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.
