Evaluation of an Over-the-Counter Medication Program

Military Medicine, Jul 2004 by Huntzinger, Paul Evan

Masking Nonacute Conditions

OTC programs were developed for nonchronic, self-limiting conditions. OTC medications are not without possible complications," and the use of such programs could inadvertently encourage the belief that OTC treatments can treat any condition.12 Furthermore, the use of the program to treat certain conditions, such as migraine headaches, could delay more appropriate medical intervention.13 Medical providers, health care technicians, and pharmacy staff must be cognizant of the limitations of OTC programs and limit its use when necessary.

Nonpharmacy OTC Programs

Historically, some MTFs established versions of OTC programs at the clinic versus pharmacy level (R. Hirsh, unpublished observation). The concept was to offer OTCs to persons presenting to sick call or other acute care departments (versus at the pharmacy department) to reduce impact on medical appointments and pharmacy visits. Some MTFs attempted to reduce costs through "self-care programs,"14 and clinic-based OTC programs may reflect these efforts. Self-care is a complex event of which the appropriate use of OTCs is one component.8 Regarding clinic OTC programs, if the MTF was accredited by a nationally recognized organization (e.g., Joint Accreditation of Health Care Organizations), there were requirements on how such programs were to be managed. For some MTFs, clinic-based OTC programs may be a cost-effective alternative to traditional pharmacy-based OTC programs.

Work Count

Prescription volume is one factor used to determine U.S. Coast Guard pharmacy budgets; however, Coast Guard regulations disallow pharmacies from using items dispensed through OTC programs to be used toward their prescription volume counts. Thus, U.S. Coast Guard pharmacies that operate OTC programs offer a service that requires time to manage, costs money, and provides no intrinsic benefit to pharmacy staff; it is simply more work for no return on investment. Nevertheless, the program has benefits to Coast Guard Island as a whole, including that it is good for morale (as reflected in active duty satisfaction noted on surveys), reflects the Command well in the eyes of pharmacy patrons, and reduces overall medical costs. OTCs in general provide intangible benefits such as avoiding the inconvenience of missing work that is associated with a doctor visit.6

Staffing

At the current level of use, the pharmacy staff is able to incorporate the OTC program into its normal operations. The pharmacy was renovated in such a way that the program could be easily implemented from either window. Because pharmacy staffing will remain static indefinitely, there may reach a point in which mission hindrance versus cost avoidance becomes the limiting factor of the program. Some MTFs may use the American Red Cross or other volunteer organizations to assist in the implementation of OTC programs.

Conclusion

The CGA pharmacy OTC program provides a cost effective mechanism for reducing demand on provider medical appointments and ultimately MTF operational costs. There may reach a point at which providing the OTC service interferes with normal pharmacy operations, and this will require reevaluation of over all utility in meeting operational requirements. Each MTF supporting an OTC program must evaluate its utility to the organization and determine whether the cost of maintaining such a program is worth the intangible impact on MTF staff, specifically, pharmacy personnel.