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Letters to the Editor
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Compliance aids
To repackage or not to repackage?
From Mr P. Williams, MRPharmS
I read with interest the article highlighting the research done by Claire
Church and Jane Smith into the stability of medicines when repackaged
into compliance aids (PJ, 21 January, pp75–81 PDF (60K)).
The article would appear to suggest that one of the main issues is the
unknown
impact
on
stability versus the known impact of withdrawal of compliance support.
However, I believe that what should actually be central to this issue
is the welfare of the patient. On the one hand, we know from the results
of an assessment tool, that if compliance support is withheld, patients
will struggle to self manage their medicines. On the other hand, the
unknown is the impact on the stability of the medicine that might result
from repackaging it.
As pharmacists we are professionals and are supposed to make decisions
which will benefit our patients’ health. If we turn our backs on
our responsibility to make these decisions or judgements and instead
rely on charts and tables, then we would be seen as being of little more
value than dispensing robots.
I do understand the dilemma that drug manufacturers face in providing
advice when there is no specification, measure or indication as to the
degree of protection that various packaging products offer. There are
obviously going to be differences in moisture and light permeability
of different packaging design and materials. There is also little information
available as to the impact on the efficacy of a treatment that may be
contaminated as a result of reusing a plastic box that has not been cleaned.
Yet, while I understand this dilemma and appreciate the information made
available following Church and Smith’s research, I do suggest caution
in pharmacists hastily translating the “where there’s no
information available, do not” comment. Particularly in relation
to changing the compliance service a patient has been successfully receiving
for a period of time.
As Chris Toothill mentioned in his letter last week (PJ, 28 January,
p105), this makes a grey area even greyer. He asks the question if the
preferred option is to stop dispensing with compliance aids and risk
complicating a drug regimen for a vulnerable patient, or carry on and
ignore the product licence. I would answer that surely, where there is
information from the GP that the treatment managed in such a way, is
functioning satisfactorily for the patient, withdrawing the compliance
support — and risking the negative impact on the patient as a result — is
actually putting the efficacy of the treatment at risk.
To help us make these decisions though, we must focus attention on researching
the evidence of clinical and health economic benefits of a pharmacist-led
compliance support and not just rely on anecdotal evidence, however compelling
it may be.
Peter Williams
Pharmacy Proprietor and Managing
Director
MTS Medication Technologies
Blackburn, Lancashire
Labelling individual blisters
From Dr M.-L. Truong, MRPharmS
I write after reading the article on the stability of medicines in monitored
dosage systems (PJ, 21 January, pp75–81 PDF (60K)).
During my training I worked in a hospital in France where they had hospital
packs. These are
blister packs intended for hospital use: they are designed with cutting
in mind, to allow for the dispensing of individual tablets onto the wards.
In these hospital packs, each tablet is clearly identified with the drug
name, dosage, batch number and expiry date. The blisters are of sufficient
size so that each individual blistered tablet can be cut from the strip
and handled without problems (about the size of half a dispensing label).
However, not all medicines were available as such from the manufacturer.
This problem was addressed in at least one hospital that I visited: tablets
were reconditioned into individual blisters, again each tablet being
individually identified.
In the UK I worked in a medical care unit with Lloyds and one main feature
of that work was transferring tablets from blister packs into proprietary
blister packs.
If MDSs are to become more widely adopted, it would be a good idea to
have blister packs designed with MDSs in mind.
Maybe the pharmaceutical industry could think of a way to do this. It
would be more time efficient and safer.
Minh-Loc Truong
Coventry, West Midlands
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