Transcript SNAP-LOCK” POLYETHYLENE MINI BAGS FOR

“SNAP-LOCK” POLYTHENE BAG
FOR DISPENSING DRUGS IN
GOVERNMENT HOSPITALS IN
SRI LANKA
SENARATHNA L (1), SAMARANAYAKE A (2),
KUMARAGE S (3), SENEVIRATHNA A (4),
KAPPAGODA S (5)
(1)OX-COL COLABORATION, DEPARTMENT OF CLINICAL MEDICINE, COLOMBO;
GOVERNMENT HOSPITALS (2)MATALE, (3)GAMPOLA, (4)MEDAWACHCHIYA, (5)KANDY.
ABSTRACT
SNAP-LOCK” POLYETHYLENE MINI BAGS FOR DISPENSING DRUGS IN SRI LANKA
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Senarathna L, Samaranayake A, Kumarage S, Senevirathna A, Kappagoda S.
Ox-Col Collaboration, Department of Medicine, Colombo; Government Hospitals in Matale, Gampola,
Medawachchiya and Kandy.
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Problem Statement: Outpatient drugs are dispensed free of charge in government hospitals in Sri Lanka,
usually as loose capsules or tablets wrapped in paper. Storage is often inappropriate, risking reduced drug
potency due to humidity and sunlight and mixing up of tablets with similar appearance. A “snap lock”
polyethylene bag (cost, USD 0.02) containing a drug information card was recently introduced for each drug.
Objectives: To determine acceptability of and patient attitude toward payment for snap-lock bags. Design:
Observational study comparing two hospitals. Setting and Study Population: Two government hospitals in
the Central Province of Sri Lanka, one that charged money for the bags and one that did not. We traced
pharmacy records and interviewed patients and pharmacists. Two hundred outpatients using bags were
randomly selected (100 from each hospital). Pharmacists from clinics answered a questionnaire Outcome
Measures: Use of bags initially and after 10 months; percentage of patients coming with the bag to
subsequent clinics initially and after 10 months; patient attitude toward payment for bags; acceptability of bag
to patients and pharmacists. Results: Payment for bags initially reduced their uptake (73% with payment;
100% without); uptake of bags in paying hospitals increased to 95% after 10 months. Patient acceptance was
high - 82% of patients brought the bag to the next clinic; after 10 months, this increased to 91%. There was
no difference between hospitals. Opening the bag caused difficulties during the first month in both hospitals;
35% of patients cut or tore the bag to open it. Education by pharmacists reduced this to 5%. An average of
65% of patients (60% in nonpaying hospital, 70% in paying hospital) agreed to pay money and thought an
acceptable payment would motivate them to bring the bag back. In both hospitals, 95% of patients liked the
bag, particularly since it prevented tablet mix-ups. Fourteen pharmacists in both hospitals agreed that the
bags enhanced the quality of their dispensing. Conclusions: Acceptance of the newly introduced bags was
good in both hospitals; acceptance was slower but still substantial where patients were charged for the bag.
Pharmacist workload increased when the bags were first issued due to patient unfamiliarity and the time
spent enclosing the drug information card, but workload subsequently decreased below previous levels with
reuse of bag and card. Both patients and pharmacists thought that the bags were an improvement. Our
experience suggests that polyethylene bags may be useful to prevent mixing of tablets/capsules; to improve
home storage of drugs; and, with the card, to provide appropriate drug information. Proper use of the bags
also suggests patients’ willingness to contribute appropriately to their health care.
Background
• Government Hospitals issue outpatient medication as
loose tablets or capsules wrapped in paper.
– Appropriate storage difficult due to high humidity &
temperature.
– Possible deterioration in drug potency &/or product
formulation (discolouration, loss of tablet coating, capsule
melting, loss of potency) e.g. phenytoin, amitriptyline
– Tablets with similar appearance may be mixed up
– Limited opportunity to provide written drug information with
product.
