Pharm World Sci (2008) 30:863–868

DOI 10.1007/s11096-008-9241-4

RESEARCH ARTICLE

Analysis and quantification of self-medication patterns

of customers in community pharmacies in southern Chile
Katherine Fuentes Albarrán Æ Lorenzo Villa Zapata

Received: 24 October 2007 / Accepted: 20 July 2008 / Published online: 20 August 2008

Springer Science+Business Media B.V. 2008

Abstract Background Self-medication refers to using
drugs which have not been prescribed, recommended or
controlled by a licensed health care specialist. Marketing,
in Chile only admitted for over-the-counter medications,
influences the practice of self-medication and extends it to
prescription drugs. Thus, a complex self-medication pro-
cess is started, due to reuse of a previous prescription,
using drugs purchased directly at the pharmacy or drugs
coming from family first-aid kits. The purpose of this study
is to determine the frequency of self-medication, the type
of medications involved, the dosages used, and the reasons
for this practice. Methods An observation-based cross-
sectional study was carried out at three pharmacies
belonging to a pharmacy chain in the city of Valdivia
(southern Chile). In addition, a previously validated form
was used. Customers who requested over-the-counter
medications were surveyed to identify the patterns that
foster the self-medication practice. Results Of 909 sur-
veyed customers, 75% self-medicate. Of these, 31% stated
that they commonly self-medicate due to suffering from
light symptoms, such as headaches (19%), the common
cold (8.8%), sore muscles (6.7%), and bone pains (5.3%).
The group of medications most requested in this study was
nonsteroidal anti-inflammatory drugs (NSAIDs) (33%),
with diclofenac sodium being the most used (14%). Influ-
ence from other people did not exceed 20% and reusing
prior prescriptions reached 46%. There were significant
differences when assessing consumer knowledge, reading
of information leaflets, and opinions about self-medication
at each surveyed pharmacy (P \ 0.001). Conclusion Most
K. Fuentes Albarrán
L. Villa Zapata (&)
Instituto de Farmacia, Facultad de Ciencias, Universidad Austral
de Chile, Campus Isla Teja, s/n, Valdivia, Chile
e-mail: lorenzovilla@uach.cl
consumers at the surveyed pharmacies use medications
without proper knowledge of their benefits, treatment
method, and duration. Drug dispensing at community
pharmacies should include active pharmacist involvement
to divulge the sensible use of drugs.
Keywords Chile
Community pharmacies

Drug utilization
Over-the-counter drugs
Self-care

Self-medication
Surveys
Impacts of findings
• The use of medication without prescription in Chile is
conditioned and increased by various circumstances,
such as restrictions on attending a doctor and the almost
complete lack of supervision of the fulfilment of leg-
islation on selling pharmaceutical specialities requiring
medical prescription.
• Commercial advertising fosters excessive use of
medication.
• In Chile health information and education should be
substantially improved since they can contribute to
responsible and positive self-medication.
Introduction
Self-medication is defined as the use of drugs that have not
been prescribed by a licensed health care professional [1].
In most households today, a large number of illnesses are
initially treated with drugs that are easily obtainable to
relieve light symptoms, such as headaches, the common
cold, sore muscles, and bone pains. This causes a large
number of people to use over-the-counter (OTC) drugs.
Other factors that determine and promote the use of these
drugs exist, such as difficulties in seeing a doctor, limited

