Section A: Policy Issue
Self-Medication/Over the Counter Drugs
Healthcare policy entails actions, plans, and decisions which are enacted to achieve healthcare principle objectives within the community. Public healthcare policies resolve numerous issues; defining the goals of healthcare future that further help in establishing primary targets for both long and short term. At the same time, public policies outline the most significant roles and priorities of diverse groupings, thus building information and consensus amongst the people. For example, the National Health Council has established a substantial momentum in the United States for both policy-makers and stakeholders intending to recognize pertinent issues facing healthcare. At the central heart of everything within the public domain is the welfare of patients in the central part of policymaking and discussions. Without the patient, public healthcare policies serve little or no purpose. People, no doubt, want to have the environment and communities that promote and secure their health.
Section 1a: Why Self-Medication/Over the Counter Drugs?
Health care policies such as patient-centered care have focused on improving patient care, diagnosis, treatment, and general care to achieve a holistic approach to the standard of care. Self-medication, for example, over the counter drugs have stood as a challenge to attaining several public health objectives that include pharmaceutical goals and objectives towards availing the right medications to the public. According to Tesfamariam et al., (2019), nursing professionals have also faced the problem of having to counter the threat posed by self-prescriptions. Snyder, Bennett, Oller, and Ge (2017) maintained that s elf-prescription has been identified as self-medication that entails identifying common health challenges and treating oneself with drugs that are effective and safe. Medications that do require self-prescriptions are known as prescription products.
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Section 1b: Relevance
Nursing professional see no danger or risk in self-prescription, especially for emergency purposes or joint ailments. If correctly used, self-prescription is an effective way of countering health emergencies or complications. However, Tesfamariam et al., (2019) further argue that self-prescription have given rise to high rates of dependence on over the counter drugs, raising much concern on the right use of the same in the market. With the dangers of wrong use of over the counter drugs, self-prescription in addition to over-dependence on over the counter drugs may pose a severe threat to numerous healthcare reforms and policies in place.
According to Rather et al., (2017) self-medication and over-dependence on over the counter drugs affect a wide array of stakeholders and departments within the healthcare sector ( Tesfamariam et al., 2019). Besides endangering users lives, illegal use and over-dependence on over the counter drugs may derail many healthcare objectives as outlined in various healthcare policy papers. It affects individuals, the sick, healthcare facilities, pharmaceutical companies, and multiple stakeholders having a particular interest in upholding productive performing healthcare sector. For example, Snyder et al., (2017) maintain that a large section of the community depending on over the counter drugs will increase research costs for the production of these drugs by pharmaceutical companies.
Section 1c: Financial Impact
While the use of over the counter drugs is legal with various medicines outlined as safe, over-dependence is risky. Firstly, it increases the cost of healthcare services with increased costs of drugs. As healthcare costs rise, a large number of people depend on self-medication and over the counter drugs. According to Snyder et al., 2017) the situation is unsafe and may endanger the lives of many while also driving pharmaceutical companies to invest more on the same, thus increasing the production cost. Enacting a policy that will guide and regulate the two issues; self-medication and over the counter drugs is critical towards achieving a host of public health policies such as affordable healthcare. .
Educating and creating awareness among the public on the two issues is critical towards achieving healthcare objectives and helping the community maintain a positive attitude towards seeking professional healthcare. Such will help the community understand the basics of healthcare, such as diagnosis in addition to understanding the importance of using professionally analyzed situations within the healthcare docket ( Tesfamariam et al., 2019). An appropriate policy for regulating and guiding the community on the two issues will help patients invest wisely on healthcare financial schemes. Such will guide people to get adequate healthcare service.
