Conceptual And Discursive Reality Of Medication Accumulation At Home

Abstract

Background: Medication hoarding is associated with unintended consequences on healthcare costs, patient safety, the environment, and quality of care. To prevent medication hoarding and its negative consequences, the reasons for the behavior must be understood. However, research regarding medication hoarding is scant and ambiguous. Medication hoarding appeared in the context of medication stockpiling and the retention of unused, unwanted, expired, or leftover (UUEL) medications. A full grasp of the relationships among these seemingly competing concepts would provide insight into the cause of the conceptual confusion. Objectives: This study aims to 1) conceptually analyze the hoarding of prescription and over-the-counter medications by individuals at home and its competing concepts, such as medication stockpiling and the retention of UUEL medications in the scientific literature, 2) establish a theoretical definition of medication accumulation based on the three competing concepts of interest, 3) analyze the discourses around medication hoarding and stockpiling in the scientific literature that utilized the two terms interchangeably, and 4) determine the congruence between the results of the principled-based concept analysis and discursive psychology. Methods: The search terms were selected based on the three related concepts: medication hoarding, medication stockpiling, and UUEL medications identified in the literature review. For the principle-based concept analysis, 107 scientific articles were reviewed. The relevant information for each concept was coded based on the seven conceptual components, and their conceptual maturity was evaluated. The three concepts were then perceived as medication accumulation and analyzed to construct a theoretical definition. Discursive psychology was conducted with six articles that used the two terms interchangeably, and the interpretative repertories around medication hoarding and stockpiling were examined. The results were compared for congruence. Results: The principle-based concept analysis revealed that the three concepts were immature. Based on the consumption activities and types of medications encompassed by each concept, the retention of UUEL medications was deemed subordinate to medication hoarding and different from medication stockpiling. Perceiving the concepts as medication accumulation revealed four causes of negative consequences. The discursive psychology found four interpretative repertories: “medication hoarding and stockpiling as a negative behavior,” medication stockpiling as a consumer behavior,” “empiricist repertories,” and “conjectural repertories.” Discussion/Conclusion: The inconsistent definitions of the concepts mainly caused their conceptual immaturity. The same type of confusion was also noted in the discursive psychology. With the confusion around the meaning of each behavior, the presumptive use of the terms worsened the obscurity. Despite the ambiguous boundaries, perceiving the three concepts as medication accumulation led to more practical implications. The causes of the negative consequences can be minimized by promoting medication take-back and reuse programs and at-home disposal kits. Consolidating the concepts will also unify any future research effort and prevent stigma around a particular behavior.