The Pharmaceutical Journal
Vol 277 No 7417 p315
9 September 2006

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British Pharmaceutical Conference 2006

Highlights from the 2006 conference practice research sessions

Practice researchers from around Britain gathered in manchester to present their work. A more extensive review will be published in The Journal’s Conference supplement later this year.

Medicines waste costs NHS £75m a year

Unused medicines cost the NHS £75m a year, according to a study presented at this year’s BPC.

Researchers examined the medicines returned to pharmacies and GP surgeries in Eastern Birmingham Primary Care Trust. Altogether, 51 pharmacies (85 per cent of the total) and 42 surgeries (71 per cent) participated in the study. Information about the medicines was obtained from labels and packaging. In addition, people returning medicines were asked why the medicine was returned and for details about the patient for whom the medicine was prescribed.

A total of 3,765 items were returned during a two-month period. These medicines were valued at £33,608, with a mean value per item of £8.93. Data extrapolation indicate that across the UK, 400,000 unwanted medicines are returned each year with a value of approximately £75m.

But pharmacist Adam Mackridge of Liverpool John Moores University, who led the research, says that the true cost is considerably higher. “These data only reflect returned medicines in primary care,” he said. “If we also consider medicines that are thrown away and not accounted for in this data, the true cost of this unnecessary waste is even more concerning.”

A change to a patient’s prescription was the most common reason for returning medicines, followed by clearing out old medicines and the patient having stopped taking the medicine. Cardiovascular drugs accounted for 27 per cent of returns and central nervous system drugs for 23 per cent. In terms of individual drugs, aspirin was the most frequently returned item, followed by co-codamol, salbutamol, furosemide and glyceryl trinitrate.

Around three-quarters of the returns were made to pharmacies. Most medicines were returned within a year of dispensing and had a median 21 months remaining before expiry. Half of packs were returned unopened and 28 per cent were judged by a pharmacist to be in a suitable condition for reuse. “There is a huge potential here to redeploy these medicines for humanitarian use,” added Mr Mackridge.

Impact of reduced prescription charge

Cutting the NHS prescription charge results in more prescriptions and reduced purchases of medicines. This is the finding of a study that took place in Wales where prescription charges were frozen in 2001 and then gradually reduced to the current £3.

Teerapon Dhippayom, from the Welsh School of Pharmacy, and Roger Walker, who additionally works for the National Public Health Service for Wales, carried out the research. They say it reveals a change in the population’s attitude to medicines. “It appears the phased reduction in the prescription charge in Wales has changed health-seeking behaviour and is creating a divergence in the pattern of medicines sales between pharmacies in Wales and England,” they comment.

The researchers assessed the number of prescriptions written for paracetamol in four 12-month periods between 2001 and 2005 using the NHS Wales prescribing database. Sales of paracetamol were quantified using data from IMS Health. Figures were obtained for all 22 local health boards in Wales and for five primary care trusts in England.

The researchers found an increase in prescriptions for paracetamol in Wales: compared with 2001/02, prescriptions were up 2 per cent, 4 per cent and 14 per cent in the subsequent three years. In contrast, paracetamol sales decreased over the same period. This pattern was only observed in Wales — paracetamol sales in England increased — leading the researchers to suggest that the reduction in prescription charge is likely to be the causative factor.

Patients and clinical trials

Patients taking part in clinical trials do not understand key concepts about what clinical trials involve, research has found. Patients registered to participate in cancer clinical trials were questioned about their understanding of the trial by Sheila Bullard, of Derriford Hospital, Plymouth, and Charles Morecroft, of Liverpool John Moores University.

Of 100 patients, 61 per cent considered the treatment they received in the trial was the standard treatment for their type of cancer and 46 per cent thought it was the best available treatment. Only 9 per cent understood participating in a trial might result in additional risk and discomfort compared with standard treatment. Despite all 100 patients being aware they could decline to participate, 32 per cent did not recall being offered an alternative treatment to that available through the trial. “The findings suggest that participants in this study do not appear to have understood some key areas of clinical trial participation, namely that clinical trials involve a different unproven treatment from the standard proven one, that additional risk and discomfort may be involved, and that there are alternatives to participating in the trial,” the authors conclude.

Success of doctors’ quality framework

The quality and outcomes framework (QOF) for diabetes works, according to research presented at the BPC. Carried out in the West Midlands, the study evaluated whether achieving high QOF scores has an impact on emergency hospital admissions and hospital stays for patients with diabetes.

GP practices that achieved a QOF score above 96 points (from a maximum of 99 points) had fewer emergency admissions than practices with lower scores. In addition, patients from higher scoring practices were admitted for shorter periods. Higher QOF scores were associated with increased likelihood of prescribing angiotensin agents and statins, and lower prescribing of non-steroidal anti-inflammatory drugs. Altogether, each single point increase in QOF score was found to reduce the number of emergency admissions for patients with diabetes.

Elderly patients have poor adherence

Just over a quarter of elderly people living in sheltered housing complexes are not taking their prescribed medicines properly. This is the finding from a study carried out by researchers from the Robert Gordon University, Aberdeen. Residents of 24 sheltered housing complexes were sent questionnaires and 645 responses were analysed. The study revealed that 28 per cent of residents say they do not always take their medicines. The older the person, the less likely they were to be taking their medicines as intended. Other factors reported to influence adherence were making changes to medicine-taking to suit lifestyle, not getting help to take medicines correctly, being confused about medicines, running out of medicines and being concerned about side effects.

Johnson George, who led the research, commented: “The results show a level of failure to take medicines in the elderly population that is much higher than that reported in medical literature.” He added that pharmacists are in an ideal position to help elderly people take their medicines effectively.