Yemm Rowan, Jones Christabel, Mitoko Tryphosa
Cardiff University School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, Wales, UK.
Integr Pharm Res Pract. 2017 Oct 24;6:173-180. doi: 10.2147/IPRP.S145567. eCollection 2017.
In 2015, the UK health secretary made public an intention to include the value of medicines costing over £20 on dispensing labels as an attempt to reduce wastage attributable to patient behavior. However, there is a lack of evidence investigating the potential effect or feasibility of this proposal, and concerns have been raised that it may introduce new problems in vulnerable groups. This pilot study aimed to gather views of the Welsh general public on this subject.
Six focus groups from within key population groups were conducted. A snowball sampling strategy was employed with participants recruited via a neutral gatekeeper. Focus groups session were audio recorded and transcribed verbatim and iterative thematic analysis was used to identify emergent themes.
Six focus groups were conducted. Three key themes were identified: "influence of cost" - whereby participants expressed concern about cost linking to their perceived value, guilt for needing prescribed medication and irrelevance of cost if the medication was considered necessary; "knowledge is power" - whereby participants expressed a desire to know more about their medicines and engage with health care professionals about them, and felt information on dispensing labels alone would be insufficient to support this and "blame the system" - whereby participants felt responsibility for wastage should be shared by both system and patient and identified existing wasteful practices such as inappropriate prescribing, ordering and disposal of returned medicines.
Findings were largely consistent with criticisms publicized by professional bodies that introducing cost may serve to make patients feel guilty or unworthy rather than encourage them to use their medicines appropriately. Similarly, providing cost information on labels alone was considered insufficient and therefore additional counseling or education would be necessary to prevent misunderstanding. The acknowledgment of system factors contributing to wastage highlights an important role for pharmacists to become involved in using medicines more cost-effectively. However, cost was considered irrelevant if the medicine was deemed necessary by the patient, and therefore more mindful prescribing of superfluous items should be promoted.
2015年，英国卫生大臣公开表示打算在配药标签上标注成本超过20英镑药品的价值，以减少因患者行为导致的浪费。然而，缺乏证据来调查该提议的潜在效果或可行性，并且有人担心这可能会给弱势群体带来新问题。这项试点研究旨在收集威尔士普通公众对该主题的看法。
对关键人群组中的六个焦点小组进行了调查。采用滚雪球抽样策略，通过中立的把关人招募参与者。焦点小组会议进行了录音并逐字转录，采用迭代主题分析来识别新出现的主题。
进行了六个焦点小组的调查。确定了三个关键主题：“成本的影响”——参与者对成本与他们所感知的价值之间的联系表示担忧，对需要处方药感到内疚，以及如果认为药物必要则成本无关紧要；“知识就是力量”——参与者表示希望更多地了解他们的药物并与医疗保健专业人员就药物进行交流，并且认为仅靠配药标签上的信息不足以支持这一点；以及“指责系统”——参与者认为浪费的责任应由系统和患者共同承担，并指出了现有的浪费行为，如不适当的开药、订购和退回药品的处理。
研究结果在很大程度上与专业机构所宣传的批评意见一致，即引入成本可能会让患者感到内疚或不值得，而不是鼓励他们正确使用药物。同样，仅在标签上提供成本信息被认为是不够的，因此需要额外的咨询或教育来防止误解。认识到导致浪费的系统因素凸显了药剂师在更经济有效地使用药物方面发挥重要作用。然而，如果患者认为药物是必要的，成本则被认为无关紧要，因此应促进更谨慎地开不必要的药品。
