Use of over-the-counter medicines: a window into chronic disease management by private medical insurance schemes in South Africa

Background In South Africa (SA) privately-insured individuals have easy access to over-the-counter (OTC) medicines. For patients registered with the insurer for management of a chronic disease through a disease management programme (DMP), the manner in which OTCs are accessed may provide insight into how well the disease is controlled and also how well the DMP is performing. Objective The study aimed to measure access to commonly-used OTC products by individuals registered for management of prevalent chronic diseases, and to consider why the medicines were selected in addition to mainstream drugs usually prescribed for treatment. Methodology Data were extracted from a large corporate database. Individuals of interest were aged ≥40 years and registered for management of one of the prevalent non-communicable diseases. Utilization of aspirin, inhaled corticosteroids and bronchodilators was assessed. Results The study population included 4 149 individuals registered for management of hypertension, hyperlipidaemia, Type 2 diabetes, asthma, chronic obstructive pulmonary disease, bronchiectasis, coronary artery disease, cardiomyopathy, cardiac failure, arrhythmia, vascular disease or glaucoma, and 12 105 controls without any of the chronic conditions. The conditions were grouped together as metabolic, respiratory, cardiovascular or glaucoma. Whether accessed directly by individuals or prescribed by doctors, there was high utilisation of bronchodilators in the respiratory group, likely for supplementary management of disease. Bronchodilators were possibly accessed for management of side effects of medicines prescribed for treatment of cardiovascular disease. Bronchodilator access was also high among control subjects, possibly indicating that this group included those with asymptomatic or undiagnosed disease. Aspirin appeared to be appropriately utilised for management of cardiovascular and metabolic disease. All the OTC medicines were inappropriately funded out of the acute medicines benefit pool instead of being funded from the chronic medicines pool. Conclusions Disease management programmes are an integral part of managed care, which itself is written into legislation as a tool to mitigate clinical and financial risk within privately-funded medical insurance schemes. Analysis of OTC medicines accessed by DMP-registered individuals strongly suggests that DMPs are falling short in both clinical and financial areas. Routine system-driven claims analysis would enable insurers to develop performance-enhancing interventions.