Waste medicines is a big, expensive problem.

The Department of Health estimates the cost to the NHS could be anything from £100 million to £800 million annually (around 10 per cent of all medicines prescribed)simply for buying medicines that are never used.1

We should add to that the £5,000 PCTs pay every year for safe disposal and the unknown cost of managing the consequences of non-adherence to treatment.1 The opportunity cost of such waste is staggering: East Midlands PCT estimated that the £30 million it spent on unwanted medicines could pay for 6,000 hip replacements or 900 community nurses.2

A DUMP campaign by North Yorkshire and York PCT found that 41 per cent of returned medicines had been dispensed to patients aged 74 and over, almost a third had been returned unopened and a half had been ordered on repeat prescriptions.3

According to the National Prescribing Centre, the underlying causes of medicines wastage are both systematic and individual, involving patients and prescriber’s alike.1,4 A range of strategies is therefore needed. These can be implemented across a PCT or at the patient level in GP practices and pharmacies. Between 50 to 60 per cent of practices say they have a waste reduction scheme of some sort1).

Getting the mix of strategies right for a PCT probably depends on local geography, demographics, priorities and resources. Many PCTs opt for a public awareness campaign and decisions about how best to conduct this will again be local. If the PCT has the funding, time, suitably skilled staff and the capacity, it can develop and implement its own campaign. An alternative is to buy in resources from an established initiative such as the Medicine Waste Campaign.

The Medicine Waste Campaign took nine months to develop. Dynamic Initiatives, in partnership with the PCTs in South Yorkshire SHA area, formed a steering group of GPs, community pharmacists, heads of medicines management and representatives of secondary care. The best creative options and media were identified through focus groups drawn from the target audience. After successful pilots in Sheffield, Doncaster, Rotherham and Barnsley, the campaign was launched in 2006.

The campaign primarily targets patients aged over 55 who have repeat prescriptions and prescriber’s, and secondarily carers and care workers. The principal aim is to reduce the amount of medicines wasted by encouraging the target audience to think for themselves.

Evaluations are available from five campaigns: Suffolk PCT, South Yorkshire, East Midlands, Ceredigion, Carmarthenshire and Pembrokeshire, and NHS Glasgow and Greater Clyde. Effectiveness has been assessed in two ways: estimated financial savings and impact on patients and prescribing.

Savings are estimated from prescription statistics for the periods preceding and following the campaign. The annual increase in prescribing volume in Suffolk PCT was 0.22 - 2.2 per cent above the national average for the years 2003 - 2007. After the campaign in November 2007 - January 2008, prescribing volume in Suffolk increased by 3.48 per cent compared with 3.99 per cent in England. The PCT estimated that, by avoiding the additional 0.51 per cent increase in volume, it had saved approximately £114,000.

Using a similar before-and-after comparison, Ceredigion, Carmarthenshire and Pembrokeshire estimated a saving across the three health boards of £147,000 for March to May, 2009. Only 2 of the 20 other health boards in Wales reduced prescribing in the same period. In South Yorkshire, prescribing volume did not change during the campaign whereas the same period in the preceding year saw growth of 3 per cent; spending increased by one per cent compared with 5 per cent in the previous year.

A patient survey in Glasgow and Greater Clyde demonstrated that the key messages were delivered effectively. Comparing pre- and post-campaign behaviours, there were large increases in the proportions of patients saying they checked whether they needed all their repeat medicines (91 vs 72 per cent); telling the surgery or pharmacy they are no longer taking a medicine (90 vs 59 per cent); and returning unwanted medication to the pharmacy (86 vs 48 per cent).

In East Midlands and Sheffield, 23 - 29 per cent of people who recalled the campaign said they had changed the way they ordered repeat prescriptions and disposed of unwanted medicines. Significantly, they also wanted to improve their understanding of their medicines and how to take them: in South Yorkshire, 65 per cent of respondents said they had discussed their medicines with a pharmacist or GP, suggesting there would be support for increasing participation in medication reviews.

 

Reasons why medicines are wasted

  • Medicines are dispensed but not uncollected
  • Patients recover and no longer need their medication
  • A medicine is unsuitable for the patient due to side effects
  • Medicines prescribed during a hospital stay, such as antibiotics, are continued unnecessarily when the patient returns home
  • Acute (time-limited) medicines are transferred onto the repeat prescription record and issued every time that a repeat prescription is generated
  • Seasonal medication remains on a repeat prescription all year
  • Some patients tend to stockpile medicines and re-order repeat medication that they do not need
  • Non-equivalent pack sizes of medicines prescribed simultaneously can lead to the slow accumulation of extra doses; over time this can generate significant amounts of waste.

 

References

1. National Audit Office. Prescribing costs in primary care. May 2007 (www.nao.org.uk/idoc.ashx?docId=3aea158f-a4bd-49c1-8a11-2693951b0351&version=-1; accessed 27.1.10)

2. East Midlands PCT. Medicine waste. East Midlands campaign (www.medicinewaste-eastmidlands.com/did_you_know.php; accessed 27.1.10)

3. North Yorkshire and York PCT. Reducing medicines waste (poster). Faculty of Public Health Annual Conference. Scarborough 16 - 18 June 2009 (www.nyypct.nhs.uk/stayinghealthy/docs/PHAnnualConf_2009/poster_A1_medwaste_new.pdf; accessed 27.1.10)

4. National Prescribing Centre. Reducing medicines waste in primary care. 2007 (www.npci.org.uk/medicines_management/service/waste/resources/5mg_waste.pdf; accessed 27.1.10)

5. National Social Marketing Centre. A short glossary of social marketing terms. 2009 (www.nsmcentre.org.uk/component/remository/func-download/140/chk,f585e6fd4c99ebbca6b7e0dcd524df30/no_html,1/; accessed 27.1.10)

6. NHS Sheffield. NHS Sheffield launch campaign to cut carbon footprint by reducing medicine waste. Press release. June 3rd 2009 (www.sheffield.nhs.uk/news/medicineswaste030609.php; accessed 27.1.10)