Multicompartment Compliance Aids Research Articles

Carer involvement in medication adherence: carer views and experiences of facilitating medication adherence using pharmacy-filled multi-compartment medication compliance aids and other methods of adherence support-a questionnaire survey.

Unpaid carers are an increasing proportion of the UK population. One of the many ways in which they help those they care for is assisting with medication adherence. Many older adults have medicines dispensed in pharmacy-filled multi-compartment medication compliance aids (pMCAs). However, evidence suggests that pMCAs may increase medication-related harm, and little is known about the interaction between the user, medication adherence systems and the carer. To explore the views of carers supporting older adults to manage their medications with and without a pMCA. A researcher-administered questionnaire survey of carers supporting older adults to manage their medicines with or without a pMCA. Participants were recruited from inpatient wards, outpatient clinics and community services in central London. Responses were analysed by two independent researchers to identify overarching themes. Eighty-eight unpaid carers were interviewed and responses were categorised according to the medication adherence method used; 47 supported a user with a pMCA and 41 supported without a pMCA. The main themes were: Time, Responsibility and Mistakes, Waste and Sustainability, and Polypharmacy, with sub-themes of design of multi-compartment medication compliance aids, organisation and reassurance. Supporting medication adherence puts considerable burden on carers regardless of whether a self- or pharmacy-filled medication compliance aid is used or not. Prescribers could alleviate this burden through regular medication review by considering the prescribing frequency and duration and medication rationalisation. Redesign of both pMCAs and systems surrounding their use could also help reduce carer's burden and environmental burden.

Accuracy of medication labels on community pharmacy-prepared dose administration aids: An observational study

BackgroundHospital prescribers often use the labels on multicompartment compliance aids or monitored dosage systems, known in Australia as dose administration aids (DAAs), as a trusted source of information about patients' medication regimens taken in the community. AimThe primary aim was to explore the prevalence and nature of labelling incidents on community pharmacy-prepared DAAs. MethodsA convenience sample of 100 adult patients admitted to a metropolitan teaching hospital who used a community pharmacy-prepared DAA at home was recruited. Patients were excluded if their DAAs were not brought to hospital. As part of usual care, a pharmacist took a best possible medication history (BPMH) using multiple information sources. This ‘gold standard’ BPMH was compared to the regimen listed on the DAA summary label and the DAA contents. The primary outcome was the percentage of patients whose DAA summary label(s) had one or more incidents for DAA packed medications. DAA label incident was defined as incorrect, missing or illegible/ambiguous medication name, strength, dose or dose-form when compared to the BPMH and DAA contents. Secondary outcomes were compliance with best-practice guidelines for labelling DAAs; and percentage of patients with a DAA packing error. ResultsThe 100 patients used 110 DAAs, packed by 75 community pharmacies. Four (4.0%) patients had no medication summary label on their DAAs. Of the 96 patients whose DAA(s) had a summary label, 82 (85.4%) had one or more summary label incidents. The most prevalent incidents were ‘illegible, ambiguous or missing medication details’, ‘truncated medication name’ and ‘omission of a medication’. The most prevalent guideline non-compliance was not including generic medication names (68% DAA-packed medications). Two DAA packing errors were identified. ConclusionA high prevalence of DAA labelling incidents was identified. Improved DAA labelling software functionality, more robust pharmacy procedures and pharmacy staff education are required.

Study on the use of multi-compartment compliance aids to improve blood pressure values in hypertensive patients

To analyse the improvement of adherence in non-adherent patients with uncontrolled HT, polymedicated and older than 55 years after the use, or not, of Multicompartment compliance aids (MCA). Longitudinal research (6 month). Levels of adherence to treatment were analysed using an adapted version of Morisky-Green test, counting of returned medication (MCA group) and blood pressure (BP) values. Site: Multicentre study in 35 community pharmacies in Spain. Participants: 195 participants (88 MCA group and 107 control group) older than 55 years, polymedicated, non-adherent to medication, with uncontrolled hypertension and using electronic prescription. Interventions: MCA group received their medication in MCA while control group received their medication as usual. Main measurements: Systolic BP/Diastolic BP was recurrently measured with a digital tensiometer in both groups. MCA group obtained a significant decrease in BP values compared to the control group (Systolic BP decreased by 18.3 mmHg in the MCA group vs. 9.9 mmHg in the control group and Diastolic BP by 9.9 mmHg vs. 8.9 mmHg). Both groups increased their adherence to over 90%. The use of MCA controlled BP levels in almost 50% of the participants. For this fact, MCA is postulated as a good tool (cost-effective, well tolerated by users, easy to use ...) to improve the adherence of patients and control their hypertension, although more studies are necessary.

