Public Perceptions About the Concept of Medication Reuse

macrocosm Perceptions About the Concept of Medication reuseMedication ball ups The public perceptions about the concept of medication reuseChapter peer slight1. Introduction1.1 Background, definitions, and classification of aesculapian run outsThere is a growing environmental realisation in the last few years, it is recognisable that the worlds environmental cytosine emissions, and global warming problems be increasing. M some(prenominal) organisations work to apply leafy vegetable principles of wellness alimony programs in their way for going green (Xie, 2012).In the UK, the Centre for sustainable Healthc ar (CSH) the institution which was developed in 2008 to wait on NHS reduce carbon liberations and emissions by 80% by 2050 by involving wellness supervise professionals, forbearing roles, and the company clarifying the connections between environment and health care system (Stancliffe, 2014). devastate is outlined by European Union Waste Framework Directive (2008) , as any substance or fair game which the holder discards or intends or is required to discard.All unwarranteds created by medical activities falls under health care lay waste tos. The Royal College of Nursing (RCN) inform and the World Health Organisation (WHO) described health care wastes as all wastes produced by research facilities, laboratories, and organisations providing health and cordial care. Moreoer, it involves the waste originating from hapless-toned or sprinkled sources such as that generated in the health course and social care started at home such as dialysis, insulin injections, bandages, swabs, sharps, blood, medicates and incontinence pads (RCN, 2014 and WHO, 2011).between (80) % of the waste produced by health-care providers is considered non-risk or cosmopolitan health-care waste, while the remaining (20) % of healthcare waste is considered as hazardous that maybe may be infectious, virulent or radioactive and may create a diversity of health risks. Health-care waste consists of possibly dangerous microorganisms with potential infectious risks such as development of microorganisms resistant to medication from health-care institution into the environment, and can infect patients, healthcare suppliers and the public. WHO classified the hazardous health care waste into (Appendix 1) infectious waste, morbid waste, sharps waste, pharmaceutical waste, genotoxic waste, chemical waste, heavy metals wastes and the radioactive waste. Pharmaceutical waste is waste containing pharmaceutical that are expired, or no longer used items pollute by or including pharmaceuticals (WHO, 2011).Usually not all the medications dispensed to the patients testament be used, this is mainly due to galore(postnominal) factors such as perverse drug reaction intolerance, relief of symptoms, changing the dose/dosage forms, medical specialty non-compliance and/or non-adherence issues and medicinal drug being expired (Dharmender, 2013).Pharmaceutical wast e is defined by UK Department of health (2013), as expired, clean, spilt, and polluted medicinal products, drugs, vaccines and sera that are no longer required and need to be disposed of appropriately and/ or discarded items contaminated with medicinal, such as bottles or boxes with residues, gloves, masks, connecting tubing, syringe bodies and drug vials.Abou-auda HS (2003), defined medication wastage as any medication or drug product that had been dispensed by a prescription or buy everywhere the counter (OTC) which is not plentifuly consumed.Chapter two2. literary works review2.1 comes of medication wastageDrugs are unavailing when dispensed to patients who are not taken them. In order to minimise the wastage of medications, it is all important(predicate) to investigate the causes butt end medicines being returned, unused, and boney by the patients. A review of the possible factors certify to potentially cause medication waste was conducted to summarise the most impor tant causes of medicine returned unused.2.1.1 Patient deathMedications being returned unused by the patients resulting from patient death was account in six studies. Mackridge et al. (2007), a wipe sectioned subscribe to of returned medicines to fifty one fraternity pharmacies and forty two general practitioner surgeries in Eastern Birmingham (UK) everyplace octonary weeks, Cameron (1996), a self-reporting questionnaire lawsuit in 58 federation pharmacies in Alberta (Canada) over eight weeks, and Ekedahl (2006), a muck up sectional study include fifty nine union pharmacies in Sweden reported that patient death was the most common cause of medication waste.In the study by Langley et al. (2005), a microscopical cross sectional observational study in eight friendship