Use Of Compliance Aids Research Articles

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.

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.

Evidence of Stability of Medicines Repackaged in Compliance Aids: A Review.

Compliance Aids have gained widespread use to assist patients in managing their medicines, with a view to addressing the issue of adherence. However, although patient outcomes may have been improved through better use of compliance aids, it has been highlighted that there are limited data on the stability of medicines, when removed from the original container and repackaged in a compliance aid. Exposure of medicines to heat, light, moisture and air (oxygen) may impact on both their chemical and physical stability, resulting in the potential for quality of the medicine and thus the safety for the patient being compromised. It is also uncertain whether the compliance aid can provide the same protection from these environmental conditions as the manufacturer's packaging, even though the time frame for repackaging is only 28 days. This paper presents a comprehensive review and detailed discussion of the available literature on the stability implications of repackaging medicines into compliance aids. The importance of repackaging is thus highlighted by its ability to impact on therapeutic outcomes for patients.

Multi-compartment compliance aids (MCAs): Application to the geriatric community

The high prevalence of co-morbidities in older people gives rise to an increasing number of prescribed medicine increasing the complexity of medicine management. Multi-compartment compliance aids and dispensing systems have the potential to organize the daily life of an older person. Various features of currently available compliance aids (such as multi-compartment design or an automated reminder function) have proved successful in assisting older patients to take their medication. This in turn enables them to manage their own often-complex drug regimens. Further investigations and collaborations between healthcare professionals, patients and carers are required for validated and effective use of compliance aids.

OHP-049 Improving Compliance Aid Dispensing For Patients Discharged from North Bristol NHS Trust (NBT) by Using a 3Rd Party Dispensing Partnership

BackgroundNorth Bristol NHS Trust (NBT) is a large teaching hospital split over two main sites. Despite NBT Pharmacy implementing an assessment tool to minimise inappropriate use of compliance aids, demand...

Compliance Aids and Medicine Stability: New Evidence of Quality Assurance

Although increasing use of compliance aids is resulting in improved clinical outcomes for patients, the stability of some drugs being repackaged into these aids is being questioned. This is due to the fact that despite their widespread use, there is limited availability of relevant stability data. This review presents clinical evidence for repackaging into Dose Administration Aids (DAAs), the Australian Pharmaceutical Advisory Committee and other guidelines on general stability issues related to repackaging and a summary of evidence for stability studies conducted in the practice. For frusemide and prochlorperazine chosen as candidates for study because of their light sensitivity, while discoloration on light exposure rendered them unacceptable for patient use, precautions in repackaging and patient counselling can easily overcome this problem. In the case of sodium valproate however, hygroscopicity results in these tablets being unusable after exposure to accelerated storage conditions. In the absence of specific data on the stability of drug products repackaged into compliance aids, the guidelines, practical recommendations for repackaging and the management of compliance aids put forward in this article provide the pharmacist with the tools to make an informed decision on this process.

Medication non-adherence in the elderly: how big is the problem?

Adherence to medication is one of the most intriguing and complex behaviours demonstrated by patients. Non-adherence to a therapeutic regimen may result in negative outcomes for patients and may be compounded in populations with multiple morbidities which require multiple drug therapy. Such a population is exemplified by the elderly. However, non-adherence may not be more prevalent in older patients and there is no consensus in the literature that age is a predictor of poor adherence. Indeed, older patients may deliberately choose not to adhere to medication (intentional non-adherence) to avoid adverse effects. Furthermore, many of the studies on adherence lack commonality in terms of how adherence is measured, the definition of an 'older' patient and the range of disease states which have been examined. Adherence may also be affected by access to medications which may be restricted by the use of formularies or insurance programmes. However, non-adherence may represent a greater risk in older people resulting in poor disease control which may be compounded with multiple morbidity and polypharmacy. A range of strategies have been implemented to try and improve adherence in this patient population. The use of forgiving drugs (those which have a prescribed dosage interval that is 50% or less the duration of drug action) may facilitate occasional lapses in drug-taking. Drug holidays (deliberate, supervised non-adherence for a fixed period of time) have been used in Parkinson's disease to reduce adverse effects. Once-daily scheduling of drug administration may offer a pragmatic approach to optimising drug therapy in some patients; this may be supplemented through the use of compliance aids. What is increasingly apparent, however, is that the role of the patient (irrespective of age) is critical in decision-making about medication, together with communication between patients and healthcare professionals. This has been articulated through the concept of concordance which has been described as a therapeutic alliance between the patient and healthcare professional. In addition, interventions employed to improve adherence must be multifaceted, and together with practical approaches (reducing unnecessary drugs and simplifying dosage regimens), the patient perspective must be considered. Good adherence should be seen as a means of achieving a satisfactory therapeutic result and not as an end in itself.

