CPA-MPS 2007,PARK ROYAL, KUALA LUMPUR.

CPA-MPS 2007,PARK ROYAL, KUALA LUMPUR.

SUBRAMANIAM THANIMALAICHING MIN WEIHALIMATUS SA’DIAH AHMAD

RETURN UNUSED MEDICINES FOR DISPOSAL PROGRAMME IN PUTRAJAYA HOSPITAL – A 3 MONTH PRELIMINARY REPORT.

Contents

BACKGROUND1

OBJECTIVES2

METHODOLOGY3

RESULTS & DISCUSSION4

5 CONCLUSION

BACKGROUND

The value of unused medicines throughout the world was immense :

Saudi Arabia & Gulf countries 2002 US150 million, Texas, USA 2003: US 26,000 Puy-de-Dome,France 2001 : 87456FF. Hisham S. et al 2002, Kevin Garey et al 2004

There is little published information on why unused medicines are returned to the pharmacies.

S.Braybrook et al. The Pharmaceutical Journal (TPJ) Sept.1999

The waste of medicines represents the end-point of sub-optimal drug use and is an anti-thesis of good medicines management.

Adam Mackridge et al TPJ January 2004

AIM OF STUDY

To obtain preliminary data on unused medicines, reasons for non-consumption, storage and disposal practices of unused medication among Putrajaya Hospital patients.

OBJECTIVE

1 2

To assess public awareness on storage conditions and disposal.

3

To analyze the costs of the unused drugs.

To identify types of unused drugs stored at home and reasons for non- consumption.

METHODOLOGY

Single-centered, Prospective, observational study.

Posters, Banners displayed and flyers were distributed.

Public who return medications voluntarily were asked to fill an investigator - assisted questionnaire.

Patients were given token of appreciation for their participation.

EXCLUSION CRITERIA

Drugs returned from the ward.

Expired drugs from hospitals, clinics and other institutions.

Drugs returned from non governmental sources and unidentifiable/ unquantifiable drugs were accepted but not included in the analysis.

DATA ANALYSIS

Drugs returned were assessed in terms of type, source, quantity, expiry, reasons for returning and ownership.

Cost of the drugs were accounted according to the Putrajaya Hospital purchase price at the end of 2006.

Data gathered were analysed using Microsoft Excel.

ASSUMPTIONS

All answers to the questionnaire were assumed to be a true reflection of the respondents practice.

Voluntary participation, without coercion from any healthcare personnel.

COST OF THE PROJECT

ESTIMATED TOTAL COST OF THE PROJECTESTIMATED TOTAL COST OF THE PROJECTESTIMATED TOTAL COST OF THE PROJECTESTIMATED TOTAL COST OF THE PROJECT

RM 2670

RM 620 POSTERS & BANNERS

Token of Appreciation- Courtesy of Hospital Management

Estimated Disposal Cost RM2000

BROCHURES &FLIERSRM 50

RESULTS &

DISCUSSION

General Information

The result reflects the data collected in the first 3 month of the study

(Nov 2006 – Jan 2007).

A total of 81 patients responded to the program and 145 types of medications were returned for various reasons.

Age Group of the Respondents

Classification of Respondents According To Age

4% 14%

19%

25%

10%7%

21%

11 – 20 years

21 – 30 years

31 – 40 years

41 – 50 years

51 – 60 years

61 – 70 years

71 - 80 years

Respondents age varies from the age 11-80 years old.

65% of the respondents were the age group of 21-60*.

Mean age group of the highest respondents were 56 years.

•This correlates with the M’sian population( UNDP Data 2001)

GENDER OF RESPONDENTS

There were almost equal amount of males and females who returned unused medicines.

Classification of Respondents According To Gender

Male48%

Female52%

Male

Female

ETHNIC DISTRIBUTION

70.4

19.8

8.61.2

0

10

20

30

40

50

60

70

80

Percentage of respondent

Malay Chinese Indian OthersRace

Ethnics Classification of Respodents

EDUCATION LEVEL OF RESPONDENTS

Education Level of Respondents

14%

49%

37%

Primary Secondary University

Medication Storage Conditions

13.73

26.47

6.86

31.37

5.88 6.868.82

0

5

10

15

20

25

30

35

Percentage of

Respondents (%)

MedicationBox

Cupboard /Drawer

Bedroom Refrigerator Handbag Kitchen OtherPlaces

Drug Storage Areas

RESULTS - Disposal Methods

57.18

4.081.02 2.04 3.06

24.49

8.16

0

10

20

30

40

50

60

Percentage of

Respondents(% )

RubbishBin

Toilet Bury Drain Sink Return ToPharmacy

Others

Method of Disposal

Preferred Method of Disposal of Unused Medications

Discussion - Disposal Methods

Majority (68%) of the disposal methods were non-environmental friendly way (rubbish bin, toilet, sink and drain).

90% of the respondents claimed to be aware of the environment risks related to the environmentally unfriendly method of medicines disposal.

