Appropriateness of self-medication: method development and testing in urban Indonesia

Most illness episodes are treated by self-medication, however, little is known about the appropriateness of this self-medication. Moreover, tools to evaluate the appropriateness of self-medication still need to be developed. In order to monitor the use of drugs by the general public, we developed methodology (for evaluation of the appropriateness of self-medication) that would be reproducible and would therefore allow comparison over time and between regions.

For each complaint, criteria for appropriate treatment were set, based on evaluation of both the efficacy and the risks of the medications used. To keep cost at a minimum and to ensure reproducibility, no use was made of expert panels. Instead, only internationally recognized printed sources were used.

This study used data on self-medication collected in urban Indonesia in 1993. After excluding illness episodes first treated only with traditional drugs, non-drug treatments or treated by a health worker, we found that self-medication used as a first action was appropriate in 16% of the cases. Fifty-six per cent combined appropriate and unnecessary components and 8% included unnecessary components only. Sixteen per cent of treatments were considered potentially harmful. Only 4.5% of the illness episodes were not treated. Analysis of these potentially harmful treatments showed that over use of antihistamine in children under 5 years of age, use of prescription drugs and multiple intake of paracetamol or antihistamines in different medicines were the main problems. The results of this analysis enabled us to set priorities and formulate recommendations to rationalize the use of drugs in self-medication.

The proposed methodology should allow international comparisons and the evaluation of the impact of future interventions.