Section 2a: Ethical Principle
Lack of healthcare insurance or care remains the number one factor pushing individuals to self-medication and reliance on over the counter drugs. A duly enacted regulation will help individuals focus on healthy living and proper healthcare. It will also help in elevating the significance of healthcare facilities towards providing effective and efficient healthcare services. Passing and enacting an appropriate health care policy regarding self-medication and the use of over the counter drugs will no doubt assist healthcare professionals such as nurses in upholding ethical values such as justice, non-maleficence, and beneficence ( Rather et al., 2017). For example, nurses will ensure that the service they offer is measured in regards to equality and fairness. It will also help nurses provide equitable treatment to all patients. Fair treatment, focus on doing good to patients, seeking out for the best results, and committing to best practice, patients and community will be fully satisfied in seeking for professional healthcare services. It will help them refrain from over-dependence on over the counter drugs and self-medication.
It is thus vital to enhance and add stringent measures, especially towards over the counter drugs/ self-prescription and self-medication. Lack of relevant policies on the same will deny the professional community medication, diagnosis, treatment, and care. A poorly diagnosed and treated health complication is a threat to the individual and the entire society, especially towards achieving a universal healthcare practice and standard of care. Rather et al., (2017) portend that an outlined framework upon which individuals can seek for over the counter drugs in addition to self-medication will help individuals and the community at large understands the essence of healthy living, health insurance, and drug usage in the face of a health complication. The policy will also establish shared responsibility, universal coverage in addition to setting the standard of care for pharmacists, pharmaceutical companies and health practitioners.
Section B: Policy Brief
Section 1:
The primary stakeholders within the healthcare sector include the insurance companies, government, physicians, patients, and pharmaceutical companies. The best-placed stakeholder or decision-maker to handle and formulate the above-discussed policy is the government. The government upholds that healthcare is a fundamental human right as stipulated in the Constitution.
Section 1a: Decision Maker: Secretary of Health and Human Services
Jacobs and Skocpol (2015) maintain that wit hout considering the differences in political ideologies in regards to healthcare, the government has the sole responsibility of enacting and upholding stipulated laws. It also has the role of regulations, and policies that advance quality care within the healthcare sector. With the legislated "shared responsibility" that exists between individuals, employers, and the government, all citizens are guaranteed proper quality health insurance and affordable schemes. The government also oversees various public policies, the safety of pharmaceutical products, and medical devices. Under health, the docket is the Secretary of Health and Human Services who will receive the above-stated policy. The Secretary is best placed to approve relevant health programs in addition to creating awareness among the public on the government's healthcare objectives ( Jacobs & Skocpol 2015) . The Secretary will thus be better placed to handle the challenges facing the healthcare sector following self-medication and over-the-counter drugs.
The Secretary will be better placed to handle legal challenges that may arise from enacting such a policy due to vested interest from social groupings, especially pharmaceutical companies. Pharmaceutical companies may attempt to derail or prevent the enactment of such a system if it comes from a junior health official. The Secretary is highly positioned with the Federal government and as a close advisor to the present on matter health, stands a better chance of upholding the policy.
Section b2: Challenges
The primary challenge may arise majorly from vested interest groups such as pharmaceutical companies and interest groups who benefit directly from patients who prefer self-medication. Due to their vast financial resources and impact within the healthcare sector, a policy that may reduce their revenue collection may be derailed before being realized. Another major challenge is resistance from the public, especially those who depend solely on over the counter drugs. Jacobs and Skocpol (2015) posit that a lthough political opposition may be encountered, these can be overcome through a way of advocacy and strategic measures. These groups may find it challenging to accept the policy due to personal reasons and interests. If advocated and sponsored from the Secretaries office, the impact and significance will no doubt be felt, and awareness created effectively.
B3: Primary Option
The best strategy to enacting the policy will be to include it as a public health policy within the healthcare Affordable Care Act. Making it law will give it relevance and significance amongst pharmaceutical companies, small scale drug retailers, and among patients. The policy will strengthen other healthcare-related policies, especially those on drugs and standard of care if passed on as an act. It will also enhance existing healthcare coverage, specifically those that promote and safeguard the use of drugs by medical practitioners.
