1
|
Smale EM, Verkerk EW, Heerdink ER, Egberts TCG, van den Bemt BJF, Bekker CL. Barriers and facilitators to implement the redispensing of unused oral anticancer drugs in clinical care: A hybrid-effectiveness type I study. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2024; 15:100493. [PMID: 39263193 PMCID: PMC11388756 DOI: 10.1016/j.rcsop.2024.100493] [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: 03/26/2024] [Revised: 08/12/2024] [Accepted: 08/16/2024] [Indexed: 09/13/2024] Open
Abstract
Background Minimizing medication waste through the redispensing of oral anticancer drugs (OADs) that were unused by patients provides economic and environmental benefits, but this is not yet universally implemented in clinical care. ObjectiveS To identify barriers and facilitators to the implementation of redispensing unused OADs in clinical care. Methods A multicentre intervention study following a hybrid effectiveness-implementation type I design was conducted, consisting of semi-structured interviews with key stakeholders involved in the redispensing program: pharmacy employees, prescribing clinicians in oncology and haematology, patients who participated in redispensing and patients who declined trial participation. Questions encompassed experiences and suggestions for future implementation. The Consolidated Framework for Implementation Research (CFIR) guided data collection and categorisation of identified barriers and facilitators through thematic analysis. Results In total, 35 interviews were conducted, identifying 15 themes encompassing barriers and facilitators, reflecting all CFIR domains. Facilitators encompassed: 1) convenient process requiring an acceptable time-investment; 2) support from project leaders and implementation champions; 3) being well-motivated by personal values and societal impact; 4) feeling ensured of medication quality upon redispensing; 5) endorsement by healthcare providers for patient participation; 6) clear and personal patient communication; 7) good visibility of intervention successes; and 8) implementation well supported through a collaborative network. Barriers encompassed: 1) unclear target population; 2) redispensing legally prohibited; 3) absence of financial compensation for pharmacies; 4) complexity arising from two parallel work processes; 5) widespread communication on adjustments within local teams challenging; 6) patient's low receptiveness due to burden of oncology treatment; and 7) lack of familiarization among pharmacy technicians. Conclusions Facilitators for implementation of redispensing unused drugs mainly related to people's values, motivation, and societal demand, whereas barriers mainly encompassed practical issues, including knowledge, time, financial resources, and legal conditions. Strategies emphasizing the benefits of redispensing and further streamlining process compatibility could support implementation.
Collapse
Affiliation(s)
- Elisabeth M Smale
- Radboud University Medical Center, Department of Pharmacy, Nijmegen, the Netherlands
| | - Eva W Verkerk
- Radboud University Medical Center, Department of IQ Healthcare, Nijmegen, the Netherlands
| | - Eibert R Heerdink
- University Medical Centre Utrecht, Division of Laboratory, Genetics and Pharmacy, Department of Clinical Pharmacy, Utrecht, the Netherlands
- Utrecht University, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht, the Netherlands
- Utrecht University of Applied Medical Centre Utrecht, Research Group Innovations of Pharmaceutical Care, Utrecht, the Netherlands
| | - Toine C G Egberts
- University Medical Centre Utrecht, Division of Laboratory, Genetics and Pharmacy, Department of Clinical Pharmacy, Utrecht, the Netherlands
- Utrecht University, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht, the Netherlands
| | - Bart J F van den Bemt
- Radboud University Medical Center, Department of Pharmacy, Nijmegen, the Netherlands
- Sint Maartenskliniek, Department of Pharmacy, Ubbergen, the Netherlands
| | - Charlotte L Bekker
- Radboud University Medical Center, Department of Pharmacy, Nijmegen, the Netherlands
| |
Collapse
|
2
|
Alzola-Andrés M, Domingo-Echaburu S, Nogales-Garcia M, Palacios-Zabalza I, Urrutia-Losada A, Arteche-Elguizabal L, de Torre Querejazu AL, Basterra AQ, Orive G, Lertxundi U. Pharmaceuticals in the Environment: A hospital pharmacy's perspective. FARMACIA HOSPITALARIA 2024; 48 Suppl 1:S13-S20. [PMID: 39097362 DOI: 10.1016/j.farma.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 09/04/2023] [Accepted: 09/06/2023] [Indexed: 08/05/2024] Open
Abstract
Drugs do not disappear once they have been excreted. In fact, 992 active principles have already been measured in the different environmental matrices. A recent study led by scientists from the University of York has studied the presence of drugs in the rivers of more than 100 different countries, showing that environmental contamination by pharmaceuticals is a global issue and that, concentrations found are frequently harmful to the environment. In this work, we have tried to briefly expose the problem of environmental contamination with medicines, but above all, we have tried to address the possible solutions, with a perspective from the field of hospital pharmacy. This is a very complex matter (a wicked problem), since it involves multiple stakeholders with different visions and interests regarding medicines. In order to find solutions, we will probably need to act at all steps of the drug's life cycle. Until now, health professionals have been part of the problem. It is time for us to be part of the solution.
