Inventory of Drug Samples in a Health Care Institution: DISCUSSION

15 Dec

In this study, important quantities of drug samples (78 955 doses worth Can$48 783) were found in a 500-bed university health centre. To the authors’ knowledge, no previous in-house study of this type has been reported. The variety of drugs, the amount of samples inventoried, and the very low level of compliance with local policy and procedures were surprising.

Other descriptive studies have evaluated the value of drug sample inventories in private practice, based on average whole­sale prices. In a 1992 study, 5546 drug samples worth a total of US$19273 were inventoried by a group of family physicians. Over a 14-month period in 1992-1993, drug samples worth a total of US$240 782 were recorded in a university-affiliated family medicine residence program. In 1998, a physician’s private practice inventory of drug samples was worth US$262661. In 2002, drug samples in a rural private practice area were valued at US$60620, whereas the value of the samples received during the observation period was US$22 029. In 2004, an inventory was obtained of drug samples in 6 general practice offices in a metropolitan and a rural area of Australia; the samples had a value of A$31 364. Campbell and others found that pediatricians were less likely than general practitioners to receive drug samples (odds ratio 0.56, 95% confidence interval 0.33-0.94). Although the value of the Sainte-Justine samples inventoried in this study was lower than that in several US studies, it was 2.4 times the maximum value of the authorized medications (excluding samples) available as floor stock in the hospital, an astonishing ratio. These results indicate that the quantity of drug samples available in hospitals is underestimated, and we therefore recommend that the use of samples in hospitals be regulated to a greater extent. If a hospital pharmacy department is unable to regulate the acquisition, storage, dispensing, and documenta­tion of samples, the use of samples could constitute a parallel pharmacy practice by the industry. kamagra soft tabs

Most previous studies have focused on the number of distribution units of drug samples (e.g., blister packs, bottles), rather than the number of doses. However, we believe that it is more relevant to record the number of doses, because most doses can be dispensed individually, and each dose represents an individual risk for misuse. Moreover, to judge the relative importance of drug samples and authorized floor stock dispensed by the pharmacy department to the clinics, the dose represents the smallest unit that would allow volume and cost comparisons. Also, the number of doses can be used to estimate the proportion of a treatment that has been given to a patient through drug samples. Nevertheless, reporting the number of doses increases the absolute number calculated for drug samples with multidose formats, such as inhalers used in the treatment of pulmonary ailments.

In this study, certain therapeutic classes were more likely to be available as samples: hormones and their substitutes (American Hospital Formulary System class 68:00; 32%), autonomic nervous system medications (class 12:00; 19%), skin and mucous membrane medications (class 84:00; 12%), and vitamins (class 88:00; 9%). Backer and others identified 4 categories for the most popular medications (representing 63% of all medications distributed): asthma and allergy agents, anti-infective agents, analgesic and anti-inflammatory medica­tions, and anti-hypertensive agents. In Wolf’s observational study,31 the drug samples fell into 6 categories: anti-inflammatories (nasal, valued at US$84690; lung, valued at US$70436), antihistamines (US$52146), antibiotics (US$25 820), bronchodilators (US$19 149), and miscellaneous (US$10420). In 2007, Mabins and others conducted an observational study with 123 patients who had received drug samples. The main conditions treated with samples were hypertension (15.4% of patients), pain (11.4%), dyslipidemia (9.8%), coughs and colds (8.9%), and depression (8.1%). The distribution of therapeutic classes of drug samples in the current study differed from those of other published studies, a difference that can probably be explained by the target patient population at Sainte-Justine (mothers and children).  Viagra Professional