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Kanyari SS, Senapati TR, Kar A. Disposal Practices of Unused and Expired Medicines Among the General Public and Pharmacies: A Mixed-Method Study in the Odisha State of Eastern India. Cureus 2024; 16:e52359. [PMID: 38361720 PMCID: PMC10867696 DOI: 10.7759/cureus.52359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2024] [Indexed: 02/17/2024] Open
Abstract
Introduction Unused and expired medicines are potentially toxic substances that should be managed effectively to avoid possible environmental hazards. The absence of well-defined protocols in India regarding the proper disposal of unused, unwanted, and expired medications raises concerns about the potential for accidental poisoning and environmental threats. Consequently, this research was conducted to evaluate the disposal practices of medications within both urban slum households and pharmacies. Methods This questionnaire-based, mixed-method study was conducted among 385 general public residing in urban slums and 10 registered pharmacies in Bhubaneswar city, India, from September 2020 to August 2021. A semi-structured questionnaire was framed to collect data from the households and the pharmacies; key informant interview was carried out among expert members regarding the disposal of expired medicines. Results Results found that 82.1% (316/385) of the study population threw unused drugs in dustbins, whereas only 2.6% (10/385) returned the medicines to the pharmacy. The most common reason for leftover medicine was the stoppage of drugs on symptomatic relief (53.2%, 205/385), followed by changes in prescription by doctors (18%, 69/385). Out of 10 pharmacies, seven pharmacies disposed of expired drugs in general dustbins. Conclusion Our findings indicate that a majority of the participants tend to dispose of medicines in an unsafe manner. Conversely, the responsible disposal of medications is significantly influenced by patient education. Hence, healthcare professionals are better positioned to impart knowledge to the public, fostering awareness about the proper storage and safe disposal of unused, unwanted, and expired medicines.
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Affiliation(s)
- S Suneeti Kanyari
- Community Medicine, Kalinga Institute of Medical Sciences, Bhubaneswar, IND
| | | | - Ansuman Kar
- Community Medicine, Kalinga Institute of Medical Sciences, Bhubaneswar, IND
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Thiruchelvam K, Byles J, Hasan SS, Egan N, Kairuz T. Home Medicines Review and frailty among community-dwelling older women. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2021; 29:548-555. [PMID: 34463322 DOI: 10.1093/ijpp/riab054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 07/27/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Home Medicines Reviews (HMRs) can optimize medications for frail older adults. This study aimed to determine the use of HMRs according to frailty status and the association between frailty and use of HMRs. METHODS The study included 9139 female participants enrolled in the Australian Longitudinal Study on Women's Health from 2003 (aged 77-82 years) to 2017 (aged 91-96 years). Generalized estimating equations (GEEs) using log-binomial regressions were used to determine associations using repeated measures on individuals over time. KEY FINDINGS The majority of participants in the study remained non-frail and did not receive HMRs from 2003 [7116 (77.86%)] to 2017 [1240 (71.31%)]. The use of HMRs was low in both groups with 33 (1.68%; 95% CI, 1.16 to 2.36) frail and 64 (0.89%; 95% CI, 0.69 to 1.14) non-frail participants receiving HMRs in 2003; by 2017, 19 (4.19%; 95% CI, 2.54 to 6.46) frail and 45 (3.50%; 95% CI, 2.57 to 4.66) non-frail participants received HMRs. Frailty was not associated with receiving a HMR (RR 1.06; 95% CI, 0.95 to 1.20), although for every 1-year increase, participants were 10% more likely to receive a HMR (RR 1.10; 95% CI, 1.09 to 1.11). Participants with continuous polypharmacy, ≥4 chronic diseases, >4 general practitioner visits and Department of Veterans Affairs coverage were more likely to receive a HMR. CONCLUSIONS Despite the proven value of HMRs for frail older people, HMRs were not used for most frail and non-frail community-dwelling women in this study. Reasons for low use of the service should be explored, with interventions to raise awareness of the benefits of the service.
