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

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

“…22 Promoting adherence, fostering independence and reducing patient and carer stress were identified as key themes around participants' experiences of successful use of MCAs, as has been reported by others. [4][5][6] However, non-adherence is known to be complex, multifactorial, In conclusion, this research has identified that while community pharmacy teams value MCAs in terms of positive impact on effective and safe medicines use by patients, there are key issues around staff assignment to particular roles and how these relate to other roles and tasks. Notably, within the same pharmacy, several different staff positions were commonly involved in the same activity.…”

“…This issue was also highlighted by MacLure et al who found that GPs in particular were unaware of capacity issues in community pharmacy. 6 Scores for the components of perceived knowledge of MCA related guidance and ease of application of guidance, issues of the appropriate working environment in terms of sufficient capacity, time, space, no undue stress or anxiety, perceived knowledge of MCA patient assessment, decision to commence, and review and encouragement and incentives to provide MCAs were more neutral. For perceived knowledge, there were issues around the application of various guidance documents to practice hence the need for practitioner engagement at all stages of guidance development and implementation.…”

“…Other studies have also noted the potential for confusion and error when medicines are altered part way through the MCA cycle, with clear implications for patient care and safety. 6,11,12 While the scores for the component of issues the appropriate working environment in terms of sufficient capacity, time, space, no undue stress or anxiety were neutral, pharmacists tended to score lower than others, perhaps reflecting their supervisory and management focus. Participants voiced particular concerns over pharmacy capacity to medicines is an acknowledged global issue with non-adherence estimated to be prevalent in 47% to 100% of older people.…”

“…While MCAs were valued by some, particularly the potential to improve medicines adherence, patient safety and independent living, the overwhelming finding was the absence of a clearly defined, effective and efficient approach to MCA provision and review. 6 Several studies have also demonstrated that MCA use could perpetuate potentially inappropriate prescribing, which is perhaps due to the lack of clinical review of prescribed medicines prior to commencing the MCA. Two pharmacoepidemiology studies based on data derived from prescribing databases in Sweden demonstrated that MCA use was associated with increased potentially inappropriate prescribing and potentially clinically significant drug-drug interactions.…”

Do multidose compliance aids do more harm than good?

“…Potential problems include uncertainty about which professionals should have responsibility for the MCA and the capacity of pharmacies to support users, 8 acceptance by the user 9 and the ease of use of some aids. 10 MCAs may deskill the user or carer by removing their autonomy, through loss of knowledge about the properties of the medicines and lack of practice with administering formulations such as liquids.…”