It is inferred from our study that approximately 60% of population in the Hong Kong community had adequate knowledge on using OTC products, primarily on western OTC products (> 60%). However, those who were at lower education level and elderly were more likely to have inadequate knowledge on using OTC products. Almost one-third (32.6%) of the respondents had purchased OTC products over the past 3 months and the majority (89.8%) claimed to follow product package instructions, which were quite consistent with the findings of the study of Wazaify and her team [18
]. Our study also showed that Chinese patients with chronic diseases tended to spend more money on western and Chinese OTC products than those without chronic diseases. A study in Australia also found that 80% of their patients with a chronic condition used OTC products and many of them were not using the right dose [19
]. It is therefore anticipated that patients with chronic diseases would be prone to higher risk of drug interactions between prescription drugs for chronic diseases and OTC products [20
]. Based on previous studies and our research findings, elderly who received lower education and with a chronic condition are at high risk of improper use of OTC products and they are the group which needs pharmacist counselling most.
The majority (94.6%) of the population supported the practice of self-care for chronic diseases, and over 80% of those with chronic diseases claimed to perform self-care tasks regularly. Community pharmacist-provided self-care programmes had demonstrated positive impact on chronic diseases. Doucette et al. conducted a randomized controlled trial in patients with diabetes to evaluate the effect of community pharmacist-provided extended diabetes care service on patients' self-care activities [21
]. Patients in the intervention group increased the number of days per week significantly (1.25 versus 0.73 days/week) engaging in diabetes diet and self-care activities. Barbanel et al. also demonstrated that patients with asthma in a self-care programme delivered by a community pharmacist had significantly better improvement of symptom scores (adjusted difference for baseline scores = 7.0 (95% CI = 4.4-9.5)) [22
]. Self-care programmes provided by community pharmacists had established ground works in various chronic illnesses through health services research in western populations, yet such evidence is limited for populations in Hong Kong, China as well as other Asia regions. Though there is evidence to support the effectiveness of pharmacist-led self-care programme, only less than half (45.5%) of the population supported the pharmacist-led approach according to our study.
The evolution of the Hong Kong healthcare system and the health policy might explain why Hong Kong people have a low acceptance rate on pharmacist-led self-care management. In Hong Kong, patients receive health services from either private or public sectors seldom have the opportunity to consult community pharmacists as patients usually receive prescribed medications from private doctors directly or from government clinic pharmacies. Community pharmacists would only have the chance to provide consultation when patients visited them to buy drugs over the counter. Patients, therefore, are not familiar with the role of pharmacists besides dispensing drugs and not very supportive of pharmacist-led self-care management.
A study on the perspectives of physicians, pharmacists, traditional Chinese medicine practitioners and dispensers on patient self-care and roles of pharmacists indicated the importance of patients to self-care of their chronic conditions and they also supported pharmacists to be involved in patient self-care and take a major role in managing patients' medication issues. To provide successful continuity of care after patients return to the community, connectivity among patients, health professions and health services within the system is vital [23
]. With the support of medicine professionals [24
] and approximately 45% of people agreed with the pharmacist-led approach in this study, there are a few strategies that can be considered to enhance the familiarity level of patients and people in the community with pharmacists.
Community pharmacists can undertake a more active role in health promotion campaign such as drug safety in order to increase their publicity. Besides, partnership programmes can be developed between doctors and pharmacists in the community so that patients can consult pharmacists when they are not able to make their appointments with doctors. In addition, it is also necessary for the government to enhance the involvement of pharmacists in primary care and promote the roles of pharmacists through patient education, so that people can have more opportunities to communicate and contact with pharmacists.
The present study was limited by the relatively small number (total 37) of questions in the questionnaire. Our description of self-care activities in the survey might be inadequate. A case scenario would have provided more detailed requirements for self-care of chronic diseases and better described the role of pharmacists. The respondents therefore might have underestimated the complexity of self-care and the role of pharmacist for each common chronic disease, including hypertension, hyperlipidaemia and diabetes mellitus. In addition, those who responded to the survey could be more interested and knowledgeable about patient self-care and role of pharmacists. The views of people who refused to participate could have been neglected in this study.