[Over-the-counter availability of potent ulcer drugs. Study of changes in the drug use pattern and the pressure on diagnostic measures].

In spring 1989, H2-receptor blockers and sucralfate were released for sale over-the-counter in Denmark and, simultaneously, the automatic National Health Insurance subsidy for all ulcer medicine was discontinued. The consequences of these alterations for the pressure on the diagnostic measures for upper dyspepsia are assessed by analysis of the number of referrals for gastroscopy, outpatient history-taking or radiographic examination of the stomach and oesophagus. The consequences for the consumer pattern were assessed in questionnaire investigations both to the practitioners who prescribed ulcer medicine before the alterations were introduced and also to patients who bought ulcer medicine after these alterations. Only approximately 3% of ulcer medicine is sold directly over-the-counter without medical assessment or control. No problems in safety were observed as regards incorrect treatment or delayed diagnosis. The relative proportion of patients with demonstrated indications for necessary ulcer medicine has increased after the alterations primarily on account of decrease in employment of medicine in therapeutic trials. This does not appear, however, to have resulted in any marked increased in the diagnostic possibilities. Potent ulcer medicine has not become generally accepted as over-the-counter medicine. The health and health-economic consequences should, therefore, be followed up for a more prolonged period.