Open Access Open Badges Research article

Irrational prescribing of over-the-counter (OTC) medicines in general practice: testing the feasibility of an educational intervention among physicians in five European countries

Christos Lionis1*, Elena Petelos1, Sue Shea1, Georgia Bagiartaki1, Ioanna G Tsiligianni1, Apostolos Kamekis1, Vasiliki Tsiantou2, Maria Papadakaki1, Athina Tatsioni3, Joanna Moschandreas4, Aristoula Saridaki1, Antonios Bertsias14, Tomas Faresjö5, Åshild Faresjö5, Luc Martinez126, Dominic Agius7, Yesim Uncu8, George Samoutis9, Jiri Vlcek10, Abobakr Abasaeed10 and Bodossakis Merkouris11

Author Affiliations

1 Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, Voutes, PO BOX 2208, Heraklion, P.C. 71003, Greece

2 Department of Health Economics, National School of Public Health, Alexandras Avenue 196, Athens 11521, Greece

3 Department of Internal Medicine, University of Ioannina School of Medicine, Ioannina 45110, Greece

4 Biostatistics Lab, Faculty of Medicine, University of Crete, Voutes, PO BOX 2208, Heraklion P.C. 71003, Greece

5 Department of Medicine and Health/Community Medicine, Faculty of Health Sciences, Linköping University, Linköping SE-581 83, Sweden

6 Department of general Practice, UMR_S 136, Sorbonne University, UPMC Univ Paris 06, Paris, France

7 Mediterranean Institute of Primary Care, Attard ATD 1300, Malta

8 Turkish Association of Family Physicians (TAHUD), 79. Sokak, No:4/5, Emek, 06510 Ankara, Turkey

9 University of Nicosia Medical School, Messinis 3, 2301 Nicosia, Cyprus

10 Faculty of Pharmacy in Hradec Kralove, Charles University in Prague, Prague, Czech Republick

11 Greek Association of General Practitioners, Kountouriotou 21, Thessaloniki 54625, Greece

12 Pierre Louis Epidemiology and Public Health Institute, EPAR Team, F-75013 Paris, France

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BMC Family Practice 2014, 15:34  doi:10.1186/1471-2296-15-34

Published: 17 February 2014



Irrational prescribing of over-the-counter (OTC) medicines in general practice is common in Southern Europe. Recent findings from a research project funded by the European Commission (FP7), the “OTC SOCIOMED”, conducted in seven European countries, indicate that physicians in countries in the Mediterranean Europe region prescribe medicines to a higher degree in comparison to physicians in other participating European countries. In light of these findings, a feasibility study has been designed to explore the acceptance of a pilot educational intervention targeting physicians in general practice in various settings in the Mediterranean Europe region.


This feasibility study utilized an educational intervention was designed using the Theory of Planned Behaviour (TPB). It took place in geographically-defined primary care areas in Cyprus, France, Greece, Malta, and Turkey. General Practitioners (GPs) were recruited in each country and randomly assigned into two study groups in each of the participating countries. The intervention included a one-day intensive training programme, a poster presentation, and regular visits of trained professionals to the workplaces of participants. Reminder messages and email messages were, also, sent to participants over a 4-week period. A pre- and post-test evaluation study design with quantitative and qualitative data was employed. The primary outcome of this feasibility pilot intervention was to reduce GPs’ intention to provide medicines following the educational intervention, and its secondary outcomes included a reduction of prescribed medicines following the intervention, as well as an assessment of its practicality and acceptance by the participating GPs.


Median intention scores in the intervention groups were reduced, following the educational intervention, in comparison to the control group. Descriptive analysis of related questions indicated a high overall acceptance and perceived practicality of the intervention programme by GPs, with median scores above 5 on a 7-point Likert scale.


Evidence from this intervention will estimate the parameters required to design a larger study aimed at assessing the effectiveness of such educational interventions. In addition, it could also help inform health policy makers and decision makers regarding the management of behavioural changes in the prescribing patterns of physicians in Mediterranean Europe, particularly in Southern European countries.

OTC medicines; Primary care; Feasibility study