Collapse
Affiliation(s)
- Maitane Alzola-Andrés
- Grupo NanoBioCel, Laboratorio de farmacéuticos, Escuela de Farmacia, Universidad del País Vasco UPV/EHU, Vitoria-Gasteiz, España
| | - Saioa Domingo-Echaburu
- Servicio de Farmacia, Servicio de Salud de Osakidetza, Organización Sanitaria Integrada de Debagoiena, Gipuzkoa, España; Bioaraba, Clinical Pharmacy Research Group, Vitoria-Gasteiz, España
| | - Maite Nogales-Garcia
- Servicio de Farmacia, Instituto de Investigacion de la salud, Biocruces Bizkaia, Hospital Universitario Galdakao-Usansolo Osakidetza, Bizkaia, España; Grupo NanoBioCel, Laboratorio de farmacéuticos, Escuela de Farmacia, Universidad del País Vasco UPV/EHU, Vitoria-Gasteiz, España
| | | | | | - Lorea Arteche-Elguizabal
- Servicio de Farmacia, Servicio de Salud de Osakidetza, Organización Sanitaria Integrada de Debagoiena, Gipuzkoa, España; Bioaraba, Clinical Pharmacy Research Group, Vitoria-Gasteiz, España
| | - Amaia Lopez de Torre Querejazu
- Servicio de Farmacia, Instituto de Investigacion de la salud, Biocruces Bizkaia, Hospital Universitario Galdakao-Usansolo Osakidetza, Bizkaia, España; Grupo NanoBioCel, Laboratorio de farmacéuticos, Escuela de Farmacia, Universidad del País Vasco UPV/EHU, Vitoria-Gasteiz, España
| | - Ainhoa Quintana Basterra
- Servicio de Farmacia, Instituto de Investigacion de la salud, Biocruces Bizkaia, Hospital Universitario Galdakao-Usansolo Osakidetza, Bizkaia, España; Grupo NanoBioCel, Laboratorio de farmacéuticos, Escuela de Farmacia, Universidad del País Vasco UPV/EHU, Vitoria-Gasteiz, España
| | - Gorka Orive
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Vitoria-Gasteiz, España; Instituto Universitario de Medicina Regenerativa e Implantología Oral - UIRMI (UPV/EHU-Fundación Eduardo Anitua), Vitoria, España; Bioaraba, Grupo de Investigación, NanoBioCel Research Group, Vitoria-Gasteiz, España; Instituto de Investigación Bioaraba, Servicio de salud del País Vasco, Osakidetza, Red de Salud Mental de Araba, Hospital Psiquiátrico de Araba, Servicio de Farmacia, Vitoria-Gasteiz, Álava, España.
| | - Unax Lertxundi
- Instituto de Investigación Bioaraba, Servicio de salud del País Vasco, Osakidetza, Red de Salud Mental de Araba, Hospital Psiquiátrico de Araba, Servicio de Farmacia, Vitoria-Gasteiz, Álava, España.