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free time, and low observance by some pharmacies of
legislation on medical specialties requiring a prescription
[2]. Furthermore, patients often lack knowledge, pharma-
cists are overworked, and drugs are sold according to a
profit-based approach [3]. Drug marketing influences these
circumstances; thus a complex self-medication process is
established, either because of reuse of prior drug pre-
scription to purchase a drug directly at a given pharmacy or
using a drug from family medical kits. These medical kits
contain an average of 7–30 drugs, including analgesics,
drugs against influenza, and anti-inflammatory drugs.
These represent a risk source when, in some instances, they
have narrow therapeutic margin, have expired, or are
within a child’s reach [4]. Marketing may also carry some
lack of information when the news spread has not been
properly contrasted and may even lead to groundless
alarms or false expectations concerning the healing value
of a drug [5]. Nevertheless, when a person chooses to self-
medicate, he or she should consider that the consequences
of his or her decision are numerous, including increased
risk of suffering adverse reactions, masking the actual ill-
ness, and consequently aggravating or making the actual
pathology worse [5–7].
In Chile, the health care system lays down specific
guarantees for access, opportunity, quality, and financial
protection for the 56 illnesses with the highest prevalence
that cause mortality and impairments in the country. These
specific guarantees include the protocolized treatment for
these diseases. Access to this treatment is backed up by
financial protection that involves a co-payment not
exceeding 20% according to the income segments of the
population. The problem is that a large portion of the
population does not have easy access to health care, due to
insufficient health care provision, among others reasons.
This exerts great pressure on the health care system, which
promotes the practice of self-medication.
During recent years, the World Health Organization
(WHO) has emphasized that self-medication should occupy
a valid place among developed societies and that there is a
need to instruct people on proper drug use as an additional
item of health education [3, 8]. In this sense, self-medi-
cation is gaining increasing recognition in the context of
what has been called ‘‘responsible self-medication’’—
defined as the use of over-the-counter drugs by an
instructed consumer—which is intended to avoid a series
of potential risks for their health and to obtain a benefit in
terms of cure or relief of the illness as much as possible [8].
The purpose of informing responsible self-medication
and adequately instructing patients on the drugs they use
leads to a personal and social benefit for the patients. If a
well-informed individual or family manages to solve or
relieve a variety of troubles or minor health problems by
themselves, they will avoid having to travel, wait, or other
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Pharm World Sci (2008) 30:863–868
inconveniences that the health care delivery system entails,
the demands on which are usually excessive. Therefore,
responsible self-medication is a great relief for the health
delivery care system because, if there is no need to see a
doctor for every ailment we may have, doctors may devote
more time to the investigation, treatment, and prevention of
serious pathologies that need a professional health care
provider [9]. This will decrease excessive demand on the
health delivery system and prevent patients from losing
confidence in the system [8]. In Chile, there are no publi-
cations, analyses, or quantitative background information
on self-medication at community pharmacies. It is for this
reason that the present study is based on describing and
characterizing the self-medication phenomenon in one of
the large pharmacy chains in the city of Valdivia to identify
the reasons for self-medication and the social arguments
that support it.
Materials and methods
An observational cross-sectional study covering three com-
munity pharmacies was undertaken in the city of Valdivia,
Chile. Data was collected using a form validated through a
piloted study, in which 40 consumers were interviewed to
detect if there were comprehension problems in users and
to find out if the questions provided the information required
to fulfill the objectives of the present study.
The sample included consumers who sought advice at
community pharmacies and requested drugs without a
medical prescription. An interviewer rotation was com-
pleted for each of the pharmacies covered in this study.
The interviews were conducted by two pharmacists.
Both of them were trained at the Instituto de Salud Pública
(Institute of Public Health) of the Universidad Austral de
Chile in fieldwork guidelines, i.e., on the purposes of this
research study, the nature of the research, its context, and
the patients to be surveyed. Fieldwork development was
planned (place, time, resources) and instruction on how to
approach patients and conduct the interviews to collect the
information was provided. Both interviewers were pro-
vided with a script to guide the introduction of the survey
and the formulation of the questions. These were read to
participants during the interviews, which lasted 30 min and
were conducted at the pharmacies. The guidelines were
available to both interviewers so they could follow the
same process.
The study was approved by the executive committee of
the Pharmacy School of the Facultad de Ciencias of the
Universidad Austral de Chile in March 2007, which also
financed this research. A confidentiality agreement con-
cerning the information collected from the patients was
applied, and the pharmacists who worked at each of the
Pharm World Sci (2008) 30:863–868 865

pharmacies included in this research were provided general
feedback. The survey was conducted between April and
August 2007.
Size of the sample
For calculating the size of the sample, the EPI INFO software
was used, considering the following criteria: assumed self-
medication rate of 60% of the population, precision of 3.2%,
confidence level of 95%, and the average patient flow at the
selected pharmacies. Thus 909 surveys were distributed
among three stores belonging to the pharmacy chain. Just
over 1,400 patients who bought medications at the selected
pharmacies were asked to participate. From these, a required
number of 909 were obtained, i.e., 909 patients who agreed to
answer the survey.
when requesting drugs without knowing their properties
and use.
Whether this was the first time the drug is requested: to
establish if this was the first time the drug was requested
without a prescription.
Reading of the information leaflet: to establish whether
the consumer learned about the requested drug by reading
the patient information leaflet.
Data analysis
For the statistical analysis, the EPI INFO software, release
3.2.2, and the chi-square test were used. The P value was
calculated; in case of a value lower than 0.05, the variable
association was considered significant from a statistical
point of view.