72% of the knowledgeable respondents

disposed it via the methods.

RESULTS - RETURNED REASON

Respondent's Reason For Returning Medicines

26%

1%

21%17%

4%

23%

8%

Excessive Stock ExpiredChange Medicines Did Not Take MedicinesOther's Medication Not SureOthers

ADVERSE DRUG REACTIONS

NO OFFENDING DRUG ADVERSE EVENT

1 Valsartan 80mg & Hydrochlorothiazide12.5mg (Co-Diovan)

Dizziness and headache.

2 Cetirizine 10mg (Xetec) Non-stop sneezing and nose blockage due to Xetec. No complaints on previous brand Adezio (Cetirizine 10mg).

3 Rabeprazole 20mg (Pariet) Dizziness and abdominal pain after second dose. Developed skin eruption (pimple-like) on eyelids, mouth area and nose along with watery eyes and headache with third dose.

4 Mecobalamin 500mcg (Methycobal) Pain in the eyes.

5 Betahistine 16mg (Betaserc) Numbness in the face and mouth along with swollen eyes.

6 Losartan 100mg & Hydrochlorothiazide 25mg (Hyzaar)

Dizziness.

DRUGS RETURNED - TOP 5 CLASSES

22

15

9

6 6

0

5

10

15

20

25

Percentage of Drugs Returned

(%)

Antihypertensives Antidiabetics Supplement Antihyperlipidaemics Antacids

Top Five Classes Of Medications Returned

RETURNED DRUGS – AMOUNT (TABs/ CAPs)

NO DRUGS RETURNED AMOUNT

1 Metformin 500mg 5,284

2 Mecobalamin 500mcg 1,833

3 Calcium carbonate 500mg 1,477

4 Nifedipine 10mg 1,310

5 Trimetazidine 20mg 1,254

6 Acetylsalicylic acid 300mg 1,135

7 Prazosin 2mg 1,080

8 Perindopril 4mg 971

9 Labetalol 100mg 906

10 Diltiazem 30mg 820

RETURNED DRUGS - Amount

NO DRUGS RETURNED AMOUNT

11 Orlistat (Xenical) 781

12 Glibenclamide 5mg 737

13 Prazosin 1mg 737

14 Gliclazide 80mg 700

15 Lovastatin 20mg 655

16 Repaglinide 2mg 647

17 Propranolol 40mg 600

18 Sulfasalazine 500mg 586

19 Ranitidine 150mg 581

20 Omeprazole 20mg 487

RETURNED DRUGS – COST (M’SIAN RINGGIT)

NO. NAME OF DRUGS TOTAL COST (RM)

1 Omeprazole 20mg 2,259.68

2 Orlistat (Xenical) 2,132.13

3 Olanzapine 10mg 664.84

4 Acarbose 50mg 592.76

5 Amlodipine 10mg 589.96

6 Losartan 50mg & Hydrochlorothiazide 12.5mg (Hyzaar)

510.15

7 Repaglinide 2mg 504.66

8 Mecobalamin 500mcg 494.91

9 Insulin regular (Actrapid) 300IU/3ml 475.00

10 Insulin pre-mixed 30/70 (Mixtard) 300IU/3ml

437.50

CASE STUDY

PT: AHD

AGE: 63 years old

ETHNIC : Malay

GENDER : Male OWN MEDICATION (6 TYPES)

DRUG ASSESSMENT

NO DRUGS RETURNED AMOUNT ESTIMATED COST (RM)

REASON FOR RETURN EXPIRY DATE

(EXPIRED)

1 Acarbose 50 mg 370 tab 751.10 Change to new medication 11/05

2 Simvastatin 20 mg 30 tab 11.10 Excessive supply 10/02

3 Metformin 500 mg 100 tab 3.00 Excessive supply 08/04

4 Atorvastatin 10 mg 60 tab 82.80 Excessive supply 02/05

5 Mecobalamin 500 mcg 120 tab 32.40 Excessive supply 11/05

6 Ranitidine 150 mg 50 tab 14.50 Excessive supply 12/04

TOTAL 894.90

TOTAL COST OF UNUSED DRUGS

RM 14,813.57

RECOMMENDATIONS

The project should be continuous and be made a regular program in more centers :

i) to account the amount of wastage; ii) to encourage environmentally safe ways to dispose drugs iii) to identify medication wastage related issues including non compliance, ADRs and side effects. Physicians are recommended to practice prudent

prescribing in chronic diseases.

Patients should be educated on the need and importance of adherence to medication, reporting of side effects, ADRs, proper storage and disposal and appreciation of the value of the drugs dispensed.

A more comprehensive study is recommended to investigate the issue of excessive stock.

CONCLUSION

Pharmacist involvement in medication management review could address issues of over-stocking, drug storage, compliance, side-effects and/or adverse drug reaction monitoring. The study also indicates the need for an appropriate method of disposal of unused medication.

ACKNOWLEDGEMENT

Pn. Hasnah IsmailPn. Norliah ArdeePn.Fathimah