Self-medication among Russians has become an epidemic

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Russians do not understand instructions for medicines

The WHO concept of responsible self-care was first announced 30 years ago. And in 2021, the WHO guidance on OS and well-being was released, suggesting that patients should be able to cope with many health problems on their own. All world concepts of self-treatment are aimed at unloading the healthcare system, which has become especially significant during the pandemic. So the topic of the OS has now become especially relevant.

According to the co-chairman of the All-Russian Union of Patients, Chairman of the Council of Public Organizations for the Protection of Patients’ Rights in the Federal Service for Surveillance in Healthcare, Professor Yan Vlasov, a survey in 10 European countries from 2013 showed that 90% of respondents consider responsible self-treatment to be the key to protecting health , but less than 20% of Europeans actually do it – they lack knowledge, skills, tools and support.

A survey conducted by VIOM in 2016 showed that 81% of Russian citizens are ready to take responsibility for their health. At the same time, 92% are ready to cure themselves if they have a sore throat; 90% – if the head, 86% will help themselves with a cough or heartburn: 76% for fever, 72% for indigestion, 55% for joint pain and 42% for high blood pressure.

However, at the same time, WHO allows self-treatment only in two cases – for mild ailments (runny nose, headache) or in chronic patients with an established diagnosis with recommended treatment in case of dose adjustment.

According to Sergey Popov, a lawyer with the All-Russian Union of Patients, there are no regulatory recommendations in Russia on this matter, although many people buy medicines without a doctor’s prescription. A VTsIOM survey from 2021 showed that 35% of people do not go to doctors in case of health problems. But most often, Russians are treated completely irresponsibly, which is detrimental to their health.

However, patients can be understood: it is extremely difficult for them to make a choice in the face of a conflicting flow of information about drugs and methods of treatment. Leading Researcher of the Federal State Budgetary Scientific Institution “National Research Institute of Public Health named after N.A. Semashko RAS Elena Volskaya says that the conscious use of methods and means to improve health is possible only if there is objective reliable information, the sources of which are doctors, pharmacists, pharmacists, and advertising. A few years ago, Russian scientists conducted a survey among patients, and found that doctors at the reception talk with half of them for less than 3 minutes, and every fifth is advised on medication for less than a minute. “As a result, the most massive source of information about drugs is the instructions for the drug. Although these instructions are intended for doctors, and often this is a huge canvas, sometimes up to a meter long, with small print, with a lot of terms unknown to patients. Studies show that the older patients are, the more difficult it is for them to perceive information in the instructions for drugs. Among the elderly, only 20% understand what is written there,” says Professor Volskaya.

Experts recall that in the days of the USSR, not annotations were put into packages with drugs, but memos for self-administration. Elena Volskaya believes that the information in the instructions should be short and understandable, contain only evidence-based, reliable and up-to-date data, the presentation should be accessible, the text should be readable. “The principle of separation works in different countries – there are instructions for use for specialists and for self-administration of drugs. We tried to introduce such a principle back in 2001 in the industry standard, but it was canceled, as a result, official sources of information about medicines are the same for doctors and patients, which leads to misunderstanding, reduced adherence to treatment, the risk of refusing treatment and the risk of the nocebo effect – this when a patient thinks that the treatment will be harmful, he refuses “chemistry” and proceeds to irresponsible self-treatment under the guidance of healers and neighbors,” says Professor Volskaya.

Doctors don’t care about patients, patients don’t care about doctors

General practitioner, doctor of medical sciences, professor, director of the institute of vocational education of the Association of Primary Care Physicians Anatoly Stremoukhov says that his association conducted a survey of patients in district clinics: only 10% of visitors reported that they receive normal information about their health from a health worker. The vast majority listen to friends, read newspapers, watch TV. “The information vacuum is filled with advertising, including healers, neighbors’ advice. Here is an example of an advertisement from a healer who says that if you breathe through the right nostril, it will become cool, and if you breathe through the left, then it will be warm. We, doctors, give recommendations to patients on healthy lifestyles – but no one follows them! What to do with the medical literacy of the population? It implies access not to quasi, but to normal knowledge. So, we need sources, of which there are two – a doctor and a pharmacist, and there should be continuity in their work,” Anatoly Stremoukhov believes.

The expert notes that there are many tools to improve the medical literacy of the population, but almost each has its own flaws. For example, this function could be entrusted to the nursing staff during a pre-hospital appointment, but, as Stremoukhov says, he is prepared in such a way that he is actually an “appendix to a doctor” and serves to supply a tool, and an educational load, as abroad, where a nurse – an independent unit, it does not carry. From polyclinics, as Anatoly Stremoukhov notes, “medicine is gone, there is still a document flow”, receptions are crumpled. The expert considers preventive appointments and clinical examinations to be very formal: “Some boast that they carry out a full medical examination in an hour and a half – but this is a conveyor belt! Health centers could cope with the task of increasing the medical literacy of the population, but attendance is not high there. What remains is pharmaceutical counseling in the place where the patient always comes – that is, to the pharmacy. He also calls for raising the level of literacy of doctors: “Our main task is to teach teachers, because in order to get a competent student, you need to educate a competent teacher.”