| |
Collapse
|
3
|
Alzola-Andrés M, Domingo-Echaburu S, Nogales-Garcia M, Palacios-Zabalza I, Urrutia-Losada A, Arteche-Elguizabal L, de Torre Querejazu AL, Basterra AQ, Orive G, Lertxundi U. [Translated article] Pharmaceuticals in the environment: A hospital pharmacy perspective. FARMACIA HOSPITALARIA 2024; 48 Suppl 1:TS13-TS20. [PMID: 39097371 DOI: 10.1016/j.farma.2024.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 09/04/2023] [Accepted: 09/06/2023] [Indexed: 08/05/2024] Open
Abstract
Drugs do not disappear once they have been excreted. In fact, 992 active principles have already been measured in the different environmental matrices. A recent study led by scientists from the University of York has studied the presence of drugs in the rivers of more than 100 different countries, showing that environmental contamination by pharmaceuticals is a global issue and that, concentrations found are frequently harmful to the environment. In this work, we have tried to briefly expose the problem of environmental contamination with medicines, but above all, we have tried to address the possible solutions, with a perspective from the field of hospital pharmacy. This is a very complex matter (a wicked problem), since it involves multiple stakeholders with different visions and interests regarding medicines. In order to find solutions, we will probably need to act at all steps of the drug's life cycle. Until now, health professionals have been part of the problem. It is time for us to be part of the solution.
Collapse
Affiliation(s)
| | - Saioa Domingo-Echaburu
- Osakidetza Basque Health Service, Debagoiena Integrated Health Organisation, Pharmacy Service, Nafarroa Hiribidea 16, 20500 Arrasate, Gipuzkoa, Spain
| | - Maite Nogales-Garcia
- Osakidetza Basque Health Service, Araba Integrated Health Care Organization, Pharmacy Service, Vitoria-Gasteiz, Alava, Spain; Bioaraba, Pharmaco-therapeutic Optimisation Research Group, Vitoria-Gasteiz, Spain
| | - Itziar Palacios-Zabalza
- Pharmacy Service, Biocruces Bizkaia Health Research Institute, Galdakao-Usansolo University Hospital, Osakidetza, Barrio Labeaga 46A. 48960 Galdakao, Bizkaia, Spain
| | - Ainhoa Urrutia-Losada
- Osakidetza Basque Health Service, Debagoiena Integrated Health Organisation, Pharmacy Service, Nafarroa Hiribidea 16, 20500 Arrasate, Gipuzkoa, Spain
| | - Lorea Arteche-Elguizabal
- Osakidetza Basque Health Service, Debagoiena Integrated Health Organisation, Pharmacy Service, Nafarroa Hiribidea 16, 20500 Arrasate, Gipuzkoa, Spain
| | - Amaia Lopez de Torre Querejazu
- Osakidetza Basque Health Service, Araba Integrated Health Care Organization, Pharmacy Service, Vitoria-Gasteiz, Alava, Spain; Bioaraba, Pharmaco-therapeutic Optimisation Research Group, Vitoria-Gasteiz, Spain
| | - Ainhoa Quintana Basterra
- Osakidetza Basque Health Service, Araba Integrated Health Care Organization, Pharmacy Service, Vitoria-Gasteiz, Alava, Spain; Bioaraba, Pharmaco-therapeutic Optimisation Research Group, Vitoria-Gasteiz, Spain
| | - Gorka Orive
- NanoBioCel Group, Laboratory of Pharmaceutics, School of Pharmacy, University of the Basque Country UPV/EHU, Paseo de la Universidad 7, Vitoria-Gasteiz 01006, Spain; Biomedical Research Networking Centre in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Vitoria-Gasteiz, Spain; University Institute for Regenerative Medicine and Oral Implantology - UIRMI (UPV/EHU-Fundación Eduardo Anitua), Vitoria, Spain; Bioaraba, NanoBioCel Research Group, Vitoria-Gasteiz, Spain.
| | - Unax Lertxundi
- Bioaraba Health Research Institute; Osakidetza Basque Health Service, Araba Mental Health Network, Araba Psychiatric Hospital, Pharmacy Service, Vitoria-Gasteiz, Spain. c/Alava 43, 01006 Vitoria-Gasteiz, Álava, Spain.