Stability implications of repackaged medications in dose administration aids: a systematic review.

Dose administration aids (DAAs) or multi-compartment compliance aids are commonly used to organise doses of medications in accordance with a patient's dosing schedule. Despite their widespread use, there is a paucity of information on the stability of repackaged medications in DAAs. The objectives of this work were to evaluate stability studies conducted on repackaged medicine in DAAs and to provide a summary of the latest stability data available. A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed on studies associated with repackaged medications in DAAs and drug stability. PubMed, CINAHL, EMBASE and SCOPUS were searched from January 1998 to June 2021. A total of 342 articles were retrieved and 29 articles met the inclusion criteria. Data regarding medications from the reviewed papers were reported according to stability testing and physicochemical properties. The extracted data were then compared with stability information on DAA provision available on the database in the UK. This review identified several discrepancies between this dataset and reported stability and reveals a significant shortage in the stability data of medications repackaged in DAAs. This review highlights the need for further studies to be conducted to better understand the impact of DAA repackaging on the stability, safety and efficacy of medications. It is recommended that a database of stability information of repackaged medications via systematic stability testing studies could be established, serving as a valuable resource for pharmacists when preparing DAAs without compromising patient safety.

Are we ‘prescribing’ MCAs correctly? A mixed method study investigating the appropriateness of MCAs initiated from hospitals within a large NHS trust

Abstract Introduction Medication non-adherence is a significant public health issue and a drain on NHS resources, therefore an important issue for patients, policy makers and healthcare professionals. Non-adherence results in poorer health outcomes and increased hospital admissions (1). ​Multi-compartment compliance aids (MCAs) are being utilised as a ‘cure all’ for all causes of non-adherence when an evidence base for overall benefit is sparse. Evidence highlights that MCA introduction may only be beneficial in a few select cohorts (2). Aim The study aim was to assess the appropriateness and patients’ opinions of newly initiated MCAs for patients over 65 in hospital. Methods A retrospective longitudinal cohort study investigated patients (≥65 years) newly initiated on MCAs in hospital. Ward-based pharmacists identified new MCA initiations between October 2020 and March 2021 across four hospital sites in a large NHS trust. Factor analysis of the data was used to identify the rationale and appropriateness of MCA initiation using UK-based assessment toolkits (NHS Tayside and ‘All in Order’ criteria by the University of East Anglia). Semi-structured interviews were conducted in a sample of patients prospectively via questionnaire. Interviews focussed on patients’ confidence managing their medications, ability to recall their medication regime and their opinions of MCA initiation into their care. Results Thirty new MCA initiations were identified during the data collection period with 87% (n=26) identified as inappropriate initiations according to UK-based assessment tools. Only one initiation was found to have a formal MCA assessment undertaken. Approximately two-thirds of MCAs were initiated for the introduction of home-carers via social care (67%; n=20). The next most common reasons for initiation were family requests (13%; n=4) and perceived cognitive impairment by healthcare professionals (13%; n=4), with a further 2 MCAs initiated for mobility issues (n=1) and lack of confidence (n=1). Over a third of MCA initiations (37 %; n=11) were prescribed <4 medications. Healthcare professional initiation requests commonly came from occupational therapists (37%; n=11); however, only 18% (n=2) of these were found to be appropriate. Overall, patient opinions on MCAs varied. Those with less confidence in their medicines were more in favour of their initiation; however, those more involved and understanding of their medication regime were less accepting of MCA introduction. Conclusion A significant number of MCAs are being started for inappropriate reasons according to validated UK toolkits e.g. initiations for social care input, lack of polypharmacy and family request. Only one initiation was linked to a documented formal assessment implying further guidance and training is required for the multidisciplinary team to ensure appropriate, evidence-based provision of MCAs. Involving the patient/carer as part of a patient- centred care assessment is essential to ensure there is understanding of how to use an MCA and to reduce unwarranted ‘over-prescribing’ of MCAs to inappropriate patient groups. Individual patient -centred assessments may combat perceived medication non-adherence as having a ‘catch all’ solution. The small sample size of this study limits the ability to draw firm conclusions, especially regarding patient opinions on MCAs. References (1) Watson SJ, Aldus CF, Bond C, Bhattacharya D. Systematic review of the health and societal effects of medication organisation devices. BMC health services research. 2016 Dec;16(1):1-3. (2) Mahtani KR, Heneghan CJ, Glasziou PP, Perera R. Reminder packaging for improving adherence to self-administered long-term medications. Cochrane Database of Systematic Reviews. 2011(9).