pharmacies and fin general practitioner surgeries in East Birmingham/UK over quartette weeks, patient death was the second most common cause of returned unused medicines by the patients. info from Cook A (1 996), a cross sectional study of returned medicines to seventeen residential district pharmacies over one calendar month in UK, Hawksworth et al. (1996), a cross sectional study of returned medicines included thirty community pharmacies in UK, insensibility et al. (2008), a cross sectional study of returned medicines to 38 community pharmacies over three months showed that patient death was reported but accounted only for about quarter of all returned unused medicines.2.1.2 Medication changed or quitThere is a proof in the literature that changing medications is a considerable cause of medication returned unused by the patients, it is reported as a common cause of medication waste (Cameron 1996, Cook 1996, Hawksworth et al. 1996, Morgan 2001, Daniszewsi et al.2002, Langley et al. 2005, Abahussain et al. 2006, Ekedahl 2006, Mackridge et al. 2007, Braund et al. 2008, Coma et al. 2008, Braund and Gn et al. 2009, Braund and Peake et al. 2009, James et al. 2009). entropy from (Hawks worth et al. 1996, Daniszewsi et al.2002, Langley et al. 2005, Abahussain et al. 2006, Braund et al. 2008), found that changing medications was the most common reported cause of medication being wasted.2.1.3 Medication Expired2.2 The environmental continue of unused wasted returned medicationsThe toxic ecological effects of the pharmaceutical battlefront in the environment was studied and evaluated in the last few years. Data from Heberer (2002) and Woodhouse (2003), confirm the presence of pharmaceuticals in physical structure of water and considered it serious, as it is not altogether removed and even if it is present in trace levels is still considered pollutant to water receivers. The improper household disposal practices of unused medicines, via the local waste, the sewers, and the toilet was identified, as a source of water contamination (Bound, 2006).The effect of pharmaceutical wastes in the environment was linked to possible development of endocrine deactivating compou nds, reducing fertility, and antibiotic resistance bacteria. Data from Schwartz et al. (2003), confirmed the development of bacterial resistance as vancomycin resistant enterococci and beta-lactam-hydrolysing Enterobacteriaceae were cultivated from all effluent biofilms. In the study by Lange et al. (2001), the feminising effects of endocrine-disrupting compounds, such as ethinyl estradiol, the synthetic ductless gland used in the contraceptive pill, on fish near wastewater preaching works outfalls was measured.2.3 The economic impact of unused wasted returned medicineStudies from inside (five) and extracurricular (six) UK, estimated the lever of the cost of medication waste are reviewed below.Results from Hawksworth et al. (1996), a cross sectional study included thirty community pharmacies in Kirklees/West Yorkshire (UK) over a termination of one month showed an estimated cost of 37 one jillion million million of unused medicine were from patients home.Langley et al. (200 5), a small cross sectional observational study in eight community pharmacies and five general practitioner surgeries in East Birmingham/UK over four weeks, showed that the center cost of returned medicines was 3986 and 3751 respectively.In the study by Mackridge et al. (2007), a cross sectional study reported an estimate of 75 million economic value of returned medicines to fifty one community pharmacies and forty two general practitioner surgeries in Eastern Birmingham over eight weeks. In the same year, the UK depicted object Audit sureness report, proposed that each year an estimate of 100 million value of unused returned medicine. As the 100 million estimate was ground on unused medicine that actually returned, this was considered as an underrated figure of the full cost of wasted medicines, as a result the throwe section of health estimated that as much as 10% of all drugs prescribed were wasted (10% of the NHS prescribing budget) which is estimated to be 800 million-wor th of drugs are wasted annually in primary care.Data from Trueman et al. (2010), a research undertaken by the York Health Economics Consortium and capital of the fall in Kingdom School of Pharmacy in 2009, estimated that the annual cost of the primary and community care medicines wastage in UK NHS was slightly 300 million per year ( 250-300 million per year), with estimated 90 million of unused medicines stored in individuals homes, 110 million returned to community pharmacies over the course of a year, and up to 50 million of NHS supplied medicines that are disposed of annually by care homes. The authors