Consumer preferences for over-the-counter drug retailers in the reregulated Swedish pharmacy market
Introduction
The Nordic pharmacy markets have traditionally been under strict governmental regulation [1]. Since the mid-1990s, regulatory reforms have resulted in major changes introducing more diverse pharmacy ownership and an increase in the number and types of retail outlets selling drugs [2], [3], [4]. Sweden was the last of the Nordic countries to re-regulate the pharmacy market when the governmental pharmacy monopoly ended in 2009 and private pharmacy enterprises entered the market [5]. At the same time, non-pharmacy retailers were permitted to sell certain over-the-counter (OTC) drugs. The intention was to stimulate price competition for cost control purposes and increase the general availability of OTC drugs [6]. Within 5 years, the number of state-owned pharmacies had decreased from 929 to 370 while 957 private pharmacies had been established [7]. In addition, about 5600 grocery stores, convenience stores and gas stations had received authorisation from the Medical Products Agency to sell certain OTC drugs accounting for 18.5% of the OTC market [7], [8].
In Sweden a drug may be approved for OTC sale if it does not pose a direct or indirect risk (i.e. if it has low toxicity and low risk of adverse events and does not conceal any underlying serious illness) or present any danger of abuse. Furthermore, it should be suitable for self-medication and the package size must be adapted to the intended treatment length (usually a maximum of 14 days). The mandatory patient information leaflet should give clear instructions so that rational use is achievable. According to Swedish legislation, community pharmacists are obliged to provide drug information and counsel patients about correct drug use on drug dispensing [5]. The sale of OTC drugs is subject to similar information requirements. However, in non-pharmacy retail outlets other rules apply as these retailers are not allowed to provide counselling on choice of treatment or dosing. The patient is instead referred to a pharmacy or the package insert for drug information. In addition, non-pharmacy retailers are limited to a list with a maximum of 1700 drugs, in a limited range of package sizes, which they can sell to individuals 18 years of age and older [9].
Patients often have limited knowledge of the properties of OTC drugs and how to use them appropriately [10], [11], [12], [13], [14]. Increased availability of OTC drugs has previously been suggested to lead to more relaxed attitudes towards the use of these drugs [15]. There is evidence that patients are unaware of the adverse risks associated with concurrent use of OTC drugs with other drugs and agents [12], [16] and the long-term use of certain OTC drugs in general [10], [17], [18]. At the same time a Dutch study has shown that people feel confident about their own knowledge about OTC drugs [19]. According to a study from Northern Ireland, people tend to base their choice of treatment firstly on what they perceive as effective, based on previous use, followed by familiarity with the brand name. Also, they know a product is effective because it was initially recommended by a pharmacist [20].
Several studies report that many people prefer pharmacies for buying OTC drugs [19], [20], [21]. In the Northern Irish study, about two-thirds preferred using a community pharmacy for their OTC drug purchases. Persons who regularly used prescription drugs were more likely to choose a pharmacy compared with those who did not [20]. In the Dutch study it was even reported that most of the respondents preferred commonly used painkillers (e.g. paracetamol and ibuprofen) to be sold in pharmacies exclusively [19]. Similar opinions were revealed among Flemish patients when asked about their preferred retail outlets for OTC drugs. Moreover, 78% agreed that a record of their personal OTC drug use should be kept in the pharmacy [21]. There are no similar studies looking into the preferences of Swedes, or other Nordic citizens, since the re-regulation of the pharmacy markets.
The aim of the present study was to investigate Swedish consumers’ preferences for OTC drug retailers since the re-regulation, and their reasons for choosing a pharmacy or a non-pharmacy retailer.
Section snippets
Setting and design
A web survey aimed at the Swedish adult population was conducted. The survey was organised by the Laboratory of Opinion Research (LORE) at the University of Gothenburg through their web panel, the Citizen's Panel. During the year of this data collection the entire panel consisted of approximately 21,000 registered respondents, slightly more than 14,000 of whom were considered active participants [22].
Study population
A sample of 4200 persons were randomly selected from the Citizen's Panel to be invited to take
Use of over-the-counter drugs in the study population
The study population consisted of 1357 men and 1237 women aged 21–76 years (mean age: 50.3 years). Twenty per cent of the participants had a university/postgraduate degree while 67% had graduated from high school and 13% had not completed high school.
The majority (87%) of the study population reported use of OTC drugs in the 6 months prior to the study. Of these, 24% had used OTC drugs about every week (>20 times/6 months), 30% at least monthly but not weekly (6–20 times/6 months) and 46% less
Discussion
Following the regulatory reform in 2009, a broad selection of OTC drugs in Sweden can now be sold in grocery stores, convenience stores and gas stations. Still, this study shows that community pharmacies are the preferred retailer for OTC drugs among Swedish adults. This is consistent with studies from other countries, by Brabers et al. and Hanna and Hughes [19], [20], but contrary to a more recent study by Koffeman et al. where users of OTC non-steroidal anti-inflammatory drugs (NSAIDs) were
Conclusion
This study among Swedish adults shows that consumer preferences for OTC drug retailers are based on increased availability in terms of geographic proximity and long opening hours, which is in line with parts of the intention of the regulatory reform. Community pharmacies are still the preferred retailer for OTC drugs for the majority of consumers while grocery stores, gas stations and the Internet are used to a lesser extent. The end of the state's pharmacy monopoly and an increase in the
Conflict of interest statement
All authors report no conflict of interest.
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