The drug deliveries that could save lives

An initiative by a Galway pharmacist is ensuring patients don’t put their health at risk by not taking their medication

A GALWAY-BASED pharmacist is doing home deliveries by motorcycle every week in a bid to reduce the potentially dangerous phenomenon of non-compliance with prescriptions.

Every Wednesday, Frank McAnena loads up with specially prepared blister packs of medications individually adapted for each patient. To date, 100 people have availed of the service.

The novel initiative began after the pharmacist and local public health nurse (PHN) Eileen Coleman found patients were hoarding large amounts of medications and putting their health at risk by not taking prescribed drugs. Many of those misusing medications were elderly and living alone.

A study to assess the scale of the problem was carried out after GPs and local PHNs identified 37 patients who they felt needed support in this area.

Since the weekly service was introduced 18 months ago, the pharmacist and 12 local PHNs now involved in the scheme have seen dramatic improvements both in the health and quality of life of dozens of patients who, until recently, had been getting prescriptions renewed on a monthly basis.

McAnena says clients had been hoarding phenomenal amounts of medication before the weekly deliveries – one diabetic patient had 14 unopened boxes of insulin worth €700 in his fridge, while a psychiatric patient had €900 worth of medication in a drawer.

The study highlighted the dangers to the public, especially small children, if large quantities of drugs are kept around the house. McAnena also stresses the huge cost to the HSE if houses throughout the country contain drawerfuls of unused medications.

The dangers to people with chronic illnesses who do not take prescribed drugs was a key reason for starting the weekly deliveries to patients in Galway city and its environs.

One factor in the widespread non-compliance was that patients normally get prescriptions filled on a monthly basis, which sometimes amounts to a bewildering supply of medications.

The study found that in many cases when a patient required one additional item during the month, the entire prescription was filled, even when two to three weeks’ supply of most products were still unused.

McAnena explains that some patients end up taking both generic and branded versions of a drug, following a medical review, “and they don’t realise they are doubling up”.

The “observational” (as distinct from “scientific”) study found that the reasons people opted not to take their medication were complex and varied.

Patients attributed their non-compliance to forgetfulness, not liking the taste or side effects, confusion as to the purpose of a particular medication, concerns that the medication was not effective and fear of becoming dependent on medications or being just tired of taking them.

Reasons observed by PHNs for non- compliance ranged from physiological factors (such as cognitive impairment or depression), behavioural issues including social isolation or loss of spouse/partner, and literacy and language problems. Some people were simply unable to take the cap off a bottle of tablets, while a general deterioration in health and mobility was also a factor.

The reasons for hoarding included wanting to avoid disclosure of non-compliance, a sense of security or “just in case” they were needed again and, in less frequent cases, there were sinister purposes.

One case involved a patient with literacy issues who was on several medications, none of which was taken as prescribed. Her relatives were stealing her valium, according to the report which showed that the woman’s prescription has halved since she started getting weekly deliveries.

“It has been estimated that 10 per cent of patients in every GP’s practice are non-compliant,” says McAnena. “We are convinced that without this service many of the people we deal with would have ended up in hospital or indeed would be in nursing homes. This is a nurse-led initiative and we think it could be done all over the country”.

He says patients sometimes abuse drugs such as sleeping tablets by, for example, using a week’s supply over three days. “I have people who abuse me saying they need more, but they now know they will only get a week’s supply and eventually the arguments stop.”

He has also come across situations where children as young as 11 are trying to manage the medications of chronically-ill parents and so a weekly blister pack means potentially serious mistakes can be avoided. “The potential for disaster is very, very high,” says McAnena.

The pharmacist is scathing about the 50 cent per item prescription charge recently introduced for medical card holders. “Can you imagine telling the schizophrenic who does not want to take his pills that he has to give you 50 cent for them?” he asks.

Eileen Coleman says the benefits to the patients since the Galway scheme started 18 months ago have been “dramatic”.

“Not only does the patient feel better when he takes the medication he needs but there is a domino effect,” she explains.

One patient, who was quite confrontational when not taking the prescribed medication, had become isolated as his family were staying away, she explains. “But now they are visiting regularly and including him in events, and so his quality of life has improved.”

Another patient had deteriorated to the degree that he could no longer live alone but now that his medications have been sorted out, he can continue to live independently.

“Obviously, if someone has a chronic illness, whether it is cancer or muscular dystrophy, they need their medication and will deteriorate without it,” she stresses.

Non-compliance leads to poor health, reduced quality of life, more GP and hospital visits and extra costs for the health system, Coleman says.

“I have no doubt that this is happening all over the country. People are hoarding medicines, are not taking medications and, as a result, are not getting better,” she says.

She believes if the weekly dispensing service was widespread, more people could live independently, there would be fewer hospital admissions, and those with life-threatening illnesses would see significant improvements in their condition and, as a result, in their quality of life. “This issue must be addressed and those who need a weekly service should get it,” she says.

In a statement, the Irish Medicines Board said: “Certain members of the public, particularly the elderly and those living alone, may require additional support and assistance from their family, carers and healthcare professionals and we welcome initiatives in this area.”

MOTORBIKE SERVICE 'AN ABSOLUTE GODSEND'

Gerard Cotter (74), a cancer patient who lives just outside Galway city, says the weekly deliveries have been “an absolute godsend”.

“I used to take a tablet and one hour later could not remember which one it was,” he explains. “The blister pack makes it really simple, and Frank takes the time to explain any changes and discuss what each tablet is for.”

Gerard, who takes 11 tablets every day, says it is always easy to get it right when in hospital, “but once you leave the hospital you are on your own”.

He calls McAnena “the Harley-Davidson man” because he arrives every week by motorbike. “Frank got me out of a hole,” he says.

“I could not even remember where my tablets where, never mind what I had taken. I was completely confused.”

Knowing that he can call the pharmacist at any time if he is worried or has a query makes him feel secure.

“I rang the hospital once but they did not want to know. I suppose they are all too busy,” he says.

The most important thing for him is that he feels better – more healthy and more alert – since he started getting his tablets right.

“I was not able to put the kettle on before this started, but now I have much more energy. I used to be stuck to the chair, but I feel more able to do things now.”

Now that he is complying with his prescriptions, Gerard, who lives on his own, says he will be able to come off some tablets soon.

“Even my consultant has noticed the improvement and now she is talking about taking me off some of the tablets. I am back in hospital next week and hopefully I will have only half the tablets when I leave. But Frank will still come and he is never in a rush, which is a blessing.”