The Pharmaceutical Journal Vol 266 No 7152 p815-820
June 16, 2001

  RPM
  In-store pharmacies
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  Patient packs
  The Profession
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  Coronary heart disease
  Influenza
  Checking technicians
  Dianette
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Patient packs

Pharmacists not to blame for failure

From Mr J. R. Martin, MRPharmS

I must take issue with Douglas Metcalf (PJ, June 9, p785) on his stance that pharmacists are to blame for the failure of patient packs as a concept. I feel the blame lies more accurately in two separate directions.

The first is in the regulations pertaining to how we dispense. Only calendar packs (ie, those with the days of the week on, and a subset of patient packs) may be given out whole. If the medicine prescribed does not come in calendar packs, we must give the quantity as prescribed. In many cases, it would be foolish to label the blisters with days of the week in the first place as some medicines are not taken on a stable basis, for example warfarin or prednisolone. I sigh when a prescription comes in for 100 tablets of 1mg, 3mg and 5mg warfarin because as it means assembling and labelling three lots of 28, 28, and 44 which takes much longer than three bottles of 100 tablets used to. Perhaps this fact may eventually get through to general practitioners who still seem to retain a knee-jerk inability to order warfarin and the like in anything other than multiples of 100.

In fact, I believe Mr Metcalf would find most pharmacists trying their best to give the patient a sensible service within this framework. For example, say I receive a prescription for three different tablets, one daily, 60 of each. If only one comes in a calendar pack of 28, I will generally supply 60 of it anyway, so the medicines all run out together. This situation is not at all uncommon. Yes, I quite believe that the prescriber “could not care less” if I give out entirely “unsnipped” packs, but I am not allowed to do so.

The second direction is with the manufacturers. Many do not print days of the week on their blisters, and so consign us to the situation above. Worse, some produce “calendar” packs of 30 in a fashion I believe to be highly cynical. The aim appears to be to sell an extra 7.5 per cent product each time this medicine is ordered along with the others (in 28s) on a four-weekly repeat. I cannot imagine any other justification. I remain unsure whether “first dose” constitutes a day of the week for the purposes of defining a calendar pack.

The factors Mr Metcalf himself raises, including addicts’ prescriptions, all contribute to a snowstorm of little bits of plastic. Unfortunately, until one or preferably both of the factors above change, the scissors will still be on a long string right next to the computer.

Jon Martin
Wallingford, Oxfordshire

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