self-care are postponement of seeking care, disease masking, incorrect diagnosis, misuse/abuse of drugs, antibiotic resistance, wrong dosage, adverse events, or interactions with other medications.[19],[20],[21]

As more and more people are now using internet to obtain health-related information and self-medication, it is necessary to educate people on the possible dangers of self-medication. The contraindications, drug interactions, and possible side effects should be communicated to the patients by providing relevant and easy-to-understand information on net.[22] Medical information found on the internet should not guide self-diagnosis or treatment and as it is meant to be supplemental and is best used to reinforce your medical-decision making not to replace it.


  Conclusions Top


Results from small observational study suggesting minimum practice standards regarding self-medication on net should be set by the governing medical associations in each country like Indian Medical Association in India. The information on website should be provided in simple, nontechnical, and local/vernacular language. The website should also contain red flag signs on side effects/over dosage of drugs and warning regarding usage of scheduled “H” drugs which should not be taken without prescription. Efforts should also be made to regulate the OTC medicines by making strict regulations and people should be made aware about it.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Association of the European Self-Medication Industry; June 2004. Available from: http://www.aesgp.eu/media/cms_page_media/68/2004study.pdf. [Last accessed on 2020 Jan 20].  Back to cited text no. 18
    
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World Health Organization. Guidelines for Regulatory Assessment of Medicinal Products for Use in Self-medication. Geneva: WHO; 2000. Available from: http://apps.who.int/medicinedocs/pdf/s2218e/s2218e.pdf. [Last accessed on 2020 Jan 20].  Back to cited text no. 19
    
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    Tables

  [Table 1], [Table 2], [Table 3]



 

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