Displaying medication costs on dispensing labels as a strategy to reduce wastage: views of the Welsh general public

Abstract

IntroductionIn 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.MethodsSix 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.ResultsSix 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.ConclusionFindings 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.

The influence of price and funding source disclosure on medication labels: Implications for intended adherence, perceived value and efficacy, and feelings of burden and guilt

“…As previously mentioned, responses to the proposed scheme were probed in a qualitative study conducted in Wales via a focus group approach. The study indicated findings consistent with the criticisms raised by the professional bodiessuggesting that introducing cost to labels may make patients feel guilty or unworthy, rather than encouraging them to use their medicines appropriately, and that this effect may be more pronounced among the elderly (Yemm et al, 2017).…”

“…Such consequences included the potential for feelings of burden and guilt, misperceptions of drug efficacy based on price of the medication, and people (particularly the elderly) being deterred from taking the medication as they may feel worried about the impact on public funds. Some evidence for this was provided by a qualitative study of Welsh respondents, in which guilt emerged as a theme from a series of focus groups (Yemm, Jones, & Mitoko, 2017). While the labelling scheme was never implemented, its proposal does raise interesting and largely unexplored questions regarding whether providing price information and including the phrase 'funded by the UK taxpayer' on medicine labels might have either (or both) positive or negative repercussions.…”

How Should Responsibility for Proper Medication Disposal Be Shared?

“…38,39 Updating patients' prescription labels to include information such as disposal locations is worth exploring, as it has been reported that patients are interested in learning more about their medications. 40 However, doing so would require support from regulatory bodies, such as the US Food and Drug Administration (FDA), to ensure consistent enactment of policy.…”

Protocol for a systematic review and systems-based exploration of interventions to reduce medicines wastage

“…A number of reviews in this area have examined the causative factors of medicines wastage and potential interventions to reduce medicines wastage [12][13][14][15][16] . Interventions to tackle this issue have included deprescribing, and the altering of duration or the nature of dispensing of repeat prescriptions 17 .…”