Organising polypharmacy: unpacking medicines, unpacking meanings—an ethnographic study

ObjectivesWe explore how older patients affected by polypharmacy manage the ‘hidden work’ of organising their medicines, how they make sense of this work and integrate it into their lives.Design and...

Do pill organisers improve medication adherence?

Multi‐compartment compliance aids (MCAs) are pill boxes or blister packs that organise medication according to the day and time it needs to be taken. On the surface of it, they seem like the ideal way to ensure older patients take their medications as prescribed, but there is actually very little evidence to support their use and they may have adverse effects. This article looks at research into the effectiveness of MCAs, and discusses factors affecting medication adherence in general.

More than 60 million multicompartment compliance aids given out each year in England

More than 60 million multicompartment compliance aids given out each year in England

Are we dispensing too many multicompartment compliance aids?

Are we dispensing too many multicompartment compliance aids?

New tool developed to support decision-making on multicompartment compliance aids

New tool developed to support decision-making on multicompartment compliance aids

Think outside the box: replacing multicompartment compliance aids

Think outside the box: replacing multicompartment compliance aids

Use of multicompartment compliance aids in the community is 'excessive', says NHS Wales

Use of multicompartment compliance aids in the community is 'excessive', says NHS Wales

Multi-compartment compliance aids for addressing poor adherence

Up to a half of all medication prescribed for long-term conditions are taken incorrectly, or not at all. This article will examine the increasing use of compliance aids, specifically multi-compartment compliance aids in primary and secondary care, and discuss their potential advantages and disadvantages. It will also highlight other options that can be used to improve adherence.

The experiences and beliefs of older people in Scottish very sheltered housing about using multi-compartment compliance aids

Background Multi-compartment compliance aids (MCAs) are promoted as a potential solution to medicines non-adherence despite the absence of high quality evidence of effectiveness of MCA use impacting medicines adherence or any clinical outcomes. Furthermore, there is a lack of qualitative research which focuses on the perspectives of older people receiving MCAs. Objectives To describe experiences and beliefs surrounding very sheltered housing (VSH) residents’ use of MCAs with emphasis on issues of personalisation, reablement, shared decision-making, independence and support. Setting VSH in north east Scotland. Methods Qualitative, face-to-face interviews with 20 residents (≥ 65 years, using MCA > 6 months) in three VSH complexes. Interviews focused on: when and why the MCA was first introduced; who was involved in making that decision; how the MCA was used; perceptions of benefit; and any difficulties encountered. Interviews were audiorecorded, transcribed and analysed using a framework approach. Main outcome measure Experiences and beliefs surrounding use of MCAs. Results Nine themes were identified: shared decision-making; independence; knowledge and awareness of why MCA had been commenced; support in medicines taking; knowledge and awareness of medicines; competent and capable to manage medicines; social aspects of carers supporting MCA use; benefits of MCAs; and drawbacks. Conclusion Experiences and beliefs are diverse and highly individual, with themes identified aligning to key strategies and policies of the Scottish Government, and other developed countries around the world, specifically personalisation shared decision making, independence, reablement and support.

Stability of medicines after repackaging into multicompartment compliance aids: eight criteria for detection of visual alteration

IntroductionMulticompartment compliance aids (MCA) are widely used by patients. They support the management of medication and reduce unintentional nonadherence. MCA are filled with medicines unpacked from their original packaging. Swiss pharmacists currently provide MCA for 1–2 weeks, although little and controversial information exists on the stability of repackaged medicines.ObjectiveWe aimed to validate the usefulness of a simple screening method capable of detecting visual stability problems with repackaged medicines.MethodsWe selected eight criteria for solid formulations from The International Pharmacopoeia: (1) rough surface, (2) chipping, (3) cracking, (4) capping, (5) mottling, (6) discoloration, (7) swelling, and (8) crushing. A selection of 24 critical medicines was repackaged in three different MCA (Pharmis®, SureMed™, and self-produced blister) and stored at room temperature for 4 weeks. Pharmis® was additionally stored at accelerated conditions. Appearance was scored weekly.ResultsSix alterations (rough surface, cracking, mottling, discoloration, swelling, and crushing) were observed at accelerated conditions. No alteration was observed at room temperature, except for the chipping of tablets that had been stuck to cold seal glue.ConclusionThe eight criteria can detect alterations of the appearance of oral solid medicines repackaged in MCA. In the absence of specific guidelines, they can serve as a simple screening method in community pharmacies for identifying medicines unsuitable for repackaging.