But while there are not so many competent teachers, “students” are engaged in self-education. According to Nikol Zhurilov, Associate Professor of the Department of Medical Law at the Sechenov University of the Ministry of Health of the Russian Federation, expert of the Council on Medicines Ethics, people resort to self-medication for various reasons. For example, because they trust the opinion of relatives or the media. Or become the target audience of advertising campaigns. They are afraid of an epidemic situation (coronavirus, measles). They do not trust doctors or are simply too lazy to go to them. They are afraid of an unfavorable outcome of treatment, they use the free sale of medicines; they choose a “different way” because of the high cost of drugs … “And today there is an acute question: the state (and all of us) spent money on treating a patient, but he did not follow the recommendations of doctors and became disabled. Is the state now obliged to take part in its rehabilitation?

Member of the Council of Public Organizations for the Protection of Patients’ Rights under the Federal Service for Surveillance in Healthcare, Chairman of the Board of the Moscow City Scientific Society of Therapists, Professor Pavel Vorobyov believes that self-medication in Russia has a clearly negative connotation. For example, in 1993, it was proposed to actively fight against it: including shamanism, hunger treatment, avoiding a heart attack, and other methods, the effectiveness of which has not been proven by science. “Responsible self-medication is understood by WHO as the reasonable use of over-the-counter drugs, although in reality OS is both prevention, and self-diagnosis, and self-treatment, and self-rehabilitation. We are used to living in the model that the doctor is the father who will tell the patient how to live. But now the model is changing – patients are often guided by the “appointments” of the pharmacist and information like “one grandmother said.” 92% of patients resort to self-treatment – these are the data of opinion polls. Today, patients know everything better than doctors, and take out their knowledge on doctors,” says Pavel Vorobyov.

Vorobyov believes that it is necessary to streamline the situation in the “drug market”, develop a system of telemedicine consultations and provide life-saving medicines free of charge not to certain groups of the population, but to all citizens.

Professor Yan Vlasov is more optimistic: he believes that the Russian patient has become more informed, and many patients are ready to become partners of doctors in the fight against the disease.

Pharmacist, you are responsible for everything!

When choosing medicines, patients most often turn to a pharmacist (according to a recent study, 61% of Russians will do this). But, as many experts have concluded, today in pharmacies, patients will most often be “bred” either for expensive drugs that they do not need, or for dietary supplements in general. In addition, it is difficult to trust the recommendations of pharmacists for other reasons.

Tatyana Fomina, Deputy Director of the Center for Social Technologies and Research, shared the results of a study conducted in April 2023 in 270 pharmacies of the country with the participation of a “mystery shopper”: “Almost 18% of pharmacists did not ask patients clarifying questions for the selection of drugs; 30% did not specify the symptoms and characteristics of well-being and almost 70% were not interested in patients’ preferences.As a result, only 34% of the recommendations turned out to be justified if the first-timers did not ask the “mystery shoppers” clarifying questions.

Professor Vlasov says that this whole situation leads to the fact that a huge number of patients in the country are treated on their own, but incorrectly or ineffectively. For example, another recent survey showed that every fifth citizen of the Russian Federation mixes drugs with alcohol, and 48% buy drugs that no one prescribed them. And until it is possible to improve the medical literacy of the population, self-medication will do more harm than good.

Pavel Vorobyov cites data from one of the surveys, according to which, when choosing a treatment, in addition to doctors, patients trust the opinions of pharmacists (36%), the Internet or the advice of friends / relatives (22% each), medical programs on TV (20%) and 11% – specialized medical newspapers. “That is, the most reliable source of medical information is trusted by the few respondents,” the expert says. – And situations have become frequent when a pharmacist in a pharmacy helpfully offers what the manufacturer paid for, and hides what works; sells supplements instead of medicines, without explaining the difference to the buyer. And responsible self-treatment is irresponsible in practice: charlatans and air sellers warm their hands on it.

Meanwhile, Elena Nevolina, executive director of the Health Products Industry Association, believes that the potential of pharmacy workers to promote the idea of ​​a responsible attitude to health in our country is underestimated: “Pharmacy is the first point of contact between the consumer and the healthcare system. More than 65% of pharmacists consider pharmaceutical consulting their duty: they must tell and convey what the doctor did not say. At the same time, medical workers are wary of pharmaceutical consultations – more than a third do not allow the possibility of such recommendations even for over-the-counter drugs at all. However, we see that after the pandemic, the functionality of pharmacies in the world is expanding, and often a consultation in a pharmacy replaces the initial appointment with a health worker,”

The association conducted a study among 1000 consumers, 1500 pharmaceutical workers and 1500 health workers. More than half of the surveyed consumers said that they receive information about their health from doctors and health workers, but if they feel unwell, 38% will be treated themselves. “At the same time, people often refuse to buy medicines because of the high cost, placing responsibility for their health on themselves. 43% sometimes and 35% rarely resort to the advice of pharmacists, although 76% believe that their advice deserves attention. Against this background, the majority (72%) of doctors noted that patients rarely or sometimes ask them about OTC drugs. But 93% of pharmacists said that more than half of consumers turn to them for advice or additional information and advice about drugs.

…Responsible attitude to health is becoming a new normal in our country, experts say. However, while patients are at a complete loss: doctors have no time to conduct heart-to-heart conversations with them; pharmacists often try to sell them what is more expensive; nothing is clear in the instructions for medicines; popular bloggers in social networks advertising drugs are not responsible for the information. So treatment on the advice of a neighbor or a friend will remain one of the main guidelines for a responsible attitude to health for a long time to come.

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