| |
Collapse
|
4
|
Watts S, Coutsouvelis J, Wickens J, Poole S, Percival M, Zalcberg JR. Medication reuse programs: a narrative review of the literature. Int J Qual Health Care 2024; 36:mzae036. [PMID: 38687831 DOI: 10.1093/intqhc/mzae036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 11/08/2023] [Accepted: 04/12/2024] [Indexed: 05/02/2024] Open
Abstract
A proportion of returned medications may potentially meet quality standards to be reused safely. In Australia, there is no regulatory guidance available to facilitate such medication reuse. This narrative review aimed to identify and review international literature describing medication reuse programs to provide insight into their implementation and potential barriers. Using the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) -based guidelines, a literature search was conducted in Medline, Scopus, and Embase using key words such as 'medication' and 'reuse' to identify relevant articles. Two reviewers ascertained eligibility for inclusion. Inclusion criteria included English language and publication after 2010. From the articles selected, identified international medication reuse programs and relevant regulatory aspects were summarized. Details, both regulatory and operational, for the specific medication reuse programs, described in the selected articles was further explored via a grey literature search. Of the 1973 identified articles, 84 were assessed for eligibility and 17 were included in this review. Of these, 14 described scenarios where medication reuse is prohibited, 2 studies described programs allowing the reuse of medication and 1 study did not discuss whether reuse was prohibited or not. From these primary articles, secondary citations were identified, with eight from gray literature. Barriers to medication reuse included exposure to environmental extremes during storage, physical appearance, evidence of tampering, safety, and efficacy concerns for the returned medication. Programs that exist globally have overcome these barriers. Several programs that provide safe and effective reuse of medications were i© The Author(s) 2024. Published by Oxford University Press on behalf of International Society for Quality in Health Care. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site-for further information please contact journals.permissions@oup.com.dentified and described. The findings described in this review should be used to inform frameworks for legislative, regulatory, and professional practice change for medication reuse. Measures implemented in the UK's pandemic response to safely reuse medications in the nursing home and hospice settings and European medication donation programs should be further investigated. The concept of medication reuse is not novel and should be considered for the Australian setting.
Collapse
Affiliation(s)
- Samuel Watts
- Pharmacy Department, Alfred Health, 55 Commercial Road, Melbourne, VIC 3004, Australia
| | - John Coutsouvelis
- Pharmacy Department, Alfred Health, 55 Commercial Road, Melbourne, VIC 3004, Australia
- Centre for Medicine Use and Safety, Monash University, Parkville, VIC 3054 Australia
| | - Joanne Wickens
- Pharmacy Department, Alfred Health, 55 Commercial Road, Melbourne, VIC 3004, Australia
| | - Susan Poole
- Pharmacy Department, Alfred Health, 55 Commercial Road, Melbourne, VIC 3004, Australia
| | - Mia Percival
- Pharmacy Department, Alfred Health, 55 Commercial Road, Melbourne, VIC 3004, Australia
| | - John R Zalcberg
- Department of Medical Oncology, Alfred Health, Melbourne, VIC 3004 Australia
- School of Public Health, Faculty of Medicine, Monash University, Melbourne, VIC 3004 Australia
| |
Collapse
|
5
|
Helwig K, Niemi L, Stenuick JY, Alejandre JC, Pfleger S, Roberts J, Harrower J, Nafo I, Pahl O. Broadening the Perspective on Reducing Pharmaceutical Residues in the Environment. ENVIRONMENTAL TOXICOLOGY AND CHEMISTRY 2024; 43:653-663. [PMID: 36647735 DOI: 10.1002/etc.5563] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/23/2022] [Accepted: 01/13/2023] [Indexed: 06/17/2023]
Abstract
The present study reviews options for reducing harm from pharmaceuticals that are known to cause adverse impacts by their presence in the environment. It reviews recent global and European Union policy development, which could go further in recognizing and addressing the issue in a global context. It considers green chemistry, which can help clean up production processes but holds only long-term promise for creating "green" alternatives. It explores the potential of health promotion and disease prevention, which can contribute significantly to a reduction of the disease burden and thus the need for medicines, both for infectious and for noncommunicable disease. Eco-directed sustainable prescribing practices are reviewed, which have been adopted successfully to reduce the use of harmful pharmaceuticals. We note recent developments in medicines optimization and precision medicine, which hold promise for improving patient outcomes, saving costs, and reducing pharmaceutical use, through individually tailored prescribing whereby the patient codecides their therapy. Waste prevention through reuse or redistribution is beginning to find public support and "take-back" waste disposal schemes set up via extended producer responsibility systems have achieved high returns. Finally, the paper summarizes preferred advanced wastewater technologies, including innovative low-cost, low-energy options. In summary, although end-of-pipe options have a role to play, particularly for highly concentrated wastewaters, solutions further up the medicinal chain and disease prevention interventions, informed by a broad view of health and health care, are needed to pursue a much greater potential reduction of pharmaceuticals in the environment than can be achieved by end-of-pipe solutions alone. Environ Toxicol Chem 2024;43:653-663. © 2023 The Authors. Environmental Toxicology and Chemistry published by Wiley Periodicals LLC on behalf of SETAC.
