Date of Award

7-2013

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Program

Nursing

Research Advisor

Michael A. Carter, D.N.Sc., D.N.P.

Committee

Patricia A. Cowan, Ph.D. Lorraine C. Mion, Ph.D. Simonne S. Nouer, Ph.D. Patricia M. Speck, D.N.Sc.

Keywords

Disposal, Diversion, Environment, Health Care System, Medications, Regulations

Abstract

Introduction: Stockpiling of unused medications by community-dwelling individuals results in Community-based ACcumulation of Home mEdicationS (CACHES). CACHES place the individual, health care and justice system, and ecosystem at risk for adverse outcomes including: a) diversion of prescription medications by friends and family, b) pediatric poisonings, c) adverse drug events, d) increased criminal justice system costs related to prescription drug abuse, e) increased health care costs, and f) pollution of local water supplies via improper medication disposal. This study explores the relationship among individual risk factors (gender, race, age, comorbid conditions), geographical location, health care risk factors (number of prescribers and dispensaries), and CACHES.

Methods: This study involved an analysis of existing data extracted from death scene charts created by the Medical Examiners and Medicolegal Death Scene Investigators of Forensic Medical, PLC in Nashville, Tennessee from January 1 through December 31, 2011. The study examined the prevalence, size, and composition of CACHES found in decedents' homes. In addition, this study included a descriptive analysis of demographic data (gender, race, age, and comorbid conditions) and presence of CACHES. Additionally, the geographic locations of CACHES were mapped. Finally, the relationship between health care risk factors (number of prescribers and dispensaries) and CACHES was explored.

Results: The analyses showed no statistical differences in gender, race, or age between decedents with medications (used and unused) in the home and decedents without medications. The study sample was predominantly male, Caucasian/Non-Hispanic, and older than the Davidson County population. Fifty-six percent of decedents had CACHES. More than half had ≥ 4 bottles of unused medications with a mean of 38.9 ± 43.7 pills. Sixty percent of the unused medications came from two major classes - those affecting the central nervous system and the cardiovascular system. The CACHES group was significantly older, had a higher likelihood of having a psychiatric diagnosis, and used more prescribers and dispensaries. The analyses did not support a statistical difference between the two groups with regards to gender, race, or total number of comorbid conditions. There was insufficient data to perform an analyses on the relationship between geographical location (Zip code) and CACHES.

Discussion/Conclusions: Limitations in the original data as well as differences in study design complicated a direct comparison of the prevalence, size, and composition of the CACHES to other studies. However, this exploratory study corroborates the CACHES model's assertion that the stockpiling of unused medications is a pervasive problem. Furthermore, the analyses support advanced age, having a psychiatric comorbid condition, and the use of multiple prescribers and dispensaries increases the individual's risk for the accumulation of unused medications in the home. Additional research is needed to further illuminate the relationship between gender, race, and the number of comorbid conditions and CACHES.

DOI

10.21007/etd.cghs.2013.0248

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