Investigating the physical stability of repackaged medicines stored into commercially available multicompartment compliance aids (MCAs).

BackgroundCompliance aids are devices which have been developed and are currently used to assist individuals in their medicines management. The use of compliance aids involves the transfer of medicines from the manufacturers' original packaging and repackaged into an multicompartment compliance aid (MCA). MCAs do not guarantee the same level of protection compared to manufacturer's original packaging.ObjectiveThe aim of this study was to investigate the stability profile of atenolol, aspirin and lansoprazole dosage forms repackaged together in two different commercially available MCAs.MethodsIn a laboratory in the United Kingdom, the physical stability of the formulations repackaged into two commercially available brands of MCAs was evaluated. After 8 weeks of storage (under controlled ambient conditions), changes in the disintegration (tablets only) and dissolution properties (all formulations) were examined in accordance with British Pharmacopoeia (BP) specifications.Key findingsFindings from this study confirm that changes in solid‐dosage form quality are observed when repackaged into MCAs compared to manufacturers packaging resulting in differences in in‐vitro dissolution performance. However, even with these changes, overall product performance was acceptable and within BP specifications.ConclusionThere is a need for greater collaboration in this area between manufacturers, hospital and community pharmacists, academics and policymakers to increase the data available on the physical stability and in turn performance of medicines repackaged into MCAs.

The behaviors and experiences of the community pharmacy team on the provision of multi-compartment compliance aids.

Multi-compartment compliance aids (MCAs) are repackaging systems for solid dosage form medicines. Acknowledging the lack of evidence that MCAs improve adherence or clinical outcomes, the Royal Pharmaceutical Society has expressed concern that MCAs have 'become regarded as a panacea for medicines use'. To determine the behaviors and experiences of the community pharmacy team around MCA provision. A cross-sectional survey was conducted in 26 community pharmacies in the north east of Scotland. Survey items were grouped into: current activities in the provision of MCAs; potential influences on these activities; reports of patient experiences; and demographics. Data were analysed using descriptive and inferential statistics, and content analysis of responses to open questions. Principal component analysis (PCA) was performed on the items of potential influences on activities. Data were collected from 136 community team members (median 4, range1-10 per pharmacy; 32.3% pharmacists). All were involved in some aspect of MCA provision and within the same pharmacy, several different staff positions were commonly involved in the same activity. PCA gave seven components; the lowest scores were obtained for the component of 'others expecting me to provide MCAs'. Participants agreed that GPs, patients and their families, and carers expected them to provide MCAs. Positive experiences of MCA provision were in themes of promoting patient adherence, reducing patient stress and enhancing patient monitoring. Further negative experiences were in of lack of shared patient decision making, worsening adherence and generation of medicines waste, and dealing with changing medicines. MCAs were not always considered to be the most appropriate solution. While community pharmacy teams value MCAs, there may be issues around staff assignment to particular roles, expectations from others and reports of negative patient experiences. A systematic approach to MCA provision and monitoring involving the multidisciplinary health and social care team is warranted.

A comparison of medication administration errors from original medication packaging and multi-compartment compliance aids in care homes: A prospective observational study