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Affiliation(s)
- Kaeshaelya Thiruchelvam
- University of Newcastle, Callaghan, NSW, Australia.,School of Pharmacy, International Medical University, Kuala Lumpur, Malaysia
| | - Julie Byles
- University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Generational Health and Ageing, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Syed Shahzad Hasan
- University of Newcastle, Callaghan, NSW, Australia.,Department of Pharmacy, University of Huddersfield, Queensgate, Huddersfield, UK
| | - Nicholas Egan
- University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Generational Health and Ageing, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Therese Kairuz
- University of Newcastle, Callaghan, NSW, Australia.,School of Pharmacy, International Medical University, Kuala Lumpur, Malaysia
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Jafarzadeh A, Mahboub-Ahari A, Najafi M, Yousefi M, Dalal K. Medicine storage, wastage, and associated determinants among urban households: a systematic review and meta-analysis of household surveys. BMC Public Health 2021; 21:1127. [PMID: 34118923 PMCID: PMC8196539 DOI: 10.1186/s12889-021-11100-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 05/19/2021] [Indexed: 11/16/2022] Open
Abstract
Background Irrational household storage of medicines is a world-wide problem, which triggers medicine wastage as well as its associated harms. This study aimed to include all available evidences from literature to perform a focused examination of the prevalence and factors associated with medicine storage and wastage among urban households. This systematic review and meta-analysis mapped the existing literature on the burden, outcomes, and affective socio-economic factors of medicine storage among urban households. In addition, this study estimated pooled effect sizes for storage and wastage rates. Methods Household surveys evaluating modality, size, costs, and affective factors of medicines storage at home were searched in PubMed, EMBASE, OVID, SCOPUS, ProQuest, and Google scholar databases in 2019. Random effect meta-analysis and subgroup analysis were used to pool effect sizes for medicine storage and wastage prevalence among different geographical regions. Results From the 2604 initial records, 20 studies were selected for systematic review and 16 articles were selected for meta-analysis. An overall pooled-prevalence of medicine storage and real wastage rate was 77 and 15%, respectively. In this regard, some significant differences were observed between geographical regions. Southwest Asia region had the highest storage and wastage rates. The most common classes of medicines found in households belonged to the Infective agents for systemic (17.4%) and the Nervous system (16.4%). Moreover, income, education, age, the presence of chronic illness, female gender, and insurance coverage were found to be associated with higher home storage. The most commonly used method of disposal was throwing them in the garbage. Conclusions Factors beyond medical needs were also found to be associated with medicine storage, which urges effective strategies in the supply and demand side of the medicine consumption chain. The first necessary step to mitigate home storage is establishing an adequate legislation and strict enforcement of regulations on dispensing, prescription, and marketing of medicines. Patient’s pressure on excessive prescription, irrational storage, and use of medicines deserve efficient community-centered programs, in order to increase awareness on these issues. So, hazardous consequences of inappropriate disposal should be mitigated by different take back programs, particularly in low and middle income countries. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11100-4.
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Affiliation(s)
- Adineh Jafarzadeh
- Department of Health Economics, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Alireza Mahboub-Ahari
- Department of Health Economics, Iranian Evidence-Based Medicine Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran. .,School of Management and Medical Informatics, Daneshgah Street, Daneshgah Square, Tabriz, Iran.
