Initial phase of chronic medication use; patients' reasons for discontinuation.

AIM: The aim of this study was to gain more insight into patients' reasons for discontinuing chronic medication. METHODS: Electronic medication overviews recorded by a pharmacy were analysed with respect to patients' return behaviour during 3 months following their first prescription. Patients who did not return in time were interviewed by telephone to find out their reasons for either returning too late or not returning at all to the pharmacy to collect their repeat medication. RESULTS: Of 232 first-time chronic medication prescriptions, 132 were not collected at all (46.1%) or too late (11%). These prescriptions involved 121 patients, 113 (93.4%) of whom participated in the telephone interview. Twenty patients returned too late to collect their repeat prescriptions, largely because they had forgotten to take their medication according to schedule (n=13). Ninety-three patients did not return to the pharmacy at all because of side-effects (24.5%), inefficacy (16.4%), medication not intended for chronic use (15.3%) and absence of need for continued use (14.3%). CONCLUSIONS: About 50% of patients who have been prescribed chronic medication for the first time stop using their drugs within a matter of months. Perceived drug side-effects, drug ineffectiveness and personal considerations related to use and a lack of need of treatment were the main reasons for discontinuing chronic drug therapy. This kind of noncompliance may result in an increased health risk as well as constituting a waste of a large amount of money. Adequate patient counselling and shared decision-making between doctors and patients are needed to prevent the unnecessary cessation of chronic drug therapy.

Communicating with patients the second time they present their prescription at the pharmacy. Discovering patients' drug-related problems.

OBJECTIVE: To assess the effect of a short inquiry the second time that the prescription was presented at the pharmacy (SP) counter on the detection of drug related-problems as perceived by patients in a community pharmacy. The implementation of the SP procedure is also described. METHOD: At SP patients were asked to give a short description of their experience with their newly prescribed drug. Patients' drug-related problems were recorded on a SP form and were categorised into three groups: side effects, inefficacy, and problems with use or instruction. Data were also matched with drug categories. The ATC classification was used. A comparison with a control pharmacy was made. MAIN OUTCOME MEASURES: Drug experience, patients' drug-related problems, side effects, inefficacy, problems with the use or instruction. RESULTS: Data from 700 SP forms showed that in 78% of cases patients did not have problems with the use of their new drugs. In the remainder of cases (22%), drug-related problems mainly concerned side effects (49%; 76 out of 156) and complaints about the drugs not being as effective as expected (inefficacy: 49%; 77 out of 156). In the control pharmacy no drug-related problems were detected in 30 SP contacts. Patients using gastrointestinal drugs reported fewer side effects than patients using cardiovascular drugs. Patients using respiratory drugs reported more often that the drug was not effective than patients using cardiovascular drugs. CONCLUSION: It was concluded that the SP procedure encourages patients to report their drug problems at the counter in the pharmacy.