Challenges Of Medication Handling At

Home And Awareness On Medication

Waste Among Chronic Disease Patients
In Malaysia
NAME: NURSYAFIQAH BINTI KHAIRUDIN (A181014)
SUPERVISOR: DR. ADLIAH BINTI MHD. ALI

1
Introduction
Definition of medication handling Definition of medication waste

● Drug product that is not fully consumed

either it is prescribed or purchased over
General
the counter that could lead to wastage.
Acquisition, prescribe, supply, dispense, (Abou-Auda HS, 2003)
distribution, storage and disposal of medicine
(Medicines Handling Policy 2021, Government of Western Australia)
● Expired medication or medication that
remains unused throughout the supply
chain.
Medication handling at home (West et al, 2015)

Appropriate medication storage,

having a drug administration
schedule, no medication
duplication, no drug hoarding,
keeping expired medicines and not
sharing medication with others.
(Lau C.L.L et al, 2022)

2
Introduction

Definition of chronic disease Challenges of medication handling at

home among the chronic patients

Poor drug storage practices, lack of medication

According to Centres For Disease Control And
administration schedule, use of drugs from
Prevention (CDC), chronic disease is defined as
multiple prescribers, use of discontinued
conditions that last 1 year or more and require
medicines, expired medications or medicines
ongoing medical attention or causing limitation
that are no longer needed and the use of
in daily activities or both.
over-the-counter medications which are not
(CDC, 2022) suitable for their condition

(L. Sorensen et al, 2006)

3
Literature review
Issue/concern potentially may lead to medication waste

● According to the Star Online News on 2016, Malaysia’s Ministry of Health has disposed

nearly RM 2.0 milion (USD 446,678) worth medicines that were consisted of returned
medicines from Return Your Medicine Programme from 2014-2016.
(The Star, 2016)

● Malaysia spends RM 2,107.61 million on drug expenditure in 2016 and the number keeps on
increasing years by years to RM 2,801.28 million in 2019.
(Pharmacy Programme Statistics Report, 2019)

● 50% of chronic disease patients do not take their long-term therapy as prescribed.

(Pagès-Puigdemont N. et al, 2016)

4
Factors of medication waste

Change of therapy

- The unused former prescribed medicine contribute to waste as the therapy changes
(Trueman P., et al, 2010; Ekedahl A.B.E., 2007)
Negative perception on generic drug

- A study shows that people’s perception are either generic drug is not effective or less quality
than the originator.
(Hatem G., et al, 2023)
Multiple prescriptions

- It happens when the prescribers are unaware of patient’s current existing medicines.
(Ali F. et al, 2003)
Excessive stock up

- Due to fear of medication shortage when they need medicine, some people will overstock.
(West et al, 2015)

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 Justification

Inadequate studies Important Benefits

About the relationship between Must perform this study to measure The findings may be used to
the challenges of medication the level of knowledge among the improve the intervention
handling at home among the chronic patient regarding their strategies as well as develop
chronic patients and their malpractice of medication handling awareness in the future.
awareness on risk of medication at home.
waste.

6
 Objectives
General: To determine the challenges of medication handling at home and the
awareness on medication waste among chronic disease patients in Malaysia

Specific:

1 2 3

To determine the challenges of To determine the current level of To study the relationship between
medication handling practice at home awareness on medication waste sociodemographic factor with the
among the chronic disease patients among the chronic disease patients medication handling practice and level of
awareness on medication waste

7
 Method

Study design
Target population Ethic application
● Cross-sectional
survey criteria Application will be done
after proposal presentation
● Questionnaire
Inclusion:
● Long term chronic Questionnaire
Target population disease patient (> distribution
Chronic disease patients 1 year)
in Malaysia ● Age >18 years old ● Online platform
● Face-to-face
Sampling method
Exclusion:
Subjects are selected ● Incomplete
based on simple random questionnaire Research time frame
sampling May 2023 - Feb 2024

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 Sample size estimation
Sample size formula ● From the formula, the

n = (Zα/2)^2 * p(1-p) /c^2

recommended sample size
= 1.96^2 * 0.5(1-0.5)/0.05^2 will be 384.
= 384

● n = the sample size

● Zα/2 = the z-score for the desired confidence level
● p = the estimated proportion of the population
(50%)
● c = the confidence interval

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Content of data collection form

Section A
Respondent demographic information

Section B
Respondent current medication handling practice at home

Section C
Respondent level of awareness about medication waste

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 Statistical analysis

Specific Objective Measured Variables Statistical Analysis

To determine the challenges of

Challenges of medication handling Descriptive statistic
medication handling practice at home
practice at home (frequency, percentage)
among the chronic disease patients

