["To be used as directed by your physician"--reasons why patients do not use prescribed medicines]

Research and practice indicate that a substantial amount of drugs prescribed for patients are never used. However, we do not know much as to why around 10% of the drugs paid for by the National Insurance are not used. The object of our survey was to identify and illustrate different reasons for this waste. On a questionnaire, 462 persons, who returned unused medication to 14 Norwegian pharmacies during a three-month period in 1994, indicated their reasons for not using the drugs. About half of these persons were also willing to participate in an in-depth interview. Using qualitative methodology, we grouped the reasons for having surplus medication into four main categories: Altered drug requirements--because of changes in the state of the patient's health or because of a new treatment regime. How the patients handled the prescribed drugs--influenced by the patient's knowledge, attitude and physical ability. Illness, social network and the complexity of the treatment were also contributing factors in this category. Coordination of the health services--related to how closely the various sections within the health care service worked together. Prescribing and distribution of drugs--related to rules and regulations, politics, technology, availability and the degree of economic consciousness among doctors and pharmacists. Both the professional and the socioeconomic aspects cited in this study call for reflection and may be used as a basis for further general discussion on the prescribing and handling of drugs, as well as the economic aspect of drug issue. They may also serve as an inspiration for local quality assurance measures and collaboration, especially between the various groups involved in the primary health care service.