Firstly, the Secretary of health and human services will get official authorization from the President to implement the policy as part of the broader Affordable Care Act. After getting the authority from the President, the Secretary will engage with all the healthcare stakeholders ( Jacobs & Skocpol 2015) . They will include pharmaceutical companies, health practitioners, interest groups, and selected patients to come up with a framework of the policy concerning the current existing situation in the country. The Secretary may create a committee to structure the policy in the best way possible that fulfill all the necessary frameworks that may have been raised by the stakeholders.
B4: Course of Action
The first course of action is to approve all drugs coming into the market. All pharmaceutical companies should show proof that all drugs enlisted as over the counter or for self-prescription are tested for efficiency and safety. All risks and benefits will, after that, help the agency grant permission for its availability over the counter. The Food and Drug Administration should also be empowered to test, review, and ascertain the safety of all over the counter drugs to classify them accordingly. All medications classified as safe and beneficial as over the counter should then be labeled. At the same time, a toll-free number that customers can use in the case a drug shows severe effects. The measure will help FDA to discontinue any drug deemed dangerous to the market or unsuitable for sale lacking a special prescription from a physician. Drug manufacturing companies will also be tasked to provide to the agency any adverse impacts to the FDA. Legislations will provide for prosecution in the case a company fails to report such a warning. At the same time, government agencies will also launch a nationwide campaign to educate locals on the dangers and usage of over the counter drugs. On the same note, healthcare facilities will be urged to inform patients of the need to seek for prescription or awareness on buying over the counter drugs or self-medication.
The best strategy towards avoiding the challenges identified above is to formulate an all-inclusive approach to bringing all parties on board. These include healthcare facilities, pharmaceutical companies, government, and non-government bodies together towards finding a roadmap to addressing the problem of over the counter drugs. Interest groups from diverse community levels should also be brought on board to help tackle the challenge from the grass-root level. Having a comprehensive framework will help reduce resistance and improve on awareness at the lowest level in the society and among prevalent customers.
Enforcing some of the recommendations and suggestions in law can also help to reduce the challenges encountered. It will reduce the level of rejection, increase acceptability among users, and create necessary awareness at the right level of understanding. By legislating the recommendations in law, all parties will be bound through an open and legal framework that will reduce legal challenges, improve awareness and help users understand the relevance of over the counter drugs and self-medication.
B5: Top-Down Approach
As described above, the top-down approach entails relying on higher authorities in determining the objectives of the policy. For example, in the above case, the Secretary of Health and Human Sciences will take the initiative to involve stakeholders in the policy enactment. The Secretary will then ask the President to or Federal government to sponsor a bill that will eventually be the law after passing through all the sue stages in Congress. The success of the entire policy brief will be determined by the response and reaction of the stakeholders who will be engaged with the Secretary towards having a joint policy paper on the same. The policy's success will also be evaluated from the response of the President and Congress during the process of enactment.
Five essential items will be used to evaluate the success of the policy. They will include: Keeping to the schedule in which the policy enactment kept to its time frame. For example, if the policy enactment was scheduled to take two years, the evaluation will focus if it took the recommended time. The second strategy will focus on the quality of the policy concerning how it is meeting its set standards. It will involve checking all the policy practices that include deliverables and their variables. The cost will also form a critical part of the evaluation in which the overall cost will be compared with the estimated cost. It will give a forecast on its relevance. Stakeholder satisfaction will form a critical aspect of the evaluation. It will involve finding out if the relevant stakeholders such as the pharmaceutical companies, the President and consumers are satisfied with the overall result of the policy. The last evaluation strategy will entail on the policy’s performance in the business environment. If it aligns to the business environment, then it is a success, but in case it fails to align with the business situation, it has still not yet achieved its overall objective.