• To overcome these issues four hospitals recently
introduced a “snap lock” polythene bag for
dispensing tablets/capsules.
– Some hospitals issued for free, others charged per bag
Ordinary Paper Wrapping
Tablets wrapped in papers
Paper bags used to dispense
tablets/capsules
Newly Introduced Bags
“Snap-lock” closure
Drug information card
Aims
We set up an observational study in two hospitals
to assess the effect of payment on:
1. Patient compliance
– Initial use of “snap lock” bags
– Ongoing use of “snap lock” bags at 10 months
2. Feedback by users
– Patient’s attitude($, ease of use, dosing errors)
– Pharmacists’ attitude (patient education, ease
of use, impact on workload).
Methodology
• Two Base hospitals were selected, both serving
~ 100 000 clinic patients per year.
– One hospital charged USD$0.02 per bag.
– One hospital issued bags free of charge.
• 100 patients systematically selected from each
hospital.
– Cross section of all the patients coming to clinics.
– Patients requiring ongoing medication therapy and
receiving >2 weeks supply per dispensing
Methodology cont …
• Each patient interviewed to assess
– Acceptance of bags and the provision of drug
information
– Compliance/confidence (subjective)
• Each pharmacist interviewed to assess
– Impact of bags on the dispensing process
– Opportunities for provision of drug
information
– Overall effect on work load
• Statistics analysed using Chi-square test
Results
• Requirement for payment reduced the
uptake of the bags initially
– 73% with payments, 100% free of charge
• Uptake of bags in the payment hospital
increased to 95% after 10 months (p<0.0001)
– Initial concerns over payment settled
– Pharmacist education (verbal & written on card)
– Encouraged use by other patients
Patient acceptance
• During first month, 35% of patients cut or tore
the bag to open
– ↓ to 5% at 10 months due to pharmacist education
(p<0.0001)
• 82% of patients brought the bag to the next
clinic after first month.
– ↑ to 91% at 10 months
(p=N/S)
• No difference in outcome between hospitals
Patient and Pharmacist feedback
95% of patients at both hospitals liked the bag.
• Prevents tablet mix-ups because of separate packaging
– Improved patient confidence
• Prevents spoilage of medication (protection from H2O)
100% of pharmacists in both hospitals accepted
bag
• Initially increased time of dispensing (selecting bag,
filling drug information sheet, education of patient)
• Reuse of the bag subsequently reduce their work load.
– Less repetition of instructions and drug information
• Overall, it was felt that he bag improved the quality of
dispensing
Discussion and Future Directions
• Our experience suggests that “snap-lock” bags may
help prevent mixing of tablets/capsules, improve home
storage and to provide drug information.
– Should they be introduced Island-wide?
– Are further studies needed to measure the impact of the
drug information card and to confirm improved compliance?
• Patients are willing to contribute to the cost of their
health care that is currently free of charge.
– This may help maintain the provision of quality and
affordable health care for patients in Sri Lanka.
– The challenge lies in implementation of other programs
Discussion and Future Directions
cont….
• Other dose forms or administration aids (eg.
typed labels, blister strips or unit-of-use packs
for selected patients) may improve outcomes
such as patient compliance and prevent
mediation misadventure and waste.
– Given restrictions in resources, the practicalities of
this in the current health system are not clear
– Feasibility of these or other alternatives should be
addressed by the Sri Lankan Ministry of Health
– This may be in cooperation with WHO, IDA
(International Dispensary Association), NGOs, others
Acknowledgements
We are grateful for the assistance of the following:
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Prof Krishantha Weerasuriya (WHO SEARO)
Dr Michael Eddleston (UK, Sri Lanka)
Dr Darren Roberts (Australia, Sri Lanka)
Hospital Directors at Matale & Gampola
Chief Pharmacists at Matale & Gampola Base
Hospitals
• Pharmacists at Matale and Gampola Base
Hospitals