Charlotte L. Bekker

Redispensing of medicines unused by patients: a qualitative study among stakeholders

Background Medication waste has undesirable economic and environmental consequences. This waste is partly unavoidable, but might be reduced by redispensing medicines unused by patients. However, there is little knowledge of stakeholders’ views on the redispensing. Objective To identify the stakeholders’ views on the redispensing of medicines unused by patients. Setting Dutch healthcare system. Method Semi-structured interviews were conducted with 19 Dutch stakeholders from September 2014 until April 2015. The interview guide included two themes: medication waste and redispensing of unused medicines. The latter included qualitative-, legal- and financial aspects and stakeholder involvement, with specific attention to the patient. Interview transcripts were subjected to thematic content analysis. Main outcome measure Requirements related to the redispensing of unused medicines. Results All stakeholders considered the redispensing of medicines desirable if the implementation is feasible and the requirements for the safe redispensing are met. All of them pointed out that the product quality of redispensed medicines should be guaranteed and that it should be clear who is responsible for the quality of redispensed medicines. The stakeholders stated that transparent communication to patients is essential to guarantee trust in the redispensing system and that patients should be willing to use redispensed medicines. Moreover, the redispensing system’s benefits should outweigh the costs and a minimal economic value of medicines suitable for redispensing should be determined. Conclusion Redispensing unused medicines could decrease medication waste if several requirements are met. For successful implementation of a redispensing system, all relevant stakeholders should be involved and cooperate as a joint-force.

Pharmacists’ Activities to Reduce Medication Waste: An International Survey

Aim: To identify activities that pharmacists undertake to reduce medication waste, and to assess the extent to which these activities are implemented, their importance for waste-reduction and feasibility for broad implementation. Methods: A two-phase survey was conducted among community and hospital pharmacists working in different developed countries. Phase one used an open-ended questionnaire to identify activities undertaken by pharmacists. Answers were thematically analysed to construct a list of medication waste-reducing activities. In phase two, a questionnaire was disseminated among pharmacists from different countries, to assess if these activities are implemented (yes/no), their importance and feasibility (1 to 5 ranking scale). Results: In phase one, 53 pharmacists participated and 14 activities were identified. These were categorized into the pharmaceutical supply chain: prescribing, dispensing (pharmacy/patient-related) and leftover stage. In phase two, 89 pharmacists participated. Most activities were implemented by a minority of pharmacists. Reducing medication amounts in stock was most frequently implemented (dispensing stage pharmacy-related; 86%), followed by collecting unused medications (leftover stage; 77%) and performing a medication review (dispensing stage; 68%). Waste-reducing activities in the dispensing stage activities were both considered most important and feasible (ranked 4). Overall, most activities scored higher on importance than on feasibility. Conclusions: Pharmacists have various opportunities to reduce medication waste throughout the pharmaceutical supply chain, however, not all are broadly implemented. Pharmacists consider waste-reducing activities important, but they are less certain about the feasibility for implementation in practice.

Cost estimation of redispensing unused medicines that are returned to the pharmacy: A micro-costing study

Mette Heringa, Annemieke Floor-Schreudering, Peter A.G.M. De Smet, Marcel L. Bouvy SIR Institute for Pharmacy Practice and Policy, Leiden, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Health Base Foundation, Houten, Departments of Clinical Pharmacy and IQ Healthcare, University Medical Centre St Radboud, Nijmegen, Netherlands

Patient compliance with drug storage recommendations

Background: To minimise post-marketing uncertainties for products with a Conditional Marketing Authorisation (CMA) in Europe, specific obligations (e.g. interventional and observational studies) are imposed as a condition to the marketing authorisation (MA). A yearly follow-up of these requirements and assessment of study results is conducted during annual renewal (AR). Objectives: To characterise changes in descriptions and due dates of obligations over time, and identify drug and obligation-related factors associated with these changes. Methods: We performed a retrospective cohort study of obligations imposed on the CMA of products licensed (excluding vaccines) since 2006 with at least one year follow-up or one AR (until 31/12/ 16). Changes in wording or due date of obligations were identified by comparing the MAs of products at granting, AR(s) and conversion of the CMA. Unconditional logistic regression was performed to calculate odds ratios (OR) and 95% confidence intervals (CI) for the association between factors extracted from documentation of the European Medicines Agency and post-marketing changes in completed obligations. Results: For 26 CMA products 79 obligations were requested (median: 2, interquartile range [IQR]: 1-3.75) with a median follow-up of 2 ARs (IQR: 1-3). Of these, 67 were imposed at time of MA and 12 during AR (6 products). In total, 31 changes were observed in 25 obligations (32% of all obligations). Changes concerned a change (delay) of due date (n = 19, 61%), description (n = 4, 13%) or both (n = 8, 26%). Six drug-related factors for changes in 61 completed obligations were identified: prospective use of CMA (OR 0.2, 95% CI 0.06-0.8), CHMP agreement on MA (majority vs. consensus; OR 3.9, 95% CI 1.2-12.4), indication (oncology vs. infectious disease; OR 3.9, 95% CI 1.1-14.0), duration of MA procedure (> 1 vs. ≤ 1 year, including clock stop time; OR 3.4, 95% CI 1.03-11.1), biologicals vs. small molecules (OR 3.3, 95% CI 1.03-10.6) and argumentation for unmet medical need (no satisfactory treatment available vs. major therapeutic advantage; OR 0.2, 95% CI 0.03- 0.8). No obligation-related risk factors were identified. Conclusions: In almost one-third of obligations imposed as a condition to a CMA, at least one change in initial wording or planning was identified. We found six factors associated with risk of change that can inform strategies for better prospective planning of post-marketing studies to reduce uncertainties.

Unused medicines returned to community pharmacy: An analysis of medication waste and possibilities for redispensing

Background and Objective: Traditionally, drug prescription and follow up have been the sole responsibility of physicians. However, interprofessional medication reviews (IMRs) have been developed to ...