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      Risks associated with borrowing and sharing of prescription analgesics among patients observed by pain management physicians in Croatia: a qualitative study

      1 , 2

      Journal of Pain Research

      Dove Medical Press

      analgesics, sharing, lending, borrowing, risks

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          Understanding and improving patient safety is a key issue in medicine. One of the potential threats to patient safety is the sharing of medication among patients, which is a form of self-medication. This study analyzed experiences and attitudes of pain management physicians (PMPs) about sharing prescription analgesics among patients.


          This qualitative study was conducted by semi-structured interviews among PMPs employed in Croatian pain clinics. The study involved two researchers and 15 PMPs.


          Among PMPs, 80% have seen patients who share their prescription analgesics with other patients for whom prescription is not intended. Most PMPs consider prescription analgesics sharing a risky and negative behavior. Some of them, however, found certain positive aspects associated to it, such as being a benevolent behavior, helping patients to get medications when they need them, and helping them cope with pain.


          The majority of physicians specialized in pain management encountered patients sharing prescription analgesics. Most of them considered this as risky behavior with a number of potential consequences. It has been noted that this problem is neglected and that physicians should inquire about medication sharing. Direct-to-consumers advertising was perceived as a factor contributing to such behavior. Patient education and more involvement of physicians in identifying this behavior were cited as potential remedies for preventing sharing of prescription analgesics.

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          Most cited references 33

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          Effects of race and income on mortality and use of services among Medicare beneficiaries.

          There are wide disparities between blacks and whites in the use of many Medicare services. We studied the effects of race and income on mortality and use of services. We linked 1990 census data on median income according to ZIP Code with 1993 Medicare administrative data for 26.3 million beneficiaries 65 years of age or older (24.2 million whites and 2.1 million blacks). We calculated age-adjusted mortality rates and age- and sex-adjusted rates of various diagnoses and procedures according to race and income and computed black:white ratios. The 1993 Medicare Current Beneficiary Survey was used to validate the results and determine rates of immunization against influenza. For mortality, the black:white ratios were 1.19 for men and 1.16 for women (P<0.001 for both). For hospital discharges, the ratio was 1.14 (P<0.001), and for visits to physicians for ambulatory care it was 0.89 (P<0.001). For every 100 women, there were 26.0 mammograms among whites and 17.1 mammograms among blacks. As compared with mammography rates in the respective most affluent group, rates in the least affluent group were 33 percent lower among whites and 22 percent lower among blacks. The black:white rate ratio was 2.45 for bilateral orchiectomy and 3.64 for amputations of all or part of the lower limb (P<0.001 for both). For every 1000 beneficiaries, there were 515 influenza immunizations among whites and 313 among blacks. As compared with immunization rates in the respective most affluent group, rates in the least affluent group were 26 percent lower among whites and 39 percent lower among blacks. Adjusting the mortality and utilization rates for differences in income generally reduced the racial differences, but the effect was relatively small. Race and income have substantial effects on mortality and use of services among Medicare beneficiaries. Providing health insurance is not enough to ensure that the program is used effectively and equitably by all beneficiaries.
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            Primary care provider concerns about management of chronic pain in community clinic populations.

            Chronic pain is a common patient complaint in primary care, yet providers and patients are often dissatisfied with treatment processes and outcomes. To assess provider satisfaction with their training for and current management of chronic pain in community clinic settings. To identify perceived problems with delivering chronic pain treatment and issues with opioid prescribing for chronic pain. Mailed survey to primary care providers (PCPs) at 8 community clinics. Respondents (N=111) included attendings, residents, and nurse practioners (NPs)/physician assistants (PAs). They reported 37.5% of adult appointments in a typical week involved patients with chronic pain complaints. They attributed problems with pain care and opioid prescribing more often to patient-related factors such as lack of self-management, and potential for abuse of medication than to provider or practice system factors. Nevertheless, respondents reported inadequate training for, and low satisfaction with, delivering chronic pain treatment. A substantial proportion of adult primary care appointments involve patients with chronic pain complains. Dissatisfaction with training and substantial concerns about patient self-management and about opioid prescribing suggest areas for improving medical education and postgraduate training. Emphasis on patient-centered approaches to chronic pain management, including skills for assessing risk of opioid abuse and addiction, is required.
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              [Pharmacovigilance of self-medication].

              Self-medication can be defined as obtaining and consuming one (or more) drug (s) without the advice of a physician either for diagnosis, prescription or surveillance of the treatment. Self-medication accounts for around 5 to 10 per cent of drug sales in France. There are few data on side effects of self-medication in France. The side effects of drugs taken by self-medication and reported to the Midi-Pyrenees drugs surveillance centre between January 1993 and June 1996 were investigated in the present study. There were 65 reports, mainly in women (58 per cent), i.e. around 2 per cent of the reports to the regional drugs surveillance centre. The most frequent side effects are neurological (32 per cent: mainly headache, vertigo, agitation, etc.), dermatological (18 per cent, mainly allergy), hepatic (10 per cent), digestive (7 per cent, mainly diarrhoea). There were 10 cases of anaphylactic shock and/or Quincke oedema. The drugs most frequently involved were analgesics and non-steroidal anti-inflammatory drugs (47 cases), neuropsychotropic drugs (7 cases), dermatological drugs (6 cases) or otorhinolaryngological drugs (6 cases).... 'Serious' side effects occurred in 40 per cent of the cases including 3 deaths. 'Severe' side effects were observed in 77 per cent of the reports. This study shows that the side effects of self-medication are relatively frequent and can be serious. They occurred more often in women than in men, mainly with analgesic and anti-inflammatory drugs. These data permit a better analysis of the risk/benefit ratio of self-medication. Drug surveillance studies of self-medication must be developed.

                Author and article information

                J Pain Res
                J Pain Res
                Journal of Pain Research
                Journal of Pain Research
                Dove Medical Press
                30 November 2016
                : 9
                : 1143-1151
                [1 ]Centre for Clinical Pharmacology, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
                [2 ]Laboratory for Pain Research, University of Split School of Medicine, Split, Croatia
                Author notes
                Correspondence: Livia Puljak, Laboratory for Pain Research, University of Split School of Medicine, Soltanska 2, 21000 Split, Croatia, Tel +385 21 557 807, Fax +385 21 557 811, Email livia@ 123456mefst.hr
                © 2016 Markotic and Puljak. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                Original Research

                Anesthesiology & Pain management

                analgesics, risks, borrowing, lending, sharing


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