To determine the current level of

Current level of awareness on Descriptive statistic
awareness on medication waste
medication waste (frequency, percentage)
among the chronic disease patient

To study the relationship between

sociodemographic factors with the
medication handling practice and
level of awareness on medication
waste
Sociodemographic factors that
influence medication handling Correlation
practice and level of awareness on Inferential statistic (nominal)
medication waste
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 Research schedule
Task Apr May June July Aug Sept Oct Nov Dec Jan Feb
2023 2023 2023 2023 2023 2023 2023 2023 2023 2024 2024

Proposal preparation
and presentation

Literature review
writing and submission

Ethic application

Questionnaire
development

Data collection

Data analysis

Manuscript writing and

submission

Research result
presentation and viva

Research project
submission 12
 References
● Abou-Auda, H. S. (2003). An economic assessment of the extent of medication use and wastage among families in Saudi Arabia and
Arabian Gulf countries. Clinical Therapeutics, 25(4), 1276–1292. https://doi.org/10.1016/s0149-2918(03)80083-8
● West LM, Diack L, Cordina M, et al. (2015). Applying the Delphi technique to define ‘medication wastage’. European Journal
Hospital Pharmacy. 22(5):274-279.
● Pharmaceutical services Programme. (2019). Pharmacy Programme statistics report 2019. Pharmaceutical services Programme,
Ministry of Health Malaysia
https://www.pharmacy.gov.my/v2/sites/default/files/document-upload/laporan-statistik-farmasi-2019_0.pdf.
● Mohamad Azmi H, Fahad S. (2015). A national survey on the use of medicines (NSUM) by Malaysian consumers. Pharmaceutical
Services Division, Ministry of Health Malaysia
https://www.pharmacy.gov.my/v2/sites/default/files/document-upload/national-survey-use-medicine-iii-nsum-iii.pdf.
● Department of Health. (2021). Medicines Handling Policy . Government of Western Australian.
https://www.health.wa.gov.au/~/media/Corp/Policy-Frameworks/Public-Health/Medicines-Handling-Policy/Medicines-Handling-
Policy.pdf
● Pagès-Puigdemont, N., Mangues, M. A., Masip, M., Gabriele, G., Fernández-Maldonado, L., Blancafort, S., & Tuneu, L. (2016).
Patients' Perspective of Medication Adherence in Chronic Conditions: A Qualitative Study. Advances in therapy, 33(10), 1740–1754.
https://doi.org/10.1007/s12325-016-0394-6
● Sorensen, L., Stokes, J. A., Purdie, D. M., Woodward, M., & Roberts, M. S. (2006). Medication management at home: Medication risk
factor prevalence and inter-relationships. Journal of Clinical Pharmacy and Therapeutics, 31(5), 485–491.
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https://doi.org/10.1111/j.1365-2710.2006.00768.x
● Ali, F., Laurin, M. Y., Larivière, C., Tremblay, D., & Cloutier, D. (2003). The effect of pharmacist intervention and patient education
on lipid-lowering medication compliance and plasma cholesterol levels. The Canadian journal of clinical pharmacology = Journal
canadien de pharmacologie clinique, 10(3), 101–106.
● Trueman P., Taylor D.G., Lowson K., Bligh A., Meszaros A., Wright D., Glanville J., Newbould J., Bury M., Barber N., et al. (2010)
Evaluation of the Scale, Causes and Costs of Waste Medicines, Report of DH Funded National Project. York Health Economics
Consortium and The School of Pharmacy; New York, NY, USA: University of London; London, UK
● Ekedahl, A. B. (2007). Reasons why medicines are returned to Swedish pharmacies unused. Pharmacy World & Science, 28(6),
352–358. https://doi.org/10.1007/s11096-006-9055-1
● Makki, M., Hassali, M. A., Awaisu, A., & Hashmi, F. (2019). The Prevalence of Unused Medications in Homes. Pharmacy (Basel,
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● Hatem, G., Itani, R., Ajrouche, R., Abbas, N., Farah, R., Goossens, M., & Awada, S. (2023). Knowledge, perception and acceptance of
generic drugs in the general Lebanese population: A cross-sectional survey among adults. The Journal of Medicine Access, 7, 1–11.
https://doi.org/10.1177/27550834221147789
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using home care pharmacy services at government hospitals in western Malaysia. BMC Health Serv Res 22, 726 (2022).
https://doi.org/10.1186/s12913-022-08069-0
● Rahimy Rahim. (2016, December 27). Malaysian ministry destroys rm2mil worth of expired meds. The Star. Retrieved from
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ule=perpetual_scroll_0&pgtype=article&campaign=2057369. 14