Collapse
Affiliation(s)
- K Helwig
- School of Computing Engineering and the Built Environment, Glasgow Caledonian University, Glasgow, United Kingdom
| | - L Niemi
- Environmental Research Institute, University of the Highlands and Islands, Thurso, United Kingdom
| | - J-Y Stenuick
- Health Care Without Harm Europe, Brussels, Belgium
| | - J C Alejandre
- School of Computing Engineering and the Built Environment, Glasgow Caledonian University, Glasgow, United Kingdom
| | - S Pfleger
- NHS Highland, Inverness, United Kingdom
| | - J Roberts
- School of Computing Engineering and the Built Environment, Glasgow Caledonian University, Glasgow, United Kingdom
| | - J Harrower
- School of Computing Engineering and the Built Environment, Glasgow Caledonian University, Glasgow, United Kingdom
| | - I Nafo
- Emschergenossenschaft and Lippeverband, Essen, Germany
| | - O Pahl
- School of Computing Engineering and the Built Environment, Glasgow Caledonian University, Glasgow, United Kingdom
| |
Collapse
|
6
|
Smale EM, van den Bemt BJF, Heerdink ER, Desar IME, Egberts TCG, Bekker CL. Cost Savings and Waste Reduction Through Redispensing Unused Oral Anticancer Drugs: The ROAD Study. JAMA Oncol 2024; 10:87-94. [PMID: 37971730 PMCID: PMC10654927 DOI: 10.1001/jamaoncol.2023.4865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 08/08/2023] [Indexed: 11/19/2023]
Abstract
Importance New strategies targeting waste are required to improve financial and ecologic sustainability of expensive therapies, such as oral anticancer drugs, that frequently remain unused by patients. Redispensing unused oral anticancer drugs seems to be a promising strategy when drug quality is guaranteed. Objectives To determine the waste reduction and net cost savings attained by redispensing oral anticancer drugs that go unused by patients compared with the standard practice of disposal. Design, Settings, and Participants The ROAD study was a prospective single-group intervention conducted in the outpatient pharmacies of 4 hospitals in the Netherlands from February 1, 2021, to February 1, 2023, with 12-month follow-up of each patient. Patients with cancer and who had a prescription for an oral anticancer drug that could be stored at room temperature were included. Of 2426 eligible patients, 602 did not consent and 601 did not respond. Data analyses were performed from August 25, 2022, to April 19, 2023. Intervention Participants received oral anticancer drugs for use at home in special packaging (ie, sealed packaging with time-temperature indicator), to be returned to the pharmacy should these remain unused. The pharmacy ensured quality of returned drugs based on authenticity, appearance, remaining shelf life and adequate storage temperature. Drugs fulfilling quality requirements were redispensed to other patients. Main Outcome and Measure Total waste reduction and mean net annual cost savings per patient compared with the standard practice of disposal. Optimization of cost savings was explored by introducing variations in the quality assurance procedure and patient population. All analyses used the average exchange rate for 2021 €1 = US $1.18. Results Of 1223 patients with cancer who consented, 1071 participated (median [IQR] age, 70 [62-75] years; 622 [58.1%] were male). In all, 171 patients (16.0%; 95% CI, 13.8%-18.3%) returned 335 unused oral anticancer drug packages. Of the returned drugs, 228 packages were redispensed, which reduced waste by 68.1% (95% CI, 67.7%-68.5%) compared with the standard practice (disposal). Redispensing unused oral anticancer drugs comprised 2.4% (95% CI, 2.2%-2.5%) of total drug costs, providing mean net annual cost savings of US $680 (95% CI, $524-$837) up to $1591 (95% CI, $1226-$2002) per participant. Conclusions and Relevance The findings of this multicenter intervention study indicate that redispensing unused oral anticancer drugs is associated with waste reduction and cost savings, which in turn may improve the affordability and sustainability of cancer treatment. Trial Registration World Health Organization International Clinical Trials Registry Platform Identifier: NL9208.