of this report also estimated that less than 50% of this arrive figure is cost effectively preventable.International studies from outside UK was also included and reviewed. A Canadian study by Cameron S (1996), in fifty eight pharmacies over eight weeks estimated the cost of unused medicines returned was $60350, the extrapolated cost which included the only 750 community pharma cies in Alberta during the same eight weeks period was $716400.Coma et al. (2008), a cross sectional study included thirty eight community pharmacies in Barcelona/Spain over a period of three months, showed that the estimated cost of returned medicines was 8,539.9, the extrapolated cost for the 20,461 community pharmacies in whole Spain was a round 129 million.Although the reuse concept of patients unused returned medicines is considered unethical in the unite Kingdome (UK), the unused medicines are returned in large quantities and prolong important financial value, with the preponderance considered acceptable to be used again by another patient (Mackridge, 2007).Table 1. Summary of research studies evaluating the economic impact of wasted medicineStudyStudy setting and continuanceStudy methodCountryMain FindingsHawksworth et al. (1996)30 CPs over duration of 1 monthCross sectional questionnaireUKA total of 1,091 items were returned by 366 patients with estimated value of 37 mil lionLangley et al. (2005)8 CP and 5 GPs over duration of 4 weeksCross sectional observational studyUKA total of 340 items were returned (42 to GPs and 298 to CPs). The total cost of returned items was 3986 to GPs and 3751 CPs.Mackridge et al. (2007)51 CPs and 42 GPsover duration of 8 weeksCross sectional studyUKA total of 3765 itemswere returned by 910 patients with estimated value of 75 millionUK National Audit Office report (2007)Based on previous analysis conducted by segment of healthBased on previous analysis conducted by department of healthUKProposed that each year an estimate of 100 million value of unused returned medicine.Trueman et al. (2010)403 of the 466 items identified in the public survey were able to be priced. Costs were identified /item using British National pharmacopeia (BNF).Public surveyUKEstimated that the annual cost of the primary and community care medicines wastage in UK NHS was around 300 million per year ( 250-300 million per year).Cameron S (1996)58 C Ps in Alberta (8% of provincial total)over duration of 8 weeksSelf-reporting questionnaireCanadaThe estimated cost of the unused medicines returned was $60350. The extrapolated cost for 750 CPs is in Alberta during the same 8 week period was $716400.Morgan (2001)Sample of 73 of Hampshire retirement community citizens healed 65 years or older.over duration of 7 months cross-sectional pilot survey/ QuestionnaireUSThe total cost of 2078 wasted pills was US $ 2,011.00 with mean annual cost of wasted medication was $30.47/person (range = $0-$131.56). soulfulness costs were modest, but if $30/individual demonstrate a low estimate of average annual cost of waste, the US extrapolated cost was estimated to be not less than $1 billion per year.Abou-auda (2003)A total of 1641 households participated (1554 from Saudi-Arabian Arabia, 87 from other countries)Questionnaire /Pilot studySaudi Arabia, and capital cities of Kuwait, Oman, Qatar, and United Arab Emirates U.A.EThe estimated cost of unus ed medicines by families in Saudi Arabia capital cities of Kuwait, Oman, Qatar, and United Arab Emirates (U.A.E) was $150 million.Coma et al. (2008)38 CPs over duration of 3 monthsCross sectional questionnaireSpainThe estimated cost of returned medicines was 8,539.9. The extrapolated cost for the 20,461 CPs in whole Spain was 129.6 millionEl-Hamamsy (2011)20 CPs over duration of 1 monthQuestionnaire(Closed-ended questions used only)Cairo/EgyptThe total wholesale price of returneddrugs calculated at10988.84 Egyptian pounds (around $1962.32 US)Hassali et al. (2012)Two parts1) Medicine wastage in the patients home.2) Medicine wastage by the benefactor at the pharmaceutics desk.over duration of 6 monthsA descriptive study of two parts1) Prospective randomised community based trial.2) Wasted medicines were collected from the patients who pass back the unwanted medicines to the pharmacy desk in the Hospital.MalaysiaThe total cost of the returned medications within 6 months was MYR 59,566 .50 (Malaysian ringgit) with a periodic average of about MYR 9,927.75. the extrapolated cost for one year of the medications returned was MYR 119,133.00Information from medication waste campaign website illustrated that the estimated cost of unused medication (300 million/year) could pay (by the average cost) for 11,778 more community nurses, 19,799 more drug treatment courses for breast cancer, 101,351 more