Inclusion criteria
The inclusion criteria for the study participants were con-
sumers over 18 years old, of both sexes, who requested
medications on their own initiative and without a medical
prescription.
Exclusion criteria
The exclusion criteria for the study were: consumers who
lacked communication skills and had difficulty writing,
consumers who requested prescribed drugs, and consumers
who asked for advice from the pharmacist before request-
ing medications, as well as customers who purchased
medications for other people.
Results
Table 1 shows social and demographical characteristics of
the population surveyed when this study was conducted.
Of the population surveyed, 73% were women. The
average age was 48 years, with 33% being between 31 and
45 years old. The commonest educational level was com-
pletion of secondary education (37%).
The main reasons that lead to self-medication were
minor symptoms (23%), repeated symptoms, i.e., patients
using the same drug for symptoms already suffered (11%),
a fast solution to the problem (10%), and lack of time to see
a doctor (9%). ‘‘Other’’ reasons applied to 25% of the
patients.

Data collection forms Table 1 Population social and demographical characteristics

Frequency (%)
The forms consisted of 13 answers that were used to define:
Age and sex: used to characterize the population that Sex
self-medicate. Female 73
School attendance: to establish a relationship between Male 27
the educational level and how much the consumer knew Age (years)
about the requested drug. 18–30 12
Requested drug identification: to identify the proprietary 31–45 33
name and the active principle; this enabled the determi- 46–60 31
nation of whether the therapeutic guidelines followed by 61–75 20
the user were suitable for a given drug. [75 4
Reason for requesting a drug: to identify the symptoms Education level
for which drugs were requested and the relationship Primary school complete 10
between the drug indication and the user’s symptoms. Primary school incomplete 14
Drug recommendation: to establish the reasons that
High school complete 37
forced consumers to request a drug in order to determine
High school incomplete 16
sources of recommendation.
Technical 11
User’s knowledge level about the requested drug: to
College 12
establish potential risks to which consumers were exposed