Collapse
Affiliation(s)
- Elisabeth M. Smale
- Department of Pharmacy, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Bart J. F. van den Bemt
- Department of Pharmacy, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Pharmacy, Sint Maartenskliniek, Ubbergen, the Netherlands
| | - Eibert R. Heerdink
- Department of Clinical Pharmacy, Division of Laboratory, Genetics and Pharmacy, University Medical Centre Utrecht, Utrecht, the Netherlands
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Faculty of Science, Utrecht, the Netherlands
- Research Group Innovations of Pharmaceutical Care, Utrecht University of Applied Medical Centre Utrecht, Utrecht, the Netherlands
| | - Ingrid M. E. Desar
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Toine C. G. Egberts
- Department of Clinical Pharmacy, Division of Laboratory, Genetics and Pharmacy, University Medical Centre Utrecht, Utrecht, the Netherlands
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Faculty of Science, Utrecht, the Netherlands
| | - Charlotte L. Bekker
- Department of Pharmacy, Radboud University Medical Center, Nijmegen, the Netherlands
| |
Collapse
|
7
|
Alhamad H, Jaber D, Abu-Farha R, Albahar F, Edaily SM, Donyai P. Factors Influencing Public Willingness to Reuse the Unused Stored Medications in Jordan: A Cross-Sectional Study. Healthcare (Basel) 2022; 11:healthcare11010075. [PMID: 36611535 PMCID: PMC9818750 DOI: 10.3390/healthcare11010075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 12/22/2022] [Accepted: 12/22/2022] [Indexed: 12/29/2022] Open
Abstract
The reissuing, redispensing, redistributing, or even recycling of the returned unused stored medicines is referred to as medicine reuse. A few studies have examined people's willingness to reuse unused stored medicines. This study aims primarily to explore the public's willingness to reuse unused stored medicines in the future and the factors affecting their decisions, and to assess the pharmacological types and formulations of the unused stored medicines by the public. A cross-sectional study was conducted using a convenient sampling technique over three weeks (February-March 2022) among Jordanian populations. Data were collected from 681 participants who agreed to fill out a questionnaire, which was distributed online. Participants showed a positive perception of reusing any of the unused stored medicines in the future; of those, 79.6% (n = 400) believed that reusing "unused medicines" has economic benefits and 50% (n = 251) believe there are environmental benefits. Moreover, more than half of the participants believed that reusing "unused medicines" is safe (n = 256, 51%), but provided that a pharmacist or a doctor evaluates their quality or that the unused medicines are stored well. Results from this study show that the public positively endorses the idea of reusing unused stored medicines if the quality and safety are assured. However, future studies are needed to evaluate the Jordanian healthcare professionals' perceptions towards medicine reuse and pharmaceutical companies' willingness to be a part or facilitator of medicine reuse.
Collapse
Affiliation(s)
- Hamza Alhamad
- Department of Clinical Pharmacy, Faculty of Pharmacy, Zarqa University, P.O. Box 2000, Zarqa 13110, Jordan
- Correspondence:
| | - Deema Jaber
- Department of Clinical Pharmacy, Faculty of Pharmacy, Zarqa University, P.O. Box 2000, Zarqa 13110, Jordan
| | - Rana Abu-Farha
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman 11931, Jordan
| | - Fares Albahar
- Department of Clinical Pharmacy, Faculty of Pharmacy, Zarqa University, P.O. Box 2000, Zarqa 13110, Jordan
| | - Sahar M. Edaily
- Department of Clinical Pharmacy, Faculty of Pharmacy, Zarqa University, P.O. Box 2000, Zarqa 13110, Jordan
| | - Parastou Donyai
- Department of Pharmacy and Forensic Science, King’s College, London SE1 9NH, UK
| |
Collapse
|
8
|
Rogowska J, Zimmermann A. Household Pharmaceutical Waste Disposal as a Global Problem-A Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192315798. [PMID: 36497873 PMCID: PMC9737308 DOI: 10.3390/ijerph192315798] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/18/2022] [Accepted: 11/24/2022] [Indexed: 05/31/2023]
Abstract
The negative effect of the pharmaceuticals presence (persistence?) in various components of the environment is a global problem today. These compounds are released into the environment as a result of, inter alia, their use and improper disposal. Therefore, it is important to reduce excessive drug consumption and to develop a system for the collection of unused/expired pharmaceuticals. The effectiveness of actions in this area is inextricably linked with the need to educate society on how to deal properly with unwanted medications. The aim of the study was to show that the inappropriate handling of unused/expired drugs by society is an important problem in waste management systems, and it impacts the state of the environment. Forty-eight scientific articles published between 2012 and 2021 were taken into account that discussed the systems in various countries for the collection of unused/expired pharmaceuticals. This literature review shows that the main method of disposing of unused/expired medications, according to respondents from different countries, is either by disposing of them in household waste or flushing them into the sewage system. This is also the case in countries with systems or programs for the return of redundant drugs, which indicates that these systems are not sufficiently effective. This may be influenced by many factors, including the lack or ineffective education of the society.
