Abstract
Background: Study looking into cardiovascular disorders (CVD) medicines or analgesics cost-saving activities during dispensing process is lacking.
 Aim: To determine differences in factors and costs associated with refused CVD medicines or analgesics during dispensing process
 Method: This study was approved by Medical Research and Ethics Committee (MREC) (Registration number: NMRR-20-177-53153(IIR)). Participants receiving CVD medicines or analgesics during dispensing process were recruited via convenience sampling technique between February and March 2020 at the Specialist Pharmacy Department of Jerantut Hospital, Malaysia. Refusal to medications and its reasons were asked based on the questionnaire developed by the researchers.
 Results: Overall, 175 patients participated in this survey and CVD drugs contributed toward 58.9% of the refused medicines. Those who refused CVD drugs and analgesics were significantly different in terms of gender, medications dosing frequency, refusal reasons namely side effects, medications use, intentionally skipping dose and skipping the dose when feeling well. No associations were found between forgetfulness and age with refusal to CVD drugs or painkillers. Those who refused CVD medicines had a significantly higher total daily medicines, total daily pill burden, and total number of medicines refused per prescription compared to those who refused analgesics. Cost of CVD medicines refused per prescription was significantly higher compared to analgesics, median Ringgit Malaysia (RM) 10.50 (IQR, RM 15.00) versus median RM 6.00 (IQR, 15.00), P=0.01.
 Conclusion: Refusal to CVD medicines and analgesics was associated with several medication’s and patient’s factors. However, higher cost-saving was observed in those refusing CVD medicines.
 
 Keywords: cardiovascular disease, analgesics, dispensing, wastage
Highlights
Today, healthcare system around the globe is burdened with increasing healthcare cost due to struggling economy and the responsibility to provide accessible medical care to the populations. (1,2) Despite this, occurrence of medication wastage is still at large
Other possible factors include oversupply of medication due to lack of interactions between pharmacists and the patients during dispensing process.[1]. This can occur under certain scenarios such as patients are continued to be dispensed with pro re nata (PRN) drugs such as analgesics by the pharmacists even though these patients are not using them (4)
This study aimed 1) to determine differences in factors associated with outpatient refusal to some dispensed cardiovascular disorders (CVD) medicines or analgesics and 2) to measure the cost difference between CVD drugs or analgesics refused by patients during dispensing process
Summary
Healthcare system around the globe is burdened with increasing healthcare cost due to struggling economy and the responsibility to provide accessible medical care to the populations. (1,2) Despite this, occurrence of medication wastage is still at large. In order to reduce drug wastage, a more proactive steps should be taken by the pharmacists at various stages of medication supply. Pharmacists can play a role during prescribing process by giving advice and recommendation related to polypharmacy intervention[4] and deprescribing of inappropriate medicines to the prescribers (5). Another step to reduce medication waste involves discussion between pharmacists and their patients regarding the quantities of medication needed during dispensing process, so that patients would not keep excess medication at home (6). Pharmacists believed that activities involving re-dispensing unused medications returned by patients as the least importance stage and impractical in medication waste reduction process (6)
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