Pharmacists’ Activities to Reduce Medication Waste: An International Survey

Abstract

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.

“Don’t Let Medicines Go to Waste”—A Survey-Based Cross-Sectional Study of Pharmacists’ Waste-Reducing Activities Across Gulf Cooperation Council Countries

“…As there are multiple causes of medication waste ( Paterson and Anderson, 2002 ; Maeng et al, 2016 ; Bekker et al, 2018a ; Bekker et al, 2018b ; Bekker, 2018 ), no single intervention will sufficiently reduce the problem. To address the issue of medication waste, it would be prudent to base strategies on good prescribing, dispensing and medication-taking practices.…”

“…To address the issue of medication waste, it would be prudent to base strategies on good prescribing, dispensing and medication-taking practices. Looking at the existing evidence of potential interventions, an example of a waste-minimising activity in the prescribing stage is to discuss sufficient medication quantities that meet patients’ needs with patients ( Bekker et al, 2018a ; Bekker et al, 2018b ; Bekker, 2018 ), review prescribed medications periodically for each patient and discontinue unnecessary therapy ( Bekker et al, 2018a ; Bekker et al, 2018b ; Bekker, 2018 ), dispense limited quantities of PRN medications to patients, prescribe new drugs for short duration ( Bekker et al, 2018a ; Bekker et al, 2018b ; Bekker, 2018 ), provide expensive medications for 1-month supply ( Bekker et al, 2018a ; Bekker et al, 2018b ; Bekker, 2018 ) and limit repeat prescription duration to 2 months ( Maeng et al, 2016 ; Bekker et al, 2018a ; Bekker et al, 2018b ; Bekker, 2018 ). Various studies have suggested that the medication waste per prescription is lower when dispensing a 1-month supply compared to a 3-month supply ( Domino et al, 2014 ; Doble et al, 2017 ; Miani et al, 2017 ).…”

“…Bekker’s instrument ( Bekker et al, 2018b ) is a self-administered survey instrument that has been developed by researchers at the Department of Clinical Pharmacy, Division Laboratories and Pharmacy, University Medical Centre Utrecht, and has previously been used in the Netherlands. The original survey questionnaire included a total of 14 activities that pharmacists can undertake or implement to minimise medication waste.…”

“…Patients may intentionally (e.g., change in belief, unsatisfactory effect, side effects) or unintentionally (e.g., forgetfulness) fail to take medications as prescribed, which could result in medication remaining unused. They may also habitually order every medicine on a repeat prescription regardless of the need, or may recover from a condition or have a change to a condition that necessitates a change in medication, and this may result in accumulation of unused medicines at home ( Abahussain et al, 2012 ; West et al, 2015 ; Al-Shareef et al, 2016 ; Bekker et al, 2018b ).…”

“…As key players in the pharmaceutical supply chain, pharmacists are in a great position to minimise medication waste ( FIP, 2015 ). They can reduce medications kept in stock, collect unused medications, educate patients about waste, and evaluate and limit medication being dispensed ( Bekker et al, 2018b ). However, only a limited number of studies have been conducted to identify activities implemented by pharmacists in routine practice to minimise medication waste in the GCC countries ( West et al, 2014 ).…”