Collapse
|
9
|
Smale EM, Egberts TCG, Heerdink ER, van den Bemt BJF, Bekker CL. Key factors underlying the willingness of patients with cancer to participate in medication redispensing. Res Social Adm Pharm 2021; 18:3329-3337. [PMID: 34973931 DOI: 10.1016/j.sapharm.2021.12.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/22/2021] [Accepted: 12/22/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Redispensing medication unused by patients to other patients could reduce the environmental burden of medication waste. Simultaneously, associated financial loss could be reduced, particularly for expensive medication such as oral anticancer drugs. An important determinant for successful medication redispensing is patient participation. OBJECTIVE(S) To identify key factors underlying the willingness of patients with cancer to participate in the redispensing of unused oral anticancer drugs. METHODS Semi-structured interviews via telephone or video call were conducted with adult patients diagnosed with cancer from two Dutch hospitals. The interview guide was framed using the COM-B model for behavioural change, to elicit patients' capability, opportunity and motivation to participate in medication redispensing. Questions were related to patients' willingness to accept redispensed medication, reasons thereof, perceived concerns and needs. Inductive thematic analysis was applied. RESULTS Seventeen patients (aged 38-82 years, 71% female), with nine different types of cancer participated. The majority of participants supported medication redispensing. Four categories of key factors underlying the willingness of patients with cancer to participate in medication redispensing were identified. First, the driver for participation was having positive societal impact, relating to affordability and sustainability of healthcare. Second, having trust in product quality was a requirement, influenced by preconceived beliefs, quality assurance and patients' knowledge of this process. Third, a facilitator for participating in medication redispensing was adequate provision of information. This concerned awareness of medication waste, information about medication redispensing, support from healthcare providers and other patients, and insight into medication dispensing history. Last, a convenient process for returning unused medication to pharmacies would facilitate participation in medication redispensing. CONCLUSIONS The willingness of patients with cancer to participate in medication redispensing relates to a drive for achieving positive societal impact, provided that medication is of high quality, there is adequate information provision and a convenient process.
Collapse
Affiliation(s)
- E M Smale
- Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Centre, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands
| | - T C G Egberts
- Department of Clinical Pharmacy, Division of Laboratory, Pharmacy and Genetics, University Medical Centre Utrecht, P.O. Box 85500, 3508, GA, Utrecht, the Netherlands; Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science, Utrecht University, P.O. Box 80082, 3508, TB, Utrecht, the Netherlands
| | - E R Heerdink
- Department of Clinical Pharmacy, Division of Laboratory, Pharmacy and Genetics, University Medical Centre Utrecht, P.O. Box 85500, 3508, GA, Utrecht, the Netherlands; Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science, Utrecht University, P.O. Box 80082, 3508, TB, Utrecht, the Netherlands; Research Group Innovations of Pharmaceutical Care, Utrecht University of Applied Medical Centre Utrecht, P.O. Box 85500, 3508, GA, Utrecht, the Netherlands
| | - B J F van den Bemt
- Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Centre, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands; Department of Pharmacy, Sint Maartenskliniek, P.O. Box 9011, 6500, GM, Nijmegen, the Netherlands
| | - C L Bekker
- Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Centre, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands.
| |
Collapse
|