Proportional determination and reasons for medication returns at a tertiary academic hospital in Gauteng

Abstract

South Africa has a quadruple burden or disease which leads to increased pharmaceutical expenditure on communicable and non-communicable diseases. This study aimed to determine the proportion of patients that return unused or expired medicine to a tertiary academic hospital pharmacy in Gauteng, including the reasons for unused or expired medicine being returned. In addition the monetary value of the returned medication was calculated. Furthermore, common medicine disposal practices were assessed. Data was collected by administering questionnaires to patients presenting at the Steve Bike Academic Hospital pharmacy awaiting prescription refills, or those attending for the purpose of returning unused medications. It was found that the proportion of patients returning unused or expired medicine was approximately 20% (P-0.2). Cited reasons for accumulating expired medicine included non-adherence (36%), doctor discontinued treatment (16%), undesirable side effects (12%), death (8%), oversupply (12%), incorrect medicine supplied (4%), short expiry of compounded medicine (4%), unknown reasons (4%), duplication from public and private sector (4%). The monetary value of all returned medicine during the two-week collection period (6 - 17 March 2017) was determined to be R652.11.This value may seem low, but did not include expired or returned medicine from hospital wards, where the usage are different compared to an out-patient setting. Cardiovascular (11.8%), anti-diabetic (11.8%), corticosteroid (11.8%) and respiratory agents (11.8%) were among the leading medicine class returned. During the previous year (2016), more than three quarters (34.7%) of the patients were in possession of unused and expired medicine, of which only 13.6% returned medicine to pharmacy for safe disposal. Other disposal practices consisted of flushing down the toilet! in drain (43.2%), discarding in refuse bins (34.1 %), throwing it into pittoilets or burying underground (6.8%), and storing for future use (2.3%). It was evident from this study that only a small proportion of patients returned unused or expired medicine to pharmacy for safe disposal. The principle reasons for medicine accumulation indicate non-adherence and treatment discontinuation. This study elucidated to the fact that there is a need to educate the public on the importance of proper storage, safe disposal practices, adherence to prescribed treatment, and to increase locations where unused or expired medicines may be dropped off for safe disposal.