| | - Moslem Najafi
- Department of Pharmacology &Toxicology, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahmood Yousefi
- Iranian Center of Excellence in Health Management, Department of Health Economics, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Koustuv Dalal
- Division of Public Health Science, Institute of Health Sciences, Mid Sweden University, Sundsvall, Sweden.,Department of Epidemiology, Biostatistics and EBM, Faculty of Medicine and Health Care, al-Farabi Kazakh National University, Almaty, Kazakhstan
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Manocha S, Suranagi UD, Sah RK, Chandane RD, Kulhare S, Goyal N, Tanwar K. Current Disposal Practices of Unused and Expired Medicines Among General Public in Delhi and National Capital Region, India. Curr Drug Saf 2020; 15:13-19. [PMID: 31593533 DOI: 10.2174/1574886314666191008095344] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 08/16/2019] [Accepted: 09/04/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Stocking unused or expired medicines or donating these to others can lead to accidental or inappropriate ingestion, increasing the risk of adverse drug reaction(s) and even lead to antibiotic resistance. Further improper disposal of expired or unused medicines is associated with environmental pollution, health hazards and damage to ecosystem. Ecopharmacovigilance is an important area in this context. OBJECTIVE To explore the awareness and disposal practices of unused/expired in the general public. MATERIALS AND METHODS The current study is an observational, cross-sectional, questionnaire-based study conducted in 956 medicine consumers in New Delhi and National Capital Region, India. The knowledge, attitude, and practice of consumers regarding the disposal of unused medicines were evaluated. RESULTS The majority (89.9%) of consumers opined that expiry of medicine(s) meant for completion of shelf life, production of toxic chemical and loss of or decreasing of beneficial effects of medicines. Majority (87%) of the consumers stored medicines at home. Almost all (92.6%) of the consumers threw away the expired medicines after storing for few days. Consumers discarded the expired medicines mainly in household trash (73%). The majority (93%) of consumers were in favour of a government program to collect unused or expired medicines from their home. CONCLUSION The knowledge and practices of consumers towards disposal of unused and expired medicines needs to be improved. Health care professionals, government and policy makers should offer training to educate and guide the general public on safe and proper disposal practices of expired or unused medicines.
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Affiliation(s)
- Sachin Manocha
- Department of Pharmacology, School of Medical Sciences and Research, Sharda University, Greater Noida, Uttar Pradesh, India
| | - Umesh D Suranagi
- Department of Pharmacology, Lady Hardinge Medical College, New Delhi, India
| | - Ravinder K Sah
- Department of Pharmacology, Lady Hardinge Medical College, New Delhi, India
| | | | - Sumit Kulhare
- Department of Pharmacology, Lady Hardinge Medical College, New Delhi, India
| | - Nitesh Goyal
- Department of Pharmacology, Lady Hardinge Medical College, New Delhi, India
| | - Krishna Tanwar
- Department of Pharmacology, Lady Hardinge Medical College, New Delhi, India
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Kelly F, McMillan S, Spinks J, Bettington E, Wheeler AJ. 'You don't throw these things out:' an exploration of medicines retention and disposal practices in Australian homes. BMC Public Health 2018; 18:1026. [PMID: 30119656 PMCID: PMC6098630 DOI: 10.1186/s12889-018-5753-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 06/26/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Consumers most commonly discard unwanted medicines in household rubbish or drains, however, there are global concerns over the extent, environmental impact and health risks. When consumers procure or store medicines for future use, this can impact negatively on quality use of medicines and consumer safety. We sought greater insight into the extent of these practices by exploring the volume and types of medicines in Australian homes, and self-reported practices related to medicine accumulation, use and disposal. This qualitative study formed part of a larger project that included a general population survey on household medicine disposal practices. METHODS Semi-structured telephone interviews were undertaken with a subset of respondents (n = 166) from the survey. Participants were eligible if they were experienced medicine users, i.e. used five or more prescribed, over the counter, and/or complementary and alternative medicines. Participants were asked to collect and name all medicines in their household; further detail was obtained about medicines used only when required or no longer used, such as expiry dates and quantity remaining. The quantitative data on the number and type of medicines stored at home were analysed descriptively. All interviews were transcribed verbatim and thematically analysed. RESULTS A total of 2301 medicines were identified as 1424 medicines not in everyday use (unused, unwanted, expired or when required) in 166 households, and 877 regularly used medicines by 119 participants. Medicines were often stored in multiple locations, particularly kitchens. Although accidental ingestion in children and pets and decreased efficacy were recognised health risks, this did not always translate to appropriate storage, usage or disposal practices. Individual risk-benefit assessments were applied to decisions to retain, use or dispose of medicines, including expired medicines. CONCLUSIONS Inappropriate medicine storage, use, and/or disposal practices raises public health concerns, particularly as there is a free returned medicines scheme available, and that this particular participant group were considered experienced medicine users. Healthcare professionals must act to address consumer misconceptions around the quality use of medicines, including medicine retention, storage and disposal. Future research is warranted to explore consumer practices in this context and confirm these findings in a younger, or healthier population.