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The most requested medication groups were nonsteroidal
anti-inflammatory drugs (NSAIDs, 33.2%), paracetamol
(15.7%), anticoagulants (4.7%), anti-influenza drugs (4.6%),
anti-ulcer agents (4.1%), laxatives (3.2%), migraine head-
ache analgesics (3.1%), mucolytics and expectorants (3.0%),
diuretics and antimycotics (2.4%), antispasmodics (1.3%),
and antiallergics (1.0%). Among the NSAIDs, the most
demanded were diclofenac sodium (13.5%), acetylsalicylic
acid (6.5%), metamizole sodium (3.5%), ibuprofen (3.2%),
piroxicam (2.2%), and mefenamic acid (1.2%). The most
recurrent symptoms for which patients requested a drug were
headaches (19%), sore muscles (6.7%), bone pains (5.3%),
and the common cold (8.8%). A drug recommendation from
a family member had been made to 6.4% and from friends to
4.1%. The use of ‘‘a prior prescription’’ had a frequency of
46%. Seven percent were influenced by media advertising
and 6% said they had received prior advice for the requested
drug from a community pharmacy. As for reading the
information leaflet, 619 consumers (68%) said ‘‘when the
drug is sold with a leaflet, I usually read it,’’ 290 consumers
(32%) did not read it, because the characters were too small
and/or because it was only technical information. As for
general consumer knowledge about the requested drug,
which involves posology, dose, adverse effects, contraindi-
cations, and precautions, 644 (71%) people admitted that
they did not have any knowledge at all; 8% said they had
information but, of these, 21% were not correct. When asked
if this was the first time that they had bought the drug without
prescription, 821 people (90%) answered that they had pur-
chased it on previous occasions, while 88 people (10%) said
it was the first time they had requested it. As for the opinion
the interviewed individuals themselves had about the prac-
tice of self-medication, 77% said it was a bad practice, 11%
said it was cost effective because they could save money that
would otherwise be spent on medical care, 6% did not have a
definite opinion, and 6% said it was good for their health.
When asked about buying over-the-counter drugs, and if they
requested information about the drug and who they requested
it from, 50% (452 people) said they did not need any help,
30% said they obtained help from the seller, and 20% asked
for information from the pharmacist. Of 452 people who said
that they did not need any help, 330 (72%) had no prior
knowledge about the requested drug and 10% were misin-
formed. Only 18% had information about the medication
they sought (P \ 0.01).
Discussion
Generally speaking, self-medication exists in all societies
and various factors contribute to make it more or less
extensive. It is a phenomenon with broad social implications
in a developing country such as Chile in which a percentage
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Pharm World Sci (2008) 30:863–868
of the population has difficulties accessing the health care
system and low income rates make it very difficult to obtain
health care services in the private health care system.
Besides, in our drug delivery system, restrictions on sales are
limited to some drugs only, such as antibiotics and psycho-
tropic drugs. Other drugs are normally sold without strong
restrictions, and some of them, such as NSAIDs, may even be
purchased in common neighborhood shops.
During the time this study took place, most drug requests
without a prescription came from women. Women request
over-the-counter drugs the most, a fact that has been
observed in other self-medication studies [4, 5, 10, 11].
The frequency of self-medication reached 75%, a high
percentage if we compare it with the assessment of self-
medication prevalence carried out in 1997 by the Pan
American Health Organization in Santiago, Chile, which
reported a frequency of 43%. A study conducted in Spain at
three Universities in Madrid [12] revealed a self-medica-
tion frequency of 63% and another one carried out in
Colombia [13] showed that 71% of pharmaceutical prod-
ucts sold in pharmacies had not been prescribed, a similar
figure to that found in our study.
The most frequent reasons why self-medication is prac-
tised is when symptoms are considered as minor, a subjective
feeling of being able to manage one’s own pathology, con-
venience (not having to set an appointment to see a doctor
and avoiding a long waiting time), and lack of time. This,
together with the results from the evaluation of the general
knowledge about the medication—with 71% admitting not
knowing anything at all about the drug and 8% having wrong
information—tells us that the general population is not
properly trained to practise responsible self-medication,
contrary to the approach promoted by the WHO.
The group of medications in highest demand was NSA-
IDs. This is a matter of concern because of the relationship
between the use of NSAIDs and gastrointestinal damage.
The incidence of high digestive hemorrhage is 650 cases per
1,000 inhabitants/year and 40% of these are attributed to
acetylsalicylic acid [14–16]. Also, one of the risks involved
in the regular and unsupervised use of NSAIDs is interstitial
nephritis. It is considered that 11% of all terminal renal
insufficiency cases, whose incidence is about 110 new cases
per 1,000,000, are attributed to analgesics [17]. Thus, at least
2% of NSAID users may suffer serious adverse effects [14].
NSAIDs can be purchased over the counter in pharmacies
and, in certain cases, at other locations not authorized by
health authorities. Our country does not keep records that
would allow us to asses the medical and economic conse-
quences of using anti-inflammatory drugs, and there are no
reasons to believe that our population is especially resistant
or has fewer problems.
The use of anti-influenza drugs, mucolytics, and expec-
torants is higher during winter time, and often influenza
Pharm World Sci (2008) 30:863–868
symptoms are socially disqualifying. Consumers who sought
anti-influenza drugs did not know the instructions for their
use in hypertense patients due to their content of pseudoe-
phedrine. The same applies for those who sought influenza
syrups without first asking if they were suitable for diabetic
patients. One of the consumers used thiazide diuretics to lose
weight, without knowing their potential side-effects associ-
ated with electrolyte disorders. The indiscriminate use of