Section C: The Plan
C1: Organization: American Medical Association
Since its establishment and incorporation, the American Medical Association has endeavored to enhance and create awareness on better public health and medication. The association has shown remarkable interest in the policy due to its promotion of healthy medical initiatives and public health. The association has often taken bold steps in pursing relevant policies that promote public health and medication. It has also made an aggressive attitude towards increasing or funding medical costs to improve healthcare services and accessibility to care. For example, AMA formed a coalition with other stakeholders, aiming at advancing the best healthcare policies and practices, towards defeating the United States National Health care Act. Thus, it stands as the best organization to partner with towards advancing the courses of the policy under discussion.
C2: CBPR Principles
Community-Based Participatory Research entails a partnership strategy that involves, for instance, researchers, organizational representative, and community members. The basic principles of CBPR are aimed at forming a strategic approach towards achieving a common goal with the community. In working with AMA, the best principles to use to address a policy change will include the recognition of the community as a unit of identity. It entails emotional identification and connection, establishing common goals, and setting shared needs. Another critical CBPR to use is building on resources and strengths within the community by way of identification of individual assets and skills, helpful contacts ad networks in addition to establishing faith-based structures. Thirdly, action, and research for the good of the partners in which it will seek to develop awareness on well-being and health.
C2a. Approaching and Collaborating AMA
The American Medical Association chief mission is "to promote the art and science of medicine and the betterment of public health." As the only medical Association with the most significant number of physicians, it can offer a very critical guideline to addressing over the counter drugs and self-medication. Thus, the best way to approach and collaborate with it is to take it as a legal advisor. For example, the Secretary of Health Services should seek for its professional opinion, advice, and recommendation on all medications involving drugs within the health facilities and especially those bought over the counter. The Association should also be incorporated into the framework of the plan as an educator, especially during the campaign and awareness exercises when legal advice and opinion will be required. Upholding its professional and highly competent approach to public healthcare will play a critical role in educating the public on self-medication and the use of over the counter drugs. The Association's collaboration will thus come in the form of providing professional viewpoint by way of their research, observations, and partnerships with pharmaceutical companies and customers.
2b: Alignment
The partnership will blend on intervention structures, research findings, and intervention strategies towards the policy change. AMA is the best to engage in this scenario as it will help in the promotion of appropriate healthcare practices that involves correct health practices and guidelines. Since its primary purpose is to promote the betterment of Medicare and public health, the plan will be aligned with communal health policies to achieve its primary purpose.
2c: Steps
Appropriate measures will be undertaken to formulate a single strategic objective towards accomplishing the goal of the policy to achieve the above mission in aligning the policy's goal to the organization's goal. It will entail, creating a draft of measures from both sides that will align with the policy change. After that, a common approach to unifying the objectives to get a common goal will be enacted. The two objectives aimed at the betterment of Medicare will be harmonized and agreed upon by the members. A final draft of the common purpose will then be sent to Congress.
From the above discussion, the first step will entail identifying all the relevant stakeholders. The second step will involve preparing a policy brief that will be discussed at length by all the identified stakeholders. The stakeholders will be required to forward their opinions and observations on the issue under discussion. After an in-depth consultation, final recommendations will be outlined ready for action. All the outlined strategies will involve the entire stakeholder’s from the grassroots’ level to the Secretary’s office. An appropriate action plan will then be put into action right from the community level.
2d: Roles and Responsibilities of AMA
The primary function of AMA in the policy change will be to research self-medication and over-reliance on over the counter drugs. The research will be carried out to understand the prevalence of the practice among the community members. The stud will also attempt to understand the common self-prescription drugs most used by the community members. AMA will, in after that, outline a draft of measures towards finding a lasting solution to the practice among the community members.
The community will have the primary role of providing the necessary frameworks and logistics to healthcare providers towards meeting established goals and objectives. The community will also ensure that all recommendations entailed in the policy brief are attained and achieved. It will help in creating a connection between the drug sellers and populations and especially vulnerable groups such as women and the aged. The activities and responsibilities of the community will strive towards meeting its unique demands and helping the stakeholders’ connect with the locals.