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Affiliation(s)
- Fiona Kelly
- Quality Use of Medicines (QUM) Network, School of Pharmacy and Pharmacology, Griffith University, Brisbane, Australia
| | - Sara McMillan
- School of Pharmacy and Pharmacology, Menzies Health Institute, Griffith University, Brisbane, Australia
| | - Jean Spinks
- Centre for Applied Health Economics, School of Medicine, and Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Emilie Bettington
- Centre for Applied Health Economics, School of Medicine, and Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Amanda J. Wheeler
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Elliott RA, C. Booth J. Problems with medicine use in older Australians: a review of recent literature. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2014. [DOI: 10.1002/jppr.1041] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Rohan A. Elliott
- Pharmacy Department; Austin Health; Heidelberg Victoria Australia
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences; Monash University; Parkville Victoria Australia
| | - Jane C. Booth
- Pharmacy Department; Austin Health; Heidelberg Victoria Australia
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Vuong T, Marriott JL, Kong DCM, Siderov J. Implementation of a community liaison pharmacy service: a randomised controlled trial. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2010. [DOI: 10.1211/ijpp.16.3.0002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Abstract
Objective
The aim of this study was to provide a pharmacy service to improve continuity of patient care across the primary-secondary care interface.
Setting
The study involved patients discharged from two acute-care tertiary teaching hospitals in Melbourne, Australia, returning to independent living.
Methods
Consecutive patients admitted to both hospitals who met the study criteria and provided consent were recruited. Recruited patients were randomised to receive either standard care (discharge counselling, provision of compliance aids and communication with primary healthcare providers when necessary) or the intervention (standard care and a home visit from a community liaison pharmacist (CLP) within 5 days of discharge). Participant medication was reviewed during the visit according to set protocols and compliance and medication understanding was measured. All participants were telephoned 8–12weeks after discharge to assess the impact of the intervention on adherence and medication knowledge.
Key findings
The CLP visited 142 patients with a mean time of 4.2 days following hospital discharge (range = 1–14 days). Consultations lasted 15–105 min (mean, 49 min; SD, ± 21 min). The CLPs retrospectively coded 766 activities and interventions that occurred during home visits, subsequently categorised into three groups: counselling and education, therapeutic interventions and other interventions. No statistical difference was detected in the number of medications patients reported taking at follow-up: the mean value was 7.72 (SD, ± 3.27) for intervention patients and 7.55 (SD, ± 3.27) for standard-care patients (P = 0.662). At follow-up self-perceived medication understanding was found to have improved in intervention patients (P < 0.001) and significant improvements from baseline in medication adherence were found in both standard-care (P < 0.022) and intervention (P < 0.005) groups; however, adherence had improved more in intervention patients.
Conclusion
The community liaison pharmacy service provided critical and useful interventions and support to patients, minimising the risk of medication misadventure when patients were discharged from hospital to home.
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Affiliation(s)
- Tam Vuong
- Department of Pharmacy Practice, Victorian College of Pharmacy, Monash University, Parkville, Australia
| | | | - David C M Kong
- Department of Pharmacy Practice, Victorian College of Pharmacy, Monash University, Parkville, Australia
| | - Jim Siderov
- Austin Health, Heidelberg, Victoria, Australia
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