A systematic review of the literature on ‘medication wastage’: an exploration of causative factors and effect of interventions
Introduction Reducing any wastage, including that of medications, is a paramount objective in promoting appropriate utilisation of finite resources. The objective was to systematically review the published literature, the possible causative factors associated with medication wastage and the effectiveness of any interventions to reduce wastage. Method A systematic review of studies published in English was identified from the following databases: Cumulative Index to Nursing and Allied Health Literature, Embase, Medline, PubMed, Science Citation Index and The Cochrane Library. Data extraction and critical appraisal was undertaken independently by two researchers. Results and discussion Title, abstract and full paper screening reduced the 14,157 studies to 42. A general definition of medication wastage was reported in one paper only. ‘Medication changed’, ‘patient death’, ‘resolution of patient’s condition’ and ‘expired medications’ were most commonly cited reasons for wastage. Only two studies were identified reporting wastage as a research outcome measure following intervention. Conclusion The systematic review has identified a limited literature on medication wastage with a lack of consistency of terms. There is a paucity of robust research focusing on the impact of healthcare interventions on outcomes around medication wastage.
KeywordsMedication Medication wastage Systematic review Wastage
Reporting of this systematic review is based, where appropriate and relevant, on the PRISMA statement 2009, which details the ‘Preferred Reporting Items for Systematic Reviews (and Meta-analysis)’.
This systematic review will form part of Lorna Marie West’s submission for PhD. The research work carried out, is partially funded by the Malta Government Scholarship Scheme.
Conflicts of interest
The authors declare no conflict of interest. The scholarship had no influence on study design, conduction, analysis, interpretation or writing of this article.
- 1.Commission of the European Communities. Taking sustainable use of resources forward: a thematic strategy on the prevention and recycling of waste. EUR-Lex., Year; http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=COM:2005:0666:FIN:EN:PDF; 5 Oct 2012.
- 2.Directive 2008/98/EC of the European parliament and of the Council of 19 November 2008. Official Journal of the European Union, 2008; http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2008:312:0003:0030:en:PDF; 20 July 2013.
- 6.York Health Economics Consortium, School of Pharmacy University of London. Evaluation of the scale, causes and costs of waste medicines, 2010. http://eprints.pharmacy.ac.uk/2605/1/Evaluation_of_NHS_Medicines_Waste__web_publication_version.pdf; 8 Feb 2011.
- 7.Duerden M, Avery T, Payne R. Polypharmacy and medicines optimisation. Making it safe and sound. The King’s Fund, 2013; http://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/polypharmacy-and-medicines-optimisation-kingsfund-nov13.pdf; 16 Mar 2014.
- 8.Higgins JPT, Green S, editors. Cochrane handbook for systematic reviews of interventions, version 5.1.0. The cochrane collaboration, 2011; http://www.cochrane-handbook.org; 30 April 2011.
- 10.Mickenautsch S. Systematic reviews, systematic error and the acquisition of clinical knowledge. BMC Med Res Methodol. 2010;10:53. http://www.biomedcentral.com/1471-2288/10/53; 13 Dec 2011.
- 11.Centre for Reviews and Dissemination. Systematic reviews. CRD’s guidance for undertaking reviews in healthcare, 2009. http://www.york.ac.uk/inst/crd/systematic_reviews_book.htm; 7 Jan 2011.
- 12.Public Health Resource Unit. Critical Appraisal Skills Program (CASP) 10 questions to help you make sense of randomised controlled trials, 2006. http://www.sph.nhs.uk/sph-files/rctappraisaltool.pdf; 4 May 2011.
- 13.Koufogiannakis D, Booth A, Brettle A. ReLIANT: Reader’s guide to the literature on interventions addressing the need for education and training, 2006. http://eprints.rclis.org/7163/1/RELIANT__final_.pdf; 4 May 2011.
- 14.Kmet LM, Lee RC, Cook LC. Standard quality assessment criteria for evaluating primary research papers from a variety of fields, 2004; http://www.ihe.ca/documents/HTA-FR13.pdf; 4 May 2011.
- 17.White KG. UK interventions to control medicines wastage: a critical review. IJPP. 2010;18(3):131–40.Google Scholar
- 22.Boivin M. The cost of medication waste. Can Pharm J. 1997;130(4):33–9.Google Scholar
- 23.Bradley TJ, Williams WH. Evaluation of medicines returned in Manchester DUMP campaign. Pharm J. 1975;215(542):547.Google Scholar
- 24.Braund R, Yuen Y, Jung J. Identification and quantification of medication returned to Otago pharmacies. NZFP. 2007;34(4):258–62.Google Scholar
- 25.Braund R, Chuah F, Gilbert R, Gn G, Soh A, Yin Tan L, et al. Identification of the reasons for medication returns. NZFP. 2008;35:248–52.Google Scholar
- 31.Cook H. Why so many drugs go to waste. Pharm Pract. 1996;6(8):268–70.Google Scholar
- 32.David BM, Carwardine E, Longmore RB, McDonald C, Page MA. Some results of a campaign for the collection of unused medicines in Perth. AJP. 1979;60:350–3.Google Scholar
- 33.Ekedahl A. Unused drugs returned to pharmacies—a few patients return a large proportion of the unused drugs. JSAP. 2003;20(6):257–8.Google Scholar
- 34.Ekedahl A, Wergeman L, Rydberg T. Unused drugs in Sweden measured by returns to pharmacies. JSAP. 2003;20(1):26–31.Google Scholar
- 37.Grant P. Return of waste medicines to a community pharmacy. Prescriber. 2001;12(4):29–38.Google Scholar
- 39.Halloran TN, Frewen DB, Frost BR. An evaluation of the cost of drug wastage in a South Australian community—a pilot study. Aust J Hosp Pharm. 1978;8(3):84–6.Google Scholar
- 41.Hawksworth GM, Wright DJ, Chrystyn H. A detailed analysis of the day to day unwanted medicinal products returned to community pharmacies for disposal. JSAP. 1996;13(4):215–22.Google Scholar
- 42.Henderson S. Hospital pharmacy: survey of unwanted medicines. Pharm J. 1984;232:603–5.Google Scholar
- 45.Longmore R, McDonald C, Sunderland B, Kailis S, Marshall C. Examination of a sample from a Medidump campaign in Perth, Western Australia. AJP. 1990;9(5):145–9.Google Scholar
- 46.Longmore RB, Sunderland VB, Sansom LN. Analysis of a “Medidump” campaign in Australia. IJPP. 1995;3(3):186–91.Google Scholar
- 48.Mackridge AJ, Marriott JF, Langley CA. Unused medicines with potential for misuse or abuse in primary care. IJPP. 2007;15(3):229–33.Google Scholar
- 56.Wongpoowarak P, Wanakamanee U, Panpongtham K, Trisdikoon P, Wongpoowarak W, Ngorsuraches S. Unused medications at home—reasons and costs. IJPP. 2004;12:141–8.Google Scholar