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

Abstract

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.

Patients’ experiences with multidose drug dispensing: a cross sectional study

“…The divergent results found in the studies conducted in the United Kingdom and Scotland were not replicated in the present study [5, 12, 13]. In our study, patients were generally involved in the decision to initiate an MDD system and patient satisfaction with MDD systems was found to be high.…”

“…Remarkably, patients stated that the initiation of the dosing aid was rarely discussed with them. These divergent results were supported by a second qualitative study among patients who lived in very sheltered housing in Scotland [5]. Patients’ opinions differed regarding shared decision making, independence, medication knowledge and their confidence in managing their medication.…”

“…Unintentional non-adherent patients are willing but unconsciously fail to adhere to their drug therapy. The capacity to adhere to the medication regimen may be diminished by a wide variety of reasons, e.g., a decline in cognitive function, polypharmacy, a change in appearance of outer packaging, or impaired manual dexterity [3–5]. Especially for unintentional non-adherence, the use of dosing aids such as multi-compartment compliance aids (MCAs) or automated multidose drug dispensing (MDD) systems can be an option [6].…”

Immediate or deferred adjustment of drug regimens in multidose drug dispensing systems

“…No % (n) Besides the high number of manual adjustments, a frequently chosen option was to dispense the newly prescribed or changed medication separately from the MDD system. The provision of medication separate from the used dosing aid could be confusing for patients with a limited medication management capacity 17,18 . Separate dispensing of newly prescribed medication might thus increase the risk of medication errors.…”

“…In the case of the addition of a new medicine or an increase in dosage, the new medication can temporarily be dispensed separately from the MDD system. However, separate dispensing can be confusing for patients who have lost the capacity to manage their medication 17,18 . A last option is the order of a new and adjusted MDD system.…”