20 December 2010
In November 2010 the final report of an independent study commissioned by the Department of Health was published; looking into the scale, causes and costs of waste medicines. The ‘Evaluation of the Scale, Causes and Costs of Waste Medicines’ report1, undertaken in 2009 by the York Health Economics Consortium and the School of Pharmacy at the University of London, estimated that NHS primary and community care prescription medicines wasted in England cost in the region of £300m a year. Not all of this is avoidable however; the researchers estimate that less than 50% of this total figure is cost effectively preventable.
The report concludes that primary and community care medicines waste in England should be seen as a normal challenge to be tackled through the continued development of existing strategies and care quality improvement initiatives.
The authors of the report1 highlight that the failures to take medicines to optimum effect are in many instances attributable to either intentional or accidental non-adherence on the part of their users, but this should not be confused with medicines wastage. Indeed, they stress that patients should not be blamed for the problems they experience in medicines-taking, or for medicines wastage, as most is not primarily the result of their deliberate actions.
The extensive research undertaken by the authors found the causes of medicines wastage to be complex. However they suggest that the root causes of medicines wastage encompass:
- Patients recovering before their dispensed medicines have all been taken
- Therapies being stopped or changed because, for example, of ineffectiveness and/or unwanted side effects
- Patients’ conditions progressing, so that new treatments are needed
- Patients’ deaths which, as well as revealing previously unused medicines, may involve drugs being changed or dispensed during the final stages of palliative care
- Factors relating to repeat prescribing, which may cause excessive volumes of medicines to be supplied
- The failure to support medicines-taking in vulnerable individuals living in the community.
The report authors indicate several qualitative improvements that could support a reduction in medicines wastage. These include placing an emphasis on improving health outcomes rather than waste cost reduction alone; continuously encouraging good communication and open relationships between service users and health professionals; and applying research findings to the development of practical interventions capable of cost-effectively improving drug use.
Positive opportunities identified in the report for the further reduction of waste medicines include:
- Providing targeted support for patients starting new therapies and those on unusually costly and/or difficult-to-take treatments
- Supporting high quality prescribing, and ensuring that medication and associated treatment regimens are effectively reviewed
- Incentivising closer professional management of medicines supply at the point of dispensing
- Encouraging the flexible and informed use of 28 day and – where it benefits patients – either longer or shorter prescribing periods
- Caring better for ‘treatment resistant’ patients who may not be taking their medicines correctly
- Providing better-quality pharmaceutical care for isolated patients and other vulnerable groups of patients
- Undertaking audits of the supply and use of monitored dosage systems
- Enhancing hospital and primary care liaison; e.g. improving the quality of care at the time of hospital discharge
- Delivering better-integrated terminal care in home settings
- Developing more effective national or local waste medicines return and related public information campaigns.
What does this mean to medicines management?
In his response to the waste medicines report, Lord Howe said: “We want to help people be more involved in decisions about their healthcare where there is no decision about me, without me.”2 Putting patients at the centre of their own care can help support the medicines-taking process by allowing health professionals to better understand the needs of their patients.
Health professionals need to actively support patients with their medicines-taking through improved concordance measures targeted specifically to the individual needs of the patient to allow the patient to get the optimum benefit from their medicines. Health professionals should engage patients in a two-way communication process and identify what the patient needs are, what barriers they are facing, and how they can help support the health and wellbeing of each individual patient.
A whole-system approach to how medicines management systems and services are used and delivered will be required at both a local and national level to effectively minimise waste medicines and involve patients in the decision-making process. This will help to alleviate existing problems around the cost of waste medicines, the dangers of storing waste medicines, non-adherence and non-compliance.
High quality prescribing requires sound, evidence-based information to support clinical decision-making. The therapeutic section of NPC provide summarised evidence to support busy healthcare professionals and include patient decision aids that can be used to help patients understand the treatment options available to them.
Supporting information on reducing waste in medicines management can be found in the following NPC topics: [Waste reduction, Introduction to medicines concordance and adherence to treatment, Involving patients in treatment decisions, Assessing adherence to treatment, Concordance consultation skills, Interventions to increase adherence to prescribed medication, Repeat prescribing, Repeat dispensing, Introduction to medication review, Medicines Use Reviews and Medicines management in care homes
How does this relate to other publications or evidence?
Reducing waste in the NHS is highlighted in the Department’s of Health’s 2010 document ‘The NHS Quality, Innovation, Productivity and Prevention Challenge: an introduction for clinicians’.3 The document identifies the importance of the Department of Health’s QIPP agenda and helps to identify the ways in which health professionals can work together locally to support clinical teams and NHS organisations to meet the challenge of cost savings in the NHS whilst improving service efficiencies.
The 2007 National Audit Office (NAO) report Prescribing costs in primary care4 identifies how cost savings can be made without affecting clinical outcomes through the implementation of more efficient prescribing systems. The report identifies the important role prescribing advisers can have in helping GPs achieve this outcome and supporting the decision-making process.
1. York Health Economics Consortium, University of York, and the School of Pharmacy, University of London (2010). Evaluation of the Scale, Causes and Costs of Waste Medicines.
2. Howe, L. (2010). Lord Howe response to medicines wastage report.
3. Department of Health (2010). The NHS Quality, Innovation, Productivity and Prevention Challenge: an introduction for clinicians.
4. The National Audit Office report (2007). Prescribing Costs in Primary Care.
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