Over-the-Counter Medication Safety in Older Adults: A Study Protocol for a Demonstration and Dissemination Study

January 24, 2017


Adverse drug events (ADEs) associated with over-the-counter (OTC) medications cause 178,000 hospitalizations each year. Older adults, aged 65 and older, are particularly vulnerable to ADEs. Of the 2.2 million older adults considered at risk for a major ADE, more than 50% are at risk due to concurrent use of an OTC and prescription medication.


To refine the intervention and implementation strategy through diagnostic and formative evaluation; to evaluate the effectiveness of the intervention for preventing misuse of high-risk OTC medications by older adults; and to evaluate the implementation of the intervention in community pharmacies.


A system redesign intervention to decrease high-risk OTC medication misuse will be tested to reduce misuse by improving communication between older adults and community pharmacists via the following features: a redesign of the physical environment to sensitize older adults to high-risk OTC medications, and the implementation of a clinical decision tool to support the pharmacist when critically evaluating the older adult’s health status. The study will be conducted in three phases: a participatory design phase, a beta phase, and a test phase. The test phase will be conducted in three mass-merchandise stores. A total of 144 older adults will be recruited. A pre (control)/post (intervention) test will determine the effectiveness of the intervention. The primary outcome will be a comparison of proportion of older adults who misuse OTC medication from baseline to post-intervention. The process of implementation in the community pharmacy setting will be evaluated using the taxonomy proposed by Proctor et al. The participatory design phase has been approved by the institution’s IRB (2016-0743).

Projected Impact

It is anticipated that this project, which focuses on achieving systems-based improvement in an underemphasized area of the medication use process, will reduce ADEs associated with inappropriate OTC medication use in older adults.

Cited by

This article is cited by 14 publications

  1. Chui, M. A., Berbakov, M. E., Gilson, A. M., Morris, A. O., & Stone, J. A. (2022). Effectiveness and sustainment of a tailored over-the-counter medication safety intervention in community pharmacies: A randomized controlled trial. Research in social & administrative pharmacy : RSAP, 18(11), 3953–3963. https://doi.org/10.1016/j.sapharm.2022.06.008
  2. Qudah, B., Maurer, M. A., Mott, D. A., & Chui, M. A. (2022). Discordance in Addressing Opioid Crisis in Rural Communities: Patient and Provider Perspectives. Pharmacy (Basel, Switzerland), 10(4), 91. https://doi.org/10.3390/pharmacy10040091
  3. Martin, B. A., Breslow, R. M., Sims, A., Harben, A. L., Bix, L., & Becker, M. W. (2022). Identifying over-the-counter information to prioritize for the purpose of reducing adverse drug reactions in older adults: A national survey of pharmacists. Journal of the American Pharmacists Association : JAPhA, 62(1), 167–175.e1. https://doi.org/10.1016/j.japh.2021.08.019
  4. Holden, R. J., Abebe, E., Russ-Jara, A. L., & Chui, M. A. (2021). Human factors and ergonomics methods for pharmacy research and clinical practice. Research in social & administrative pharmacy : RSAP, 17(12), 2019–2027. https://doi.org/10.1016/j.sapharm.2021.04.024
  5. Gilson, A. M., Stone, J. A., Morris, A. O., Brown, R. L., Xiong, K. Z., Jacobson, N., Holden, R. J., Albert, S. M., Phelan, C. H., Walbrandt Pigarelli, D. L., Breslow, R. M., Welch, L., & Chui, M. A. (2021). Impact of a pilot community pharmacy system redesign on reducing over-the-counter medication misuse in older adults. Journal of the American Pharmacists Association : JAPhA, 61(5), 555–564. https://doi.org/10.1016/j.japh.2021.04.007