Exam (elaborations) UNDERSTANDING Medical Surgical Nursing

This research was conducted by the York Health Economics Consortium, University of York, and The School of Pharmacy, University of London. Researchers from the York Health Economics Consortium were responsible for the quantitative aspects of the research whilst the School of Pharmacy led on the qualitative aspects, and research relating to care homes. However, the outputs reported in this document represent a collaborative effort on the part of the entire research team. Throughout this report references are made to the work of Primary Care Trusts in areas such as medicines management and further reducing medicines wastage. With the publication In July 2010 of Equity and Excellence: Liberating the NHS it is apparent that by 2013 responsibility for such tasks will in England have moved on to GP Commissioning Consortia and/or the NHS Commissioning Board. However, the authors believe that the data and findings offered here should remain relevant. The authors would like to express their gratitude to the many people involved in this research, including members of the steering group appointed by the Department of Health, participants in the public survey, pharmacists who assisted with the community audits, PCT based colleagues, individuals who gave time for personal interviews, focus group members and those care home staff who assisted in the analysis of medicines wastage in that setting. In addition, we would like to thank Paul Rhodes and Robin Hulme of QA Research who assisted in the development of the public survey. Further thanks go to individuals who advised the research team over the course of the study, including Professor Rob Horne of the School of Pharmacy and Martin Phillips, Chief Pharmacist at York Hospital. Readers seeking further information about the work reported here are invited to contact either Professor Paul Trueman at or Professor David Taylor at David.Taylor@Pharmacy. This is an independent report commissioned and funded by the Policy Research Programme in the Department of Health. The views expressed are not necessarily those of the Department Acknowledgements Acknowledgements 2 Executive Summary 5 Section 1: Introduction 9 1.1 Introduction 9 1.2 distinguishing between medicines wastage and non- compliance and non- adherence in medicine taking 10 Section 2: Structured Literature Reviews on Medicines Wastage 14 2.1 Background 14 2.2 Method 14 2.3 Findings 15 2.4 Summary 27 Section 3: Estimating the Volume of Waste Medicines in the National Health Service in England 28 3.1 Background 28 3.2 national public survey 28 3.3 audit of community pharmacies 34 3.4 Discussion 36 3.5 Limitations of this research 30 3.6 Summary 40 Section 4: Estimating the Cost of Waste Medicines in the National Health Service 41 4.1 Background 41 4.2 Public survey 41 4.3 Survey of community pharmacies 43 4.4 Discussion 44 4.5 Limitations of the research 44 4.6 Summary 45 Section 5: The Economic Impact of Poor Compliance 46 5.1 Background 46 5.2 Methods 46 5.3 Asthma findings 48 5.4 Diabetes findings 49 5.5 Hypertension 51 5.6 Statins for primary prevention of cardiovascular disease 53 5.7 Statins for secondary prevention of cardiovascular disease 55 5.8 Schizophrenia 56 5.9 Summary 58 Contents 4 Evaluation of the Scale, Causes and Costs of Waste Medicines Section 6: Waste Medicines in Care Home Settings 60 6.1 Background 60 6.2 Objectives 60 6.3 Methods 60 6.4 Findings 61 6.5 Discussion 66 6.6 Limitations of the research 67 6.7 Summary 68 Section 7: Public, Health Professional and PCT Staff Experience, Attitudes and Beliefs about Medicines Wastage 69 7.1 Introduction 69 7.2 Methods 69 7.3 Findings 70 7.4 Summary 85 Section 8: Implications of the Research Findings 87 8.1 The scale, costs and root causes of NHS medicines waste 87 8.2 Implications for Policy 89 8.3 Conclusion 93 References