What is the place for monitored dosage systems?

Duerden, Martin

doi:10.1136/dtb.2018.9.000004

Cited by 9 publications

(9 citation statements)

References 7 publications

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“…These can be extremely useful and can support patients to remain at home by helping them to manage their own medication. They can also be a useful tool in supporting Home Care Workers to safely prompt and administer medications in patients' homes [7][8][9]45]. Conversely, these aids can have negative implications for a person's independence and agency when they disempower patients by removing responsibility for, and understanding of, their own medications [46].…”

Section: Discussionmentioning

confidence: 99%

An exploration of the experiences of professionals supporting patients approaching the end of life in medicines management at home. A qualitative study

et al. 2020

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Background The management of medicines towards the end of life can place increasing burdens and responsibilities on patients and families. This has received little attention yet it can be a source of great difficulty and distress patients and families. Dose administration aids can be useful for some patients but there is no evidence for their wide spread use or the implications for their use as patients become increasing unwell. The study aimed to explore how healthcare professionals describe the support they provide for patients to manage medications at home at end of life. Methods Qualitative interview study with thematic analysis. Participants were a purposive sample of 40 community healthcare professionals (including GPs, pharmacists, and specialist palliative care and community nurses) from across two English counties. Results Healthcare professionals reported a variety of ways in which they tried to support patients to take medications as prescribed. While the paper presents some solutions and strategies reported by professional respondents it was clear from both professional and patient/family caregiver accounts in the wider study that rather few professionals provided this kind of support. Standard solutions offered included: rationalising the number of medications; providing different formulations; explaining what medications were for and how best to take them. Dose administration aids were also regularly provided, and while useful for some, they posed a number of practical difficulties for palliative care. More challenging circumstances such as substance misuse and memory loss required more innovative strategies such as supporting ways to record medication taking; balancing restricted access to controlled drugs and appropriate pain management and supporting patient choice in medication use. Conclusions The burdens and responsibilities of managing medicines at home for patients approaching the end of life has not been widely recognised or understood. This paper considers some of the strategies reported by professionals in the study, and points to the great potential for a more widely proactive stance in supporting patients and family carers to understand and take their medicines effectively. By adopting tailored, and sometimes, ‘outside the box’ thinking professionals can identify immediate, simple solutions to the problems patients and families experience with managing medicines.

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Section: Discussionmentioning

confidence: 99%

An exploration of the experiences of professionals supporting patients approaching the end of life in medicines management at home. A qualitative study

et al. 2020

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“…These can be extremely useful and can support patients to remain at home by helping them to manage their own medication. They can also be a useful tool in supporting Home Care Workers to safely prompt and administer medications in patients' homes [10][11][12]46 . Conversely, these aids can have negative implications for a person's independence and agency when they disempower patients by removing responsibility for, and understanding of, their own medications 47 .…”

Section: Discussionmentioning

confidence: 99%

“…This increases risk of adverse events, lack of effective symptom management, and instability of some medications when stored outside their original packs. The result is often considerable wastage of pre-prepared boxes or multiple additional medications which are not included in the box or blister pack 46 . These types of issues add to the challenge of optimising pain control in the home environment 48,49 .…”

Section: Discussionmentioning

confidence: 99%

Thinking outside the (dosette) box: Professional support for medicines management at home for patients approaching the end of life. A qualitative study

Wilson

Caswell

Latif

et al. 2019

Preprint

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Background: The management of medicines towards the end of life can place increasing burdens and responsibilities on patients and families. This has received little attention yet it can be a source of great difficulty and distress patients and families. Dose administration aids can be useful for some patients but there is no evidence for their wide spread use or the implications for their use as patients become increasing unwell. Aim: To explore how healthcare professionals describe the support they provide for patients to manage medications at home at end of life. Methods: Qualitative interview study with thematic analysis. Participants were a purposive sample of 40 community healthcare professionals (including GPs, pharmacists, and specialist palliative care and community nurses) from across two English counties. Results: Healthcare professionals reported a variety of ways in which they tried to support patients to take medications as prescribed. While dose administration aids were useful for some they posed a number of practical difficulties. Other strategies described included: rationalising the number of medications; providing different formulations; explaining what medications were for and how best to take them; providing and supporting ways to record medication taking; and ways of balancing restricted access to controlled drugs and appropriate pain management for patients in the context of substance misuse and memory loss. Conclusions: The burdens and responsibilities of managing medicines at home for patients approaching the end of life has not been widely recognised or understood. This paper considers some of the strategies reported by professionals in the study, and points to the great potential for a more widely proactive stance in supporting patients and family carers to understand and take their medicines effectively. By adopting tailored, and sometimes, ‘outside the box’ thinking professionals can identify immediate, simple solutions to the problems patients and families experience with managing medicines.

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“…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 ]. Historically, hospitals may have sent the discharge letter for patients with MDS to the community pharmacy via fax, but this did not always occur and may have suffered from poor resolution of document images [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

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

Alqenae,

Steinke,

Belither

et al. 2023

Drug Saf

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Background and Objective Medication safety problems are common post-hospital discharge, and an important global healthcare improvement target. The Transfers of Care Around Medicines (TCAM) service was launched by a National Health Service Trust in the North-West of England, initially focusing on patients with new or existing Monitored Dosage Systems (MDS). The TCAM service is designed to enable the prompt transfer of medication information, with referrals made by hospitals at discharge to a named community pharmacy. This study aimed to explore the utilisation and impact of the TCAM service on medication safety. Methods The evaluation included a descriptive analysis of 3033 anonymised patient referrals to 71 community pharmacies over a 1-year period alongside an assessment of the impact of the TCAM service on unintentional medication discrepancies and adverse drug events using a retrospective before-and-after study design. Impact data were collected across 18 general practices by 16 trained clinical pharmacists. Results Most patient referrals (70%, 2126/3033) were marked as ‘completed’ by community pharmacies, with 15% of completed referrals delayed beyond 30 days. Screening of 411 patient records by clinical pharmacists yielded no statistically significant difference in unintentional medication discrepancies or adverse drug event rates following TCAM implementation using a multivariable regression analysis (unintentional medication discrepancies adjusted odds ratio = 0.79 [95% confidence interval 0.44–1.44, p = 0.46]; and adverse drug events adjusted odds ratio = 1.19 [95% confidence interval 0.57–2.45, p = 0.63]), although there remained considerable uncertainty. Conclusions The TCAM service facilitated a number of community pharmacy services offered to patients with monitored dosage systems; but the impact of the intervention on unintentional medication discrepancies and adverse drug event rates post-hospital discharge for this patient group was uncertain. The results of this exploratory study can inform the ongoing implementation of the TCAM service at hospital discharge and highlight the need to understand service implementation in different contexts, which may influence its impact on medication safety. Supplementary Information The online version contains supplementary material available at 10.1007/s40264-023-01342-z.

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What is the place for monitored dosage systems?

Cited by 9 publications

References 7 publications

An exploration of the experiences of professionals supporting patients approaching the end of life in medicines management at home. A qualitative study

An exploration of the experiences of professionals supporting patients approaching the end of life in medicines management at home. A qualitative study

Thinking outside the (dosette) box: Professional support for medicines management at home for patients approaching the end of life. A qualitative study

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

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