Quantifying and characterising multi-compartment compliance aid provision

Abstract

BackgroundMedication compliance aids (MCAs) to support adherence lack evidence for cost-effectiveness yet a 2001 survey in England estimated 100,000 patients receiving an MCA whilst living in their home. Objective(s)To obtain a contemporary estimate of MCA provision by community pharmacies in England and describe factors influencing pharmacist decision-making regarding MCA initiation. MethodsA stratified random sample of two community pharmacies per county (n=40) in England were surveyed by telephone and a more detailed postal survey sent to participants expressing an interest. Data were collected to determine magnitude of MCA provision and, professional and administrative factors influencing initiation were reported as percentage (95% confidence interval) respondents reporting a factor. ResultsAn estimated 273,529 MCAs are filled by community pharmacies in England with a median (IQR) of 20(10, 50) MCAs per pharmacy per month provided for patients living in their home. Practitioners' judgement of appropriateness for MCA initiation was reported by 51.3 ±11% as the primary factor influencing decision-making relative to 16.3 ±8% and 20 ±8.8% reporting patient's and carer's opinion respectively. Some form of assessment tool was reported by 13 ±7.3% respondents.Postal survey respondents (n=31) indicated that decision-making regarding MCA initiation was often or always affected by suitability of medication for dispensing in an MCA by 58% ±17% of respondents; 74.2% ±15.4% and 53.3% ±17.9% of respondents' decision-making was never or rarely affected by the risk of adverse events and reduced patient autonomy arising from an MCA respectively. ConclusionsProvision of MCAs by pharmacies in England has more than doubled in the past decade. Beyond considering the practicalities of whether an MCA is suitable for a patient, there is limited evidence of pharmacists considering patient choice or risk of adverse events arising from sudden increased adherence prior to initiation.

Medication compliance aids unpackaged: A national survey

“…This survey was carried out with hospital Trusts and did not study community services. A study of MCA provision in the community in England has been carried out recently 21 and thus our results, while only capturing hospital services, add to existing knowledge. In addition, our survey has only included Trusts in England, and practice might vary in other parts of the UK.…”

“…Free-text responses also showed that some care agencies will only accept the patient if their medication is supplied within an MCA. Care agency request as a main driver for MCA use has been shown in previous research, with acknowledgement that this may be because "carers are not permitted to issue medications to patients (as their company policy)" 21 and that home care workers are required to "have the necessary knowledge and skills" to provide medicines support, 22 which may not be available.…”

Do pill organisers improve medication adherence?

“…In contrast, a review of community pharmacies in England found that most cited a practitioner's judgement of appropriateness as the primary factor informing their decision to give an MCA. Only 16% and 20% respectively reported the patient's or carer's opinion as the key factor 7 . In fact, only 28% of pharmacies carried out a needs assessment at all before commencing use of an MCA, according to a 2019 survey 2 authored by Andre Yeung, a Specialist Pharmacist Advisor and Local Professional Network Chair for Northumberland, Tyne and Wear.…”

A Multi-method Exploratory Evaluation of a Service Designed to Improve Medication Safety for Patients with Monitored Dosage Systems Following Hospital Discharge

“…Multi-compartment compliance aids (MCAs), commonly known as monitored dosage systems (MDS) or blister packs [ 12 ], have been suggested to improve patient adherence [ 13 , 14 ]. In a recent survey in England, it was estimated that a median of 20 MDS were being prepared by community pharmacies per month [ 15 ], with an estimated 64 million MDS dispensed to around 1.2 million patients in England annually [ 16 ]. However, despite widespread use, there is a lack of evidence of the benefits of MDS [ 17 , 18 ] alongside emerging reports of risk including incidents of patient confusion regarding changing MDS' brands post-hospital discharge [ 19 ].…”