knee replacements, 80,906 more hip replacements, and 300,000 more drug treatment courses for Alzheimers. In 2012 the NHS of Berkshire started major actions to reduce medicine waste, data from the NHS southwest central press release, showed that an estimate cost of wasted medicine crossways the Berkshire NHS and south central was 20 million per year.The full cost of wasted medicine is not only the cost of returned medicines as estimated by the studies reviewed in a higher place (Table 1), in addition the cost of the destroying processes of the returned medicines, and the hidd en costs of non-compliance/non-adherence effects which was not studied should be added to the full cost of wasted medicines in upcoming research (UK National Audit Office Report, 2007).2.4 Disposal practices for unused medications2.5 Public perceptions about unused/wasted pharmaceuticals2.6 Medication reuse and recyclingA medicine reuse concept involves the return of unused and/or loaded medicines to a pharmacy, healthcare facility or charitable organisation for consequent redistribution to recipients locally or internationally. This was implemented on a charitable stern in the United States of America (USA) and in developing countries which experienced brusk medicine supply (Bero, 2010).Although such practice is considered unethical and not O.K. in UK, it may have environmental and economic advantages as many of these considered acceptable to be used again (Mackridge, 2007).Ipsos MORI conducted 1,101 face to face interviews for Sustainable Development Unit of the UK NHS (SDU) with respondents aged cardinal and more using around one hundred and fifty sample points. The research was carried out in two periods between the eleven of November and the fifth of December 2011. All data was weighed to reverberate the population profile of British people aged fifteen and more. Data from this recent survey reported that around half of the British people (52%) agreed to accept reissued medicines returned (that are unused and the safety was checked) by other patients while 32% said that they would not.According to Dr David Pencheon the director of sustainability unit, medicine reuse concept had been unaccepted in the past based on the assumption that patients are not willing to take the medicine returned by others. In healthcare system, the health care provider is always go away strongly on the side of safety caution and discard medicines. For the date beings, the economics of this behaviour need to be reconsidered (Cooper, 2012).Chapter ThreeResearch planEcologi calImpactIs medicine being wastedNoYesNo say that Mr. Smith who is ill with diabetes is prescribed four medications each month. He doesnt pay for his medicines. He use all medicines as prescribed.Imagine that Mr. Smith who is ill with diabetes is prescribed four medications each month. He doesnt pay for his medicines. He sometimes fails to take his medicines as prescribed.YesAppendicesAppendix 1 (WHO and RCN Definitions and classifications of health care wastesInfectious wasteWaste contaminated by blood and its secondary products, cultures and supplies of infectious agents, waste come from isolated patients, any septic thrown away diagnostic samples with blood and body fluids, infected animals from laboratories, and contaminated swabs, bandages, and equipment such as disposable medical devices.Pathological wasteRecognizable parts of the body and contaminated animal dead bodies.Genotoxic wasteVery dangerous, mutagenic, teratogenic, and carcinogenic, such as cytotoxic drugs and their metabolites.Pharmaceutical wasteExpired, unused, and contaminated drugs vaccines and seraRadioactive waste such as contaminated glass materials with radioactive diagnostic or therapeutic materials.Heavy metals wasteSuch as broken mercury thermometers.ChemicalsSuch as broken mercury thermometersSharpsSuch as syringes, needles, disposable scalpels and bladesHazardous or Non Hazardous wasteclinical waste if it contains or is contaminatedwith a medicine containing eitherA pharmaceutically-active substance (a substance able to affect biological systems) orA dangerous substance such as chemicals at sufficient parsimony to produce a hazardous property.Clinical or Non Clinical wasteHazardous if it contains or is contaminated with a cytotoxic or cytostatic medicine. early(a) medicines are not hazardous waste.Offensive waste or sometimes called hygiene waste)Is waste that is non-infectious and not clinical, but may cause disrespect due to the presence of recognisable health care waste mat erials, body fluids or odour, and secretions or excretions or that collection and disposal is not subject to special requirements in order to prevent infection.*Adapted from WHO fact tacking (2011), and RCN guidance (2014)