Older people's experiences of changed medication appearance due to generic prescribing: a qualitative study

Williamson, T; Howarth, ML; Greene, L; Prashar, A

Abstract

Research was undertaken in response to requests by older people in Rochdale Borough to investigate an issue of great concern to them namely prescription medications constantly changing appearance due to generic prescribing.

When branded drugs are still in their ‘patent’ period, which is a number of years after they are introduced into the market, there is only one sole supplier. Expiration of this period allows other manufacturers to ‘mimic’ the branded product, at a fraction of the cost. It is an NHS directive for prescribers to use the generic drug name when a drug is prescribed unless there is a clinical justification for using the brand name. When people receive their tablet medicines from their pharmacist, the brand and so the appearance (colour, size, shape) can be vastly different to those dispensed following their previous prescription despite having the same active ingredient. This is often due to a lack of standardisation practice required amongst manufacturers. Drugs are made to British and European Pharmacopoeia standards but these do not specify colour, size and shape. Medicines are required to be of 'essential similarity' but that does not include appearance. Many pharmacists believe that standardisation, should not only include size, shape, colour but also packaging. Packaging changes from the same company on consecutive orders presents considerable challenge to pharmacists as well as patients.

This patient experience study involved in-depth qualitative interviews with 32 people across Greater Manchester aged between 62 and 88 years of age taking three or more prescribed tablet medications. Findings revealed that these older people were challenged by the changes in their medications which impacted on their confidence and forced them to repeatedly double check their medicine regimes. The older people we interviewed felt they were only able to cope with the changes in medicine appearance due to their own diligence and because they had capacity to do so. Most were very concerned that as they became older and their capacity to self-manage medicines reduced, that they would be at risk of medication errors. They also believed there were many older people less capable than themselves who were already struggling to cope with medicine appearance changes.
One participant said “You wouldn’t buy an orange cabbage would you?” to illustrate how disconcerting they found changes to their established medicines.
This study builds on the team’s other Greater Manchester-wide research of the same topic which was a survey of 2000 older people and which painted a much more negative picture (Williamson et al 2009) [available from http://usir.salford.ac.uk/2989/] and many older people reported being stressed or confused with the changes in medication appearance.

Study recommendations centre on future research and multiple agency work to:
• Improve written information and information processes
• Consider of the use of pictures on boxes of medications
• Require manufacturers to notify pharmacists and explain changes and provide standardised packaging in terms of quantity (28 or 30 day packs)
• Scope individual strategies - formal and informal - that people use to manage their medicines at home as a means of identifying risk
• Identify training / education needs amongst primary care workers e.g. district nurses, pharmacists and GPs and partners such as Local Authorities in supporting older people with their medicines and identifying those most at risk e.g. vulnerable adults
• Explore the frequency and nature of changes to individual’s medication appearance
• Undertake economic analyses of generic prescribing practices including cost and quality of life implications
• Explore the impact of changed appearance of medication with the wider older population including those who are less able to participate e.g. seldom heard or marginalised groups, those who are socially isolated and especially those at higher risk of negative effects such as those with reduced capacity to self manage medications
• Devise a public information poster explaining 1) how large savings from generic prescribing are reinvested into patient services and 2) how when drugs come off patent, other manufacturers are free to produce them at lower cost, as long as they maintain efficacy 3) how pharmacists cannot order medicines from a specific manufacturer as it depends what wholesaler has in stock 4) the requirement to bulk some tablets up with excipients 5) the need for patients to talk to their pharmacist

Citation

Williamson, T., Howarth, M., Greene, L., & Prashar, A. Older people's experiences of changed medication appearance due to generic prescribing: a qualitative study

• Report Type: Project Report
• Deposit Date: Mar 30, 2010
• Publicly Available Date: Mar 30, 2010
• ISBN: 9781905732876
• Additional Information: Funders : The former Greater Manchester Older People’s Network (Greater Manchester SHA);University of Salford