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Letters to the Editor
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Compliance
Difficulties in drug-taking apparent in the elderly
From Dr T.U. Qazi, MRPharmS
The elderly are one group who receive multiple drugs to treat their
numerous conditions. They are also well known for non-compliance due
to drug-related side effects and other factors such as poor health, confusion,
memory loss and lack of motivation. Non-compliance is an issue that has
been addressed many times in the past but still remains unresolved.
Recently I noticed that a couple of patients were not taking their warfarin
tablets. They had been in hospital not long before this and, after being
discharged, had received their medicines from their community pharmacist.
The reason they gave for not taking their warfarin tablets was that the
new calendar packs, which they had received recently, were from a different
manufacturer to those taken in hospital. Non-compliance of warfarin tablets
can have serious consequences and the best solution to this situation
is to ensure all anticoagulant patients have their medicines in compliance
aids.
Another issue that confuses the elderly is the switching of generics
to brand generics or vice versa by prescribers. A few elderly patients
commented that they did not take their medicines, ie, simvastatin tablets
and ramapril capsules, because they looked different to the Simvador
and Lopace capsules they had taken previously. This was despite telling
them, while I dispensed their drugs, that they were being given the same
medicines, just with a different appearance and name. It is also the
prescriber’s responsibility to explain to the patient that even
though their medicines may vary in colour, shape and name, it is still
the same drug.
Most manufacturers of generics market different drugs in calendar packs
of a similar appearance.
Elderly patients who suffer from colour blindness or poor vision may
find it difficult to differentiate between such calendar packs. It has
been reported that patients who were taking medicines for several different
conditions were confused because of the similarity and this had serious
consequences. It also increases the chance of error in a busy pharmacy.
Compliance in the elderly can only improve if doctor-patient and patient-pharmacist
relationships improve. We should be polite, understanding and patient-oriented
in the transfer of medicines information.
Tariq Qazi
Halifax,
West Yorkshire
Negative impact of generic prescribing and parallel importing
From Ms E. Mitchell, MRPharmS
I am writing as a representative of the Dementia Services Collaborative User and Carer Group in Calderdale, which I attend as the South-West Yorkshire
mental health trust location pharmacist. The group wishes to highlight
some problems that occur due to present practices, and how they relate
to the people using services.
In particular, I wish to highlight problems relating to the use of generically
prescribed tablets and parallel importing. As a pharmacist I realise the
problems we face when ordering items from wholesalers and the limited availability
of generic lines occasionally. However, if tablets change colour, shape
and size, this can often cause problems for people with impaired memory
and result in non-compliance, even though carers can understand substitutions.
Changes of this nature should be kept to a minimum. The packaging of medicines
is important for this user group, who are best served using blister packs
with the days of the week printed on. The packaging should also be in English.
This is an appeal to pharmacists to keep changes of tablet colour, shape
and size to a minimum for their customers with memory impairment, and to
keep English labelled calendar packs. Until services change, carers will
be struggling on, but any help will be appreciated.
Members of the user and carer group do appreciate and acknowledge all the
efforts of local community pharmacy services and have a good rapport with
local pharmacies. Monitored-dosage systems do enable many memory impaired
people to keep some control over their medicines since they can take premeasured
doses at the indicated times in their own homes and this can be checked
by themselves and their carers.
The shortage of community pharmacists willing to give their services for
free to fill monitored dosage systems has not substantially affected services
yet, as it has in other areas. Free services are limited and we know the
true cost to the pharmacist in real monetary terms so we do not want to
overload those who provide this service. Keeping tablet presentation constant
would go a long way to help resolve some of the difficulties and non-compliance
issues with medicines, that frustrate both carers and users of our service.
We would welcome pharmacists’ comments and input.
Elaine Mitchell
Calderdale Royal Hospital,
Halifax, West Yorkshire HX3 OPW |
The
Pharmaceutical Journal