BackgroundNo published study has been specifically designed to compare medication administration errors between original medication packaging and multi-compartment compliance aids in care homes, using direct observation. ObjectivesCompare the effect of original medication packaging and multi-compartment compliance aids on medication administration accuracy. DesignProspective observational. SettingTen Greater London care homes. ParticipantsNurses and carers administering medications. MethodsBetween October 2014 and June 2015, a pharmacist researcher directly observed solid, orally administered medications in tablet or capsule form at ten purposively sampled care homes (five only used original medication packaging and five used both multi-compartment compliance aids and original medication packaging). The medication administration error rate was calculated as the number of observed doses administered (or omitted) in error according to medication administration records, compared to the opportunities for error (total number of observed doses plus omitted doses). ResultsOver 108.4h, 41 different staff (35 nurses, 6 carers) were observed to administer medications to 823 residents during 90 medication administration rounds. A total of 2452 medication doses were observed (1385 from original medication packaging, 1067 from multi-compartment compliance aids). One hundred and seventy eight medication administration errors were identified from 2493 opportunities for error (7.1% overall medication administration error rate). A greater medication administration error rate was seen for original medication packaging than multi-compartment compliance aids (9.3% and 3.1% respectively, risk ratio (RR)=3.9, 95% confidence interval (CI) 2.4 to 6.1, p<0.001). Similar differences existed when comparing medication administration error rates between original medication packaging (from original medication packaging-only care homes) and multi-compartment compliance aids (RR=2.3, 95%CI 1.1 to 4.9, p=0.03), and between original medication packaging and multi-compartment compliance aids within care homes that used a combination of both medication administration systems (RR=4.3, 95%CI 2.7 to 6.8, p<0.001). A significant difference in error rate was not observed between use of a single or combination medication administration system (p=0.44). ConclusionThe significant difference in, and high overall, medication administration error rate between original medication packaging and multi-compartment compliance aids supports the use of the latter in care homes, as well as local investigation of tablet and capsule impact on medication administration errors and staff training to prevent errors occurring. As a significant difference in error rate was not observed between use of a single or combination medication administration system, common practice of using both multi-compartment compliance aids (for most medications) and original packaging (for medications with stability issues) is supported.

Multicompartment compliance aids in the community: the prevalence of potentially inappropriate medications.

To assess the prevalence of potentially inappropriate medications (PIMs) use in a population of community-based multicompartment compliance aid (MCA) users in north-east Scotland. Data for MCAs dispensed by 48 of the 50 community pharmacies in Aberdeen City between 1st June to 31st October 2014, together with concurrently prescribed medications, patient demographics and Carstairs index of social deprivation were recorded. Drug-specific quality indicators for PIMs from the Swedish National Board of Health and Welfare were applied and bivariate logistic regression analysis used to assess for associations with demographic variables. The median age was 82years (range 12-105years, 59% female). A total of 1977 PIMs were identified affecting 57.8% of patients. A quarter of patients were prescribed ≥10 medications and 43% had a prescription containing at least one clinically significant drug-drug interaction (DDI). Ten drug groups accounted for 76% of all DDIs. A significant increase in the risk for at least one PIM was associated with female sex (for all indicators of PIM use), age <80years (three or more psychotropic medicines [OR 5.88, 2.96-11.70, P<0.001]) and lower socioeconomic status (prescription of ≥10 medications [OR: 1.43, 95% CI: 1.16-1.78], prescription of a long-acting benzodiazepine [OR: 1.84, CI: 1.14-2.98]). MCA use is associated with a significant incidence of PIMs particularly affecting those younger than 80years and those living in deprived areas. Our findings indicate the need for a more aggressive multidisciplinary approach to the review of the medications prescribed to MCA users.

A Case Study Investigation into the Use of Multi-compartment Compliance Aids in Older People Resident in Very Sheltered Housing.

Multi-compartment compliance aids (MCAs) are repackaging systems for solid dosage form medicines, heralded by some as a solution to non-adherence but with little evidence of benefit. The aim was to use a theoretical approach to describe the behavioural determinants impacting the use of MCAs in older people from the perspectives of the individual and health and social care providers. A case study investigation was conducted. The study took place in three very sheltered housing sites in North East Scotland. Twenty residents (≥65 years) using an MCA for at least 6 months and 34 members of their care team [17 formal carers, eight general practitioners (GPs), eight pharmacists, one family member]. Semi-structured, face-to-face interviews with items based on the Theoretical Domains Framework were conducted. Interviews were audio-recorded, transcribed and analysed thematically. Several behavioural determinants impacted the use of MCAs from the perspectives of the stakeholders involved. Goals of use related to promoting adherence and safety, with less emphasis on independence. Beliefs of consequences related to these goals and were considered of value, with additional consequences of concern around reduced awareness of medicines and complexities of changing medicines. There was a lack of clearly defined roles of professionals for all processes of MCA use, with evidence of blurring and gaps in roles. There were additional issues relating to capabilities of older people in using MCAs and capacity issues for pharmacy-supplied MCAs. Several behavioural determinants impacted the use of MCAs, and while MCAs were valued, there is a need to more clearly define, develop, implement and evaluate a model of care encompassing resident and medicines assessment, supply and ongoing review of MCAs.