Pill dispensers: How can we balance usefulness with sustainability

Pharmacists are well positioned to offer effective and environmentally friendly solutions, whether by reducing, recycling or reusing pill dispensers, writes pharmacist Marc Parent.Weekly pill dispensers with blister packs, commonly known as “DispillMD,” are seen as an extremely useful tool for facilitating medication adherence. Indeed, more than 14 million of these pill dispensers were dispensed by pharmacies in Quebec last year. Due to the nature of their technology, but also for safety reasons, they are not reused and are considered disposable.La Presse recently reported that a fellow pharmacist has developed a recyclable and compostable alternative. This is a fine example of Quebec ingenuity and resourcefulness. What a brilliant idea!In our fight to give the environment a chance, we often refer to the 3Rs: Reduce, Reuse, Recycle. Since pill dispensers are very useful, reducing them is tough. Hygiene and contamination also make reuse difficult. The main solution proposed is therefore to recycle them.Nevertheless, we should consider the possibility of reducing or reusing them. First, we can ask ourselves whether all patients whose medication is placed in weekly pill dispensers really need them. For patients in residential care, medication is often required to be prepared in “Dispill” form to ensure the safety of the process and the protection of the staff who distribute the medication. Responsibility is clearly transferred to pharmacists.But for other patients, as soon as the possibility of missing a dose or two is mentioned, the reflex comes to pack the medication. We often worry about a patient who is a few days late in renewing their prescription. It should never be forgotten that good compliance is based on a patient taking at least 80% of their doses. This means that a 30-day supply can stretch to 36 days and the patient can still be considered compliant.We should also remember that although these weekly pill dispensers have proven effective, this solution is not foolproof and improves treatment compliance to about 71%. Studies on the effectiveness of these devices generally do not take into account all the variables that influence treatment compliance in patients. Timing medication can be tricky, and simply placing the medication somewhere that isn't in plain view can lead to a patient forgetting. Treatment compliance is a complex issue affected by many factors. The goal for seniors is often to maintain their independence for as long as possible. It is likely that some people currently using weekly pill organizers would be more independent if they were given the responsibility of preparing their own reusable weekly pill organizers. These reusable pill organizers are available in several formats and brands, the most popular of which is probably Dossett®. These products have the advantage of empowering patients, allowing them to become more familiar with their medications, while benefiting from the reminder aspect of the weekly pill organizer. Of course, there are also risks involved. First, since the pill organizer is filled by the patient themselves, there is already a risk of error and a lack of validation by a professional. This is also true if the medication is dispensed in a vial for a month. Since these weekly pill organizers cannot be separated, they are less portable and more likely to be left behind by the patient when they are away from home. Needed info to identify the medication in these pill organizers is also much less comprehensive, or even absent.This type of approach has been shown to be slightly less effective in supporting treatment compliance than pill organizers prepared by pharmacists. Again, it all depends on the underlying cause.Underlying causeNevertheless, I think it is important to consider the issues that cause patients to miss doses in order to find the solution that is most likely to remedy the problem. An elderly person with cognitive problems is certainly not the best person to prepare their pill dispenser—indeed, perhaps their cognitive impairment is too severe for them to manage their medication using a pill dispenser at all. Vision problems or manual dexterity issues can also make it difficult to use a pill dispenser. People who have problems with temporal disorientation often forget to take their medication. How many times have I met patients who could explain perfectly how their pill dispenser worked, yet regularly forgot to take their medication?Adherence to treatment remains a major challenge. The WHO continues to assert that the adherence rate for chronic treatment is only around 50%. A pill that remains in the bottle or in its packaging, whatever it may be, has no chance of relieving the patient's symptoms! So we must focus on improving adherence.The solution of a compostable and recyclable pill dispenser is an excellent initiative. The choice to use a pill dispenser should be part of a more comprehensive approach to all solutions in order to promote better treatment compliance. Pharmacists are well placed to make this analysis and propose effective and environmentally friendly solutions, whether by reducing, recycling or reusing the device. Our patients and the planet will be all the better for it.Marc Parent is a pharmacist in a family medicine clinic.This article has been translated from its original French and first appeared on our sister site Profession Santé.

Pill dispensers: How can we balance usefulness with sustainability

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