2e: Key Elements
Some of the critical elements to establishing a collaborative evaluation plan will entail capacity building. The partners will formulate measures of education the public on its roles and responsibilities ( Chambers, Feero & Khoury 2016) . Capacity building will involve meetings, study groups, and evaluation exercises towards understanding the part of the collaboration. It will also strike a balance between mutual benefit and action with the view of benefiting all the members.
A participatory evaluation plan will be the best ways to develop a collaborative assessment plan. The first step will involve engaging all stakeholders and connecting them at the community. They include healthcare practitioners, AMA, Secretary of Health issues, interest groups, pharmaceutical companies, and medical agencies. The second step will involve describing the plan as envisioned by the stakeholders. It will majorly comprise of a developed logical model that will be understood by all the stakeholders from the grassroots’ level to the highest level (medical practitioners). The fourth step will entail gathering relevant information from reliable data and measurements. All stakeholders, especially the community will have their roles and responsibilities aligned with the critical objectives of reducing over-reliance on over the counter drugs and self-medication. The last element will entail drawing out a conclusion relevant to all the features of the CBPR principles.
2f: The Success of the Plan
Fleiszer et al., (2015) clarify that engaging members of the community will evaluate the progress of the arrangement on their understanding of the research project and policy change initiative. During the awareness engagement exercise, the public will be interviewed to determine their level of knowledge following the effort to enact a policy change. According to Fleiszer et al., (2015) the community members will be engaged directly at a personal level. Another group that will be involved will be medical practitioners and personnel on their understanding of the policy.
The precise action steps will involve comprehensive research and analysis of the response of community members using over the counter drugs or who undertake self-medication. Through follow-ups and close observation, their reaction towards self-medication versus seeking healthcare services will be monitored to determine the level of success. At the same time, production of over the counter drugs will be monitored to determine their sale in the market and the community's response to their availability. The success of the plan will thus be noted by way of having a close collaboration with the community and drug sellers towards patients who depend on over the counter drugs. The general public's health status of community members will also provide a pointer towards the success of the plan, and this will be recognized by evaluating the number of those seeking drugs or health services.
Section D: Analysis
Challenges and Benefits of Bottom up and Top-down approach
D1: Challenges
One of the most significant drawbacks and challenges of the top-down approach is minimal participation from those at the lower ranks. Thus decision making is mostly left to the leading personnel within the group. Bishop (2016) articulates that i n case the leading figure understands less, the entire team is disadvantaged in formulating a proper solution since participation from the other member is curtailed. It is difficult to understand another’s point of view, and at the same time, there will not enough conflict that will inspire problem-solving approach. The scenario will thus not argue well for constructive engagement.
D2: Strengths
However, according to Bishop (2016) authority wielded by the topmost personnel will positively influence the enactment of the policy since they will have sufficient resources, and influence to sway public and political forces. On the other hand, the community will have greater confidence in the policy if it is enacted and influenced by persons at a higher authority.
D3: Effective Approach
The bottom-up approach offers clarity and lessens conflict as it originates from the community members first. Thus, the chances of adoption are high. At the same time, less time will be taken in research and collaborations. Bishop (2016) further observes that i t will find an excellent definite appeal from among the public in addition to garnering enough support from the grassroots. It thus means that the period of enactment is reduced significantly. However, one of the most significant challenges to the bottom-up approach is the policy may face various changes in later implementation phases ( Bishop 2016) . The community members may also feel the impact of the policy much earlier than intended. It may give rise to opposition if the policy is changed on later stages.
References
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Cairney, P. (2016). The politics of evidence-based policy making . Springer.
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Tesfamariam, S., Anand, I. S., Kaleab, G., Berhane, S., Woldai, B., Habte, E., & Russom, M. (2019). Self-medication with over the counter drugs, prevalence of risky practice and its associated factors in pharmacy outlets of Asmara, Eritrea. BMC public health , 19 (1), 159. http://www.jddtonline.info/index.php/jddt/article/view/2538
