Use of dosette boxes doubles despite evidence of harm

A team of University of East Anglia academics has estimated UK pharmacies are giving out double the number of medication compliance aids (MCAs) they were 10 years ago, despite evidence that they may be harmful for some patients.

The UEA researchers estimate community pharmacies are filling 273,529 MCAs each month, with an estimated median of 20 per pharmacy, based on a telephone survey of 40 community pharmacies.

However, the same group of researchers found in a previous study that in some cases having patients switch to using a dosette box can actually hinder compliance. The team has developed a guidance tool to help pharmacists and prescribers assess which patients they will be appropriate for.

Lead researcher Dr Debi Bhattacharya from UEA’s school of pharmacy explained: “Our research showed that patients were more likely to become unwell when they switched from taking their medication straight from the packet to using a pill organiser.

“In some cases, older people can even end up being hospitalised. This is likely because when the patients had been taking their medication sporadically, they weren’t getting the expected health improvements.

“Their doctor may therefore have increased the dose of the medication to try to get the desired effect.”

Alternatively, the researchers suggested, a patient may wish to skip one medicine on a given day but may be not be able to distinguish it from the others in the MCA, and may skip all their medicines as a result.

RPS endorses new guidance

The UEA researchers found that few pharmacies used a tool to assess whether a dosette box will be appropriate, and that 74 per cent said the decision to use one was not affected by the risk of adverse events. The authors say that while dosette boxes will be appropriate for many patients, pharmacists and prescribers should consider other options first.

Their Medication Adherence Support Decision Aid (MASDA) guidance tool suggests first exploring alternatives such as using easy-to-open medicine bottles or coloured labelling.

Dr Bhattacharya said: “Our new algorithm encourages prescribers to consider the emotional and practical barriers that might stop patients taking their medication correctly.”

Factors such as anxiety, a lack of motivation or experiencing unwanted side effects could be a sign that an MCA will not be appropriate, she suggested.

Dr Bhattacharya stressed that those already using a pill organiser without ill effects “should not stop using it as they do seem to help some patients take their medication as prescribed… it’s the switching stage which appears to be the danger”.

Royal Pharmaceutical Society professional support pharmacist Sabes Thurairasa said: “People can experience a range of barriers to their medicines adherence and often multi-compartment compliance aids are viewed as a solution. However, the limited evidence base suggests a lack of patient benefit outcomes, and sometimes they can cause harm.”

Mr Thurairasa said the RPS welcomed the MASA guidance as a tool that “can help pharmacists have effective consultations with patients to find out what the barriers are to them managing their medicines and find potential solutions for this”.

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