Evaluation of an Over-the-Counter Medication Program

Military Medicine, Jul 2004 by Huntzinger, Paul Evan

Nonprescription medication (i.e., "over-the-counter") programs have historically been popular at many military treatment facilities. These programs were developed to provide a mechanism through which active duty members could obtain certain nonprescription medications without seeing a health care provider. The goal of such programs was to reduce demand on health care provider appointments and operational costs associated with such visits. Coast Guard military treatment facilities are encouraged to provide the service. The purpose of this paper was to evaluate whether the nonprescription medication program offered at the Coast Guard Alameda pharmacy reduced demand on health care provider appointments for self-limiting conditions and reduced costs associated with such visits.

Introduction

The evolution of the U.S. pharmaceutical distribution system into a two classes involving over-the-counter (OTC) and prescription-only medications began 150 years ago (Table I).1 Legislation passed by Congress gradually increased the level of federal government oversight of pharmaceuticals, including OTC medications. As of June 2000, there were more than 100,000 OTC drug products involving 800 active ingredients available on the U.S. market.2 In 2002, U.S. citizens spent $38.781 billion on nonprescription medications,3 and with a population of 280.3 million people,4 that translates to $138.36 per capita spending annually on OTC products.

Coast Guard Island is base for 1,500 active duly service members and is situated between the cities of Alameda and Oakland, California. Coast Guard Island has a military treatment facility (MTF) that provides basic medical, dental, and pharmacy services to eligible active duty members. The Coast Guard Alameda (CGA) pharmacy averages 110 prescriptions a day and is staffed with a pharmacy officer, pharmacy technician, and occasionally externship students from the University of California, San Francisco. Seventy percent of the pharmacy prescription volume originates from nonactive duty beneficiaries (i.e., retirees and dependents).

One of the services the pharmacy provides is a program in which certain pharmaceutical items may be obtained through a nonprescription, or OTC, medication program. Coast Guard regulations dictate what items may be offered in such programs and does not permit additions to the program (Fig. I).5 It appears the original intent of OTC programs in the services was two-fold. First, they were an attempt to regulate undefined "cold-packs" (R. Hirsh, unpublished observation). The medications contained in cold-packs varied between units and were contingent on the person responsible for managing them. OTC programs were designed to make the benefit more uniform across a given branch of service. second, the programs were designed to keep persons who would normally seek prescriptions for OTC medications for self-diagnosed, mild conditions from making medical appointments to obtain them. The goal was to conserve health care provider appointments for more urgent conditions and ultimately to reduce overall medical expenditures.

The Coast Guard formalized and standardized its OTC program benefit in the early 1990s; however, whether these programs reduce sick call visits and decrease overall operational costs have not been explored. This paper attempts to address the cost-effectiveness of the OTC program at Coast Guard Island.

The CGA pharmacy waiting area has a small table on which forms for the OTC program are located and is denoted by a conspicuous sign (Fig. 2). Laminated signs over the table list program items and their indications. Customers fill the OTC request form out at the table and proceed to the prescription pick-up window. OTC program items are located in readily accessible drawers for quick dispensing (Fig. 3). As a guideline, customers may receive two items per family per week; however, for active duty members, there is no limitation on the number of items as long as the items are to treat an acute, usually selflimiting condition. The OTC forms are on individual 4-inch by 5-inch sheets to conserve paper and minimize storage requirements for the forms. Brand versus generic names are used on the forms because of printing limitations. Currently, the pharmacy does not enter medications dispensed from the OTC program into patient profiles on the Composite Healthcare System.

The dispensing of OTC program products with no other transactions takes an average of 10 seconds from the time the OTC form is handed to a pharmacy staff member until the products are bagged and handed to the patient. The process takes longer if there are questions about program items, if there are prescription refills to pick-up in addition to the requested OTC medications, if the OTC drawers need restocking, if or the pharmacy staff becomes engaged in conversation. Because the pharmacy dispenses an average of 53 OTC program products per workday, the total time daily spent strictly on dispensing OTC program items by pharmacy staff is 8.8 minutes; the adjusted time is 15 minutes if the three points noted above are factored into this total. Of the 53 OTC program products dispensed daily, 10 are to active duty members obtaining items for themselves or family members.