Mixed-methods approach to determine adherence, knowledge and behavioral determinants associated with medication wastage

Extent and causes of unused medications among patients in rural Ethiopia: a prospective multicenter cohort study

BACKGROUND

Medication waste poses health, economic, and environmental challenges. However, the extent among patients living in rural areas is underexplored. This study assessed the proportion of prescribed medications remaining unused by patients living in rural areas of Ethiopia, and identify the causes thereof and disposal practices.

METHODS

A prospective multicenter cohort study was conducted in 5 rural health centers in Ethiopia. Patients (≥ 18 years), who received a prescription for acute or chronic medication for pick up from the outpatient pharmacy were included. After 3 months, participants received a house visit by a health employee during which a questionnaire was verbally administered to assess the quantity of unused medication, reason thereof, and disposal practices used. Data were analyzed using descriptive statistics and multivariate logistic regression to identify factors associated with presence of unused medications.

RESULTS

In total, 178 patients participated. Up to 136 out of 601 (22.6%) dispensed medications ended up unused, mainly antibiotics and analgesics, with an average economic value of $0.37. Of 178 patients, 72 (40.4%) ended up with unused medication, and 15 (8.4%) did not use 80% or more of the prescribed quantity. Early discontinuation of therapy was the main reason (61.8%) for patients' ending with unused medication. Patients reported to primarily dispose of unused medication either through the toilet (43.6%), household garbage (22.7%), burning (13.6%), or returning it to the pharmacy (2.7%). Medications dispensed to be administered with two or more-unit doses at a time were more likely to remain unused (adjusted OR 1.6 [1.0-3.4]) compared to medications dispensed to be administered one-unit dose.

CONCLUSION

A substantial amount of prescribed medications remains unused by patients in rural areas, frequently not properly disposed. Interventions are needed to ensure medications are not wasted and reduce the unwanted consequences.

Unused and Expired Medications Disposal Practices among the General Public in Selangor, Malaysia

The appropriate disposal practice of unused and expired medications has become a global challenge that has caught the attention of health policymakers, pharmaceutical organizations, healthcare professionals, and the wider community. The current study aimed to evaluate the awareness, attitudes, and behaviors relating to the disposal practice of unused and expired medications and medication wastage issues among the general public in Selangor, Malaysia. The quantitative, cross-sectional study was conducted using a pre-validated structured survey form. Among the approached individuals, 426 showed their willingness to participate in the study. More than 80% of the study population reported being aware of the medication wastage issue and its impact on patients and the economy. The respondents with a higher level of education (OR = 1.85; 95% CI = 1.18–2.52; p < 0.003) were more likely to be cognizant of the detrimental consequences of inappropriate waste disposal. The female respondents were more likely to report comprehending that the availability of free healthcare resources is contributing to medication waste (OR = 1.33, 95% CI = 1.015–2.34; p < 0.005). The majority of respondents reported throwing away unused medications (202; 47.4%) and expired medications (362; 84.9%) in the garbage. The respondents believed that the provision of appropriate directions by healthcare professionals (312; 73.2%) and prescribing/dispensing medications in quantities for the duration that ensures patient adherence (114; 26.7%) could minimize medication wastage. The Ministry of Health (258; 60.5%), pharmaceutical organizations (212; 49.7%), and pharmacists (193; 45.3%) were the respondents’ perceived responsible sources of information. The current findings reported that respondents were familiar that inappropriate practices of medication wastage might have harmful consequences. However, a gap exists between their awareness and practice, and the disposal approaches practiced by the respondents were generally not appropriate.