Drug therapy in the elderly: what doctors believe and patients actually do.

To examine the medication adherence among old persons living in their own homes, to assess their knowledge of their medication, and to indicate target areas for intervention. A cross-sectional study of data collected from randomly selected samples of 348 persons, aged 75 years recruited from a population-based register in the municipality of Aarhus, Denmark. Information on all drugs was collected from the subjects during a home visit, and their drug storage was examined. Information was collected from the general practitioners (GP). The measures of adherence were scores of agreements between the GPs' lists and the subjects' actual drug consumption. We found disagreement between the drug information collected from the study population and from the GPs: concerning drugs in 22% of the study-population, concerning doses in 71%, and concerning regimens prescribed by the GP in 66%. Twenty-four percent stated that they did not always follow prescriptions. Most of the deviations from prescriptions were toward lower doses and less frequent drug intake. The drugs most often involved in deviations were hypnotics, analgesics, bronchodilators and diuretics. Sixty percent of the participants knew the purpose of medication, and 21% knew the consequences of omission of the drugs. Less than 6% of the subjects knew about the toxic risks, side-effects, or potential drug interactions. The participants' knowledge of the drugs was positively associated with their adherence. We found a correlation between an increased number of prescribed frequency of drug intake per day and deviation from the regimen (r = 0.25, P = 0.01). There was a positive association between nonadherence and the use of three or more drugs (odds ratio (OR) 2.5; 95% confidence interval (CI) 1.5,4.1), prescriptions from more than one doctor (OR 2.5; 95% CI 1.3,4.8), and probability of dementia (OR 9.0; 95% CI 1.1,72.5). Moreover compliance aids facilitated adherence (OR 4.4; 95% CI 1.6,12.3). Persons living alone were more prone to medication errors (OR 2.0; 95% CI 1.1,3.5). A differentiated evaluation of adherence by considering the drug, the dose, and the regimen separately produced quantifiable data concerning the subjects' medication habits. Non-adherence ranged from 20 to 70% depending on the measuring method. The participants' knowledge of the treatment was poor. Our results suggest that better information on medication and the use of compliance aids may prevent nonadherence. Special attention should be paid to persons receiving three or more drugs, living alone, receiving drugs from other doctors, and to persons with predementia symptoms, as they are at higher risk of nonadherence.

An evaluation of pharmacy assessment for geriatric patients.

Evaluation of a pharmacy assessment for geriatric patients on a geriatric assessment and rehabilitation unit is described. The assessment has been developed to identify functional, comprehension and therapeutic problems affecting an elderly patient's ability to self-medicate. The pharmacy assessment identified more obstacles to self-medication than the nursing and medical assessments. The detection of obstacles was particularly apparent in the areas of medication knowledge deficit, complicated medication regimes and the inability to follow directions. The pharmacist made more recommendations than the other health professionals for improving the safety and efficacy of drug therapy and medication compliance (p less than .01). Recommendations included simplification of medication regimes, requesting drug levels or specific lab tests, and the use of compliance aids. Seventy-seven percent of the recommendations made by the pharmacist were acted upon by the physician or nurse. Results of the study demonstrate the pharmacy assessment was the most significant predictor of self-medication success.

Compliance aids--do they work?

The decision to use a compliance aid will depend on the motivation of the patient, their specific medication regimen, and their physical and cognitive ability. The administration of oral medicines may be facilitated through the appropriate use of 'organisers' which act as aides memoire. 'Medidos' and 'Dosett' are the most frequently studied compliance aids and both have been shown to be beneficial to the elderly and to community-based psychiatric patients. Adherence to a medication regimen may be improved without the use of proprietary compliance aids by ensuring that the most appropriate traditional container is used and by paying attention to the highest standard of labelling on the medicine container. Gadgets that are designed to improve physical dexterity can be useful when applying topical preparations, administering insulin injections, operating pressurised inhalers or administering eyedrops. The accurate administration of eyedrops is particularly important when treating glaucoma and may be facilitated by using devices that are designed to help with aiming of the eyedrops ('Easidrop', 'Mumford Auto-drop,' 'Opticare'). If squeezing the eyedrop container is a problem the 'Opticare' device may be particularly suitable. There may be value in the use of the compliance aids to provide assistance to carers who become involved with preparing medication for patients. Selection of an appropriate compliance aid is not likely to be the total solution to inadequate adherence and most patients will require a combination of strategies to facilitate adherence to treatment with medicines.