Study: Exact pill dispensing reduces waste, boosts adherence

A study of antibiotic delivery methods in France revealed an important finding that could be applied to other pharmaceuticals around the world: Patients receiving a per-unit dispensing of pills demonstrated greater adherence to the medication than those receiving prepackaged boxes.

In all, 91.4 percent of patients who received the exact number of prescribed pills reported strict adherence, compared to 65.6 percent who received prepackaged boxes—the standard delivery method in France.

Adherence was measured via phone surveys by the number of pills remaining. Zero for the exact-amount group qualified as strict adherence, as did the difference between delivered pills and prescribed pills for the control group.

“Supplying antibiotics per unit is not only beneficial in terms of a reduced number of pills to reimburse or for the environment (less pills wasted and non-recycled), but also has a positive and unexpected impact on adherence to treatment, and thus on both individual and public health,” wrote lead researcher Carole Treibich, with Aix-Marseille University, and colleagues in PLOS One.

Compliance has been a persistently tricky issue in medicine, including cardiology. Recent research suggests less than half of patients are adherent to all of their prescriptions following a heart attack.

One-hundred pharmacies participated in the PLOS One study, 75 of which dispensed the medication by units and 25 of which continued providing treatment in the traditional pharmaceutical company boxes. Of the nearly 1,200 patients who were included, 907 experienced personalized delivery while 278 were assigned to the prepackaged group.

In addition to the adherence differences, the researchers noted a reduction of 9.9 percent in the total number of pills supplied using the personalized delivery model.

Also, 13.1 percent of survey respondents reported they generally throw away their extra pills instead of recycling them. While there were no differences between the groups in terms of throwaway rate, the excess number of pills given to the prepackaged group means more medication would be wasted if France preserved its current delivery system.

Treibich et al. noted adherence was measured by patient responses, which could be subject to recall bias or social desirability bias (over-reporting good behavior). Also, the cost of moving to a per-unit system of distribution—including increasing workload for pharmacists—wasn’t studied.

However, the long-term benefit of this model on public health and reimbursement might eventually lead to cost savings, the authors wrote.