laxatives has a very high frequency, particularly in young
women; some of them said they used them for constipation
problems and others said that they used them for losing
weight. Few of them knew the potential damage of laxative
abuse and even those who suffered from irritable bowel
syndrome used them on a regular basis, without realizing that
this practice worsened their symptoms due to irritation of the
intestine [18]. The use of migraine headache analgesics is of
utmost importance. Consumers who sought combinations
with ergotamine did not know the risks of their use for
hypertensive patients. Others pointed out they had used these
drugs for a long time and, as they were no longer provided
relief at the initial dose, they had almost doubled the rec-
ommended daily dose. Many of these patients had not been
given proper therapeutic and clinical appraisal that would
have helped them understand their condition because they
had decided not to see a doctor. The indiscriminate use of
these drugs has produced quite a number of patients with
chronic migraines, independent of the fact that initial cause
of the migraine had been its normal evolution or the result of
very frequent tension headache spells [19, 20].
The most recurrent symptom leading to seeking drugs
without a medical prescription was pain. The most frequent
pains were headaches, followed by sore muscles and bone
pains, the latter two being self-limited most of the time.
Usually using a physical remedy such as applying heat or
cold locally, or using topical analgesics and rubefacients,
would have been enough. It is a matter of concern that a
large quantity of NSAIDs were used for their treatment,
even for long periods of time [21].
Influence of other people on drug use was not very fre-
quent. Reusing a prescription would have been a responsible
action as long as the illnesses had been easily identified and
the patient had been given the necessary information about
proper drug use when it was prescribed. Most of the indi-
viduals who practised self-medication said that ‘‘the drug
made them well’’ or ‘‘they always had good results when they
took it.’’ However, we have to remember that 71% of the
population surveyed admitted not having any knowledge at
all about the medication they had requested.
Reading the information leaflet is an important aspect of
the self-medication process since it gives information about
the process itself. However, when analyzing what is written
on the leaflet together with the patient’s level of knowledge
about the medication, we realize that the population does not
867
have the necessary information about the requested medi-
cation, and in 8% of the cases this information is wrong, even
when considering that 68% of these say they usually read the
leaflet. These conflicting results could have been produced
by an information bias, either because the drug requested had
no information leaflet or, if it did, it was not properly
understood or was not written at the appropriate educational
level. This coincides with results of a study conducted in our
country, which found that around 80% of the 16–65-year-old
Chilean population did not have the minimum ability to
understand the information contained in patient information
leaflets and technical journals [5, 22, 23].
Educational level influences both the level of general
understanding of the requested medication, and the habit of
reading the information leaflet that comes with some con-
tainers. People with a lower educational level are usually
those who do not normally read the leaflet.
Half (50%) of the interviewed population did not ask for
advice when requesting a drug without a medical pre-
scription. Ten percent of consumers who said they asked
for help from the seller admitted that they did not know
about the existence of a pharmacist at the community
pharmacy or they thought all those behind the pharmacy
counter wearing a white overall were pharmacists. This
accounts for the lack of information and instruction among
the population about a pharmacist’s role. There are con-
sumers who think pharmacists only have to prepare
medicines and confine their work to the laboratory, and do
not know they are the most accessible health care profes-
sionals in each of the community pharmacies, giving
information and assistance concerning medication and
chemicals with biological activity.
The surveyed consumers were asked about their opinion
on self-medication, and surprisingly 77% of them admitted
it was a bad practice. They argued it could have negative
consequences and damage people’s health. However, they
said it was a necessary evil, since they did not had access to
a health care professional’s advice through the private
health care delivery system, and had to wait long periods to
access the public health care system.
Limitations
The research was conducted at the pharmacies that belong
to one of the three pharmacy chains existing in the city of
Valdivia. Business policies held by each of them may
influence the sale of drugs, especially those that require a
prescription from a doctor; these differences might cause
different consumer behaviors and various health problems.
It would be advisable to carry out a study that considers all
the other pharmaceutical companies for the purpose of
verifying whether their individual policies are factors that
influence the practice of self-medication.
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Conclusions
Self-medication is a common practice among consumers in
the surveyed community pharmacies. Most of them prac-
tise self-medication irresponsibly, as they lack the proper
information. The main symptoms leading to self-medica-
tion are pains of various kinds, thus nonsteroidal anti-
inflammatory drugs (NSAIDs) are the drug group in
highest demand. The influence of other people on the
process of self-medication is low. The most influential
factor is reuse of a prior prescription. Efforts should be
made to launch public campaigns to develop a drug culture
that fosters respect for pharmaceuticals, and promotes their
sensible use and adherence to treatments.
Acknowledgements Thanks are extended to the pharmacy chain
Salcobrand in the City of Valdivia for allowing us to use their
facilities during the research.
Funding This research was financed by the Pharmacy School of the
Facultad de Ciencias of the Universidad Austral de Chile.
Conflicts of interest There are no conflicts of interest.
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