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The Pharmaceutical Journal Vol 265 No 7114 September 16, 2000
Pharmacy Practice Research
Papers presented at the British Pharmaceutical Conference, Birmingham, September 10 to 13, 2000 pR71

The impact of the patient pack initiative on the provision of monitored dose systems

By Mark Andrew Green, James R. Johnson and Richard Wells*

Introduction The patient pack initiative has led to the inclusion of patient information leaflets to implement European Community directive 92/27/EEC.1 In addition, it has been suggested that the introduction of patient packs (PPs) will lead to a reduction of 30-40 per cent in the number of blister packs that have to be cut before dispensing.2
While PPs represent a marked advantage over loose tablets in the traditional dispensing of prescriptions, they have, however, created some problems when dispensing monitored dose systems (MDSs). With the advent of PPs, tablets have to be removed from their manufacturers' blister packs before they can be placed into the MDS. In many cases, these systems are then re-blistered. The present study was designed to determine the length of time required to dispense a variety of prescriptions into an MDS (Nomad), from loose tablets and to compare this with the time taken to dispense the same prescriptions from PPs.

Methods The study took place in a dedicated closed dispensary, a centralised unit for MDS dispensing. Ten prescriptions (chosen to cover various types and sizes of tablets/capsules) were dispensed twice by each of 10 dispensers, once from loose tablets and once from PPs. All prescriptions were for 28 days' supply and were dispensed into four Nomad trays.
The times for all dispensers were collated and Student's t tests were performed to determine any difference between the two methods of dispensing.

Focal points

  • A study was designed to compare the length of time required to dispense a variety of prescriptions into an monitored dose systems from loose tablets with the time taken to dispense the same prescriptions from patient packs
  • Filling from loose tablets (average time 1.26_0.57 minutes) is less time consuming than from patient packs (2.13_1.16 minutes)
  • The time to dispense monitored dose systems has recently increased
  • Pharmacy contractors increasingly have to subsidise monitored dose system dispensing

Results The present study shows that the filling of Nomad MDS from loose tablets is less time consuming than from PPs (Figure 1). On each occasion, the time taken was greater when dispensing from PPs (significantly different in nine out of 10 cases). The average time taken to dispense a prescription from loose tablets was 1.26±0.57 minutes, whereas from PPs this time increased to 2.13±1.16 minutes.
Figure 1
Figure 1. Mean±SD time taken by 10 dispensers to fill various prescriptions from loose (open bars) and blistered (filled bars) medication

The data were also expressed as a percentage increase in dispensing time. The percentage increase in time taken to dispense from patient pack blisters was between 4 and 109 per cent when compared with dispensing the same prescriptions from loose tablets.

Discussion The present study clearly shows that MDS filling has become more time consuming since the introduction of PPs.
For certain tablets, the patient pack initiative has led to a more than doubling of the filling time. There was a significant difference (P<0.05) between the times taken to dispense from loose medication and PPs in nine out of 10 cases. The exception (No 6) required the tablet to be halved, and the extra procedure probably accounts for this result.
Transformation of the data gave an average increase in dispensing time of 69 per cent, an increase that clearly represents a further decrease in profit for MDS dispensing when compared with traditional dispensing.
On questioning the dispensers after the study, it was found that there was a general perception that to dispense from loose tablets was quicker and easier than to dispense from PPs. This finding is supported by the data presented here.
More specifically, dispensers reported that small tablets were more difficult than large tablets to "pop out" of their blister packs. By contrast, most dispensers found capsules easy to "pop" because loose capsules tended to "stick together". This study shows that the time taken to dispense MDSs has recently increased.
It has previously been reported that dispensing for MDSs is more time consuming3 and less profitable4 than traditional dispensing. Pharmacy contractors increasingly have to subsidise MDS dispensing. If adequate remuneration is not negotiated, many may cease to offer this service.

School of pharmacy, University of Strathclyde, Glasgow, UK; *H. I. Weldrick Ltd, Highfield Houses, Highfield Road, Doncaster, UK

References

1. Smith A, Spooner A. The patient pack fiasco. Pharm J 1997;259:940-1.
2. Pharmaceutical industry to go it alone on patient pack introduction. Pharm J 1998;260:621.
3. McElnay JC, Thompson J. Dispensing of medicines in compliance packs. Int Pharm J 1992:6:10-15.
4. Kibble SL, Kendray JC. Cost analysis of supplying monitored dosage systems to residential homes from a community pharmacy. J Pharm Pharmacol 1996; 48(Suppl 2):11.