How are multi-compartment compliance aids used in primary care?

Abstract

RESULTSResponses were received from 123 phar- macies (80%), of whom 95 (77%) supplied 1,328 patients with a multi-compartment compliance aid (MCA). Most commonly used were the Nomad (694; 52%), Dosett (363; 27%) and Medidos (116; 9%). 7 of the 10 pharmacists interviewed required 7 day pre- scriptions and 8 paid for the aid themselves. 5 would make an initial visit to assess patients and 8 supplied their preferred device without reference to the patient. 1 had a written procedure and in 2, an unqualified assistant filled the devices. In 4 pharmacies delivery was by a non-qualified person. Of the 169 eligible patients, 56 patients were interviewed (33%). In total 48 (86%) had no input into ordering their prescription and had their device delivered by the pharmacy. The names of their medicines were not known by 38 (68%) and 10 (18%) said they had difficulty using the device; 22 patients (39%) thought they would be able to remember to take their medicines if still in conven- tional containers. CONCLUSIONLarge numbers of patients living at home have their medicines in an MCA, but initiation and supply appears not to be focused on their needs. MCAs can take away a key link between the patient and their health professional. They can also cause patients to lose some responsibility for their own medicines. Before supply, an assessment should deter- mine individual needs and the appropriate interven- tion — supply of an MCA is only one option. Lack of a payment mechanism makes the need for appropriate targeting urgent; pharmacists are expected to provide the service without support or resources, placing a strain on inter-professional relationships. An evi- dence-based mechanism for use, targeting those who really need an MCA, should be sustainable through implementation of medicines management, as a result of the NHS National Plan.