Progress in Understanding and Using Over-the-Counter Pharmaceuticals for Syndromic Surveillance

Introduction: Public health researchers are increasingly interested in the potential use of monitoring data on over-the-counter (OTC) pharmaceutical sales as a source of timely information about community health. However, fundamental uncertainties persist, including how timely such information is and how best to aggregate information about hundreds of products. Objectives: This analysis provides new information about OTC timeliness and illustrates a method of OTC product aggregation for surveillance purposes. Methods: Timeliness measurements were made by correlating pharmaceutical sales counts with counts of physician encounters, after adjustment to remove seasonal effects from both counts. OTC product aggregations were formed by a two-stage process. In the first stage, individual products were placed into small groups based on qualitative observations. In the second stage, a clustering algorithm was used to form supergroups (i.e., product group clusters) sharing similar sales histories. Results: Even after seasonal correction, OTC counts correlated with clinical measures of community illness. However, the lead time of nonseasonal fluctuations was substantially shorter than that for uncorrected data. The clustering approach produced 16 meaningful supergroups containing products that behaved approximately alike. Conclusions: Measurements of OTC lead time sensitive to the timing of annual cyclic trends in the behavior of persons seeking health care do not reliably indicate the lead time observed for short-term (e. g. weekly or monthly) fluctuations in community health-care utilization.