Medication delivery dilemma results

Before making this change the pharmacy contractor had a large number of delivery patients. Some of these patients were those who receive repeat prescriptions and some were patients who received weekly multicompartment compliance aids (MCA). The contractor had grown the compliance aid side of the business in recent years helped undoubtedly by the associated free medication delivery service.

As is the case in most community pharmacies many of these patients are vulnerable for various reasons. For example, many of the patients who receive weekly MCAs are elderly and housebound. The pharmacy team have never met many of these patients because the prescriptions are ordered by the pharmacy and then delivered by the delivery driver.

Do you think offering MCAs improves patient care? If so, how?

“Yes. For those people who genuinely find them useful as an aide memoir then they can support them to manage their medicines independently.”

“No. They are often seen as a solution but if the cause of non-compliance is not clear as in most cases simply putting in MDS won’t help. I’ve seen them come back with tablets all over the place.”

“Only if an assessment has been carried out to determine if this is appropriate for the individual to allow them to safely take their medicines without additional support.”

“In some ways, yes. For elderly patients, it can help them remember if they’ve taken them, for arthritic patients, it may be difficult to pop the individual tablets themselves and some carers are not trained to pop medication and don’t feel confident doing this.”

“Yes. allows them to have better compliance with the medication.”

“MCA helps partly for compliance on complicated regimes of administration and as a record that medicine was administered.”

“No, or rarely.”

“It does in some cases, particularly if the patient is taking a complicated mix of medicines.”

“Only if it is suitable for the patient, in some cases it just isn’t the answer, some elderly people just don’t understand the packs, which can be a huge worry , however when you are left with the dilemma of some patients not being able to be discharged from hospital without one in place, you really have no choice.”

“Occasionally, for example in patients with very complex medication regimes.”

“In some instances yes where patients have a lot of meds and there are compliance issues, memory problems. Where a DDA assessment has been done.”

“No.”

“I do not necessarily think it improves patient care in some cases. I think it often prevents people from taking responsibility for their own medication. It benefits fewer patients than expected. I think the MAR chart system should be more widely used instead.”

“No. You don’t have the same interaction with the patient. Less likely to be aware of any side effects etc they may be having.”

“Sometimes, if there is no other option. Pharmacy is more likely to notice changes and query them.”

“Not always but some patients can’t do without.”

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“For those who really need the MCAs, it can improve their care. There can be associated problems though – taking meds out of blisters where they are the most stable, the inclusion of dispersible medications and the number of meds that need to be left out due to prn status etc.”

“From my experience, it doesn’t always improve patient care. In many cases it actually reduced it. A simple switch to a different company that uses a slightly different type of cassette boxes has landed patients in the hospital. Many returned dosettes have some mornings not taken, and most afternoon and evening doses not taken.”

“Only if it helps the patient to remember to take the medication! Lots of HCP’s think the boxes are magic and will encourage compliance.”

“On limited occasions as they can help to remind patients if they have taken their meds and help them to know which med should be taken when.”

“Yes, I think some people definitely need help with medication and a device to aid compliance.”

“Not always.”

“No.”

“Yes, in a small number of cases it improves compliance.”

“Helps ensure compliance and therefore clinical outcomes for patients. Supports social care services and maintenance of patient at home rather than in residential care.”

“Can be useful to the patient in organising their medication. Not always the right thing to do.”

“Helps keep them at home and out of the hospital. Allows the family to monitor compliance more easily.”

“Slightly- only if patient struggles with many medications and when to take what etc. Seems to give more ease of mind to family members than actually improve patient care.”

Do you think housebound patients who receive their medication through a delivery service receive the same quality of pharmaceutical care as patients who collect their prescriptions in person?

Yes 21%

No 79%

Given the weak evidence of benefit for the use of MCAs, why do you think their use is so widespread?

“The cynic in me would say:

7-day Rxs paid more.
The myth perpetuated about carers not being able to give meds unless in an MCA.
DDA was used by patients as a means of securing use of an MCA.

The other side of this is that my loved ones use MCAs because for tablets that don’t come in calendar packs it helps them to remember if they have taken their dose of each medicine.”

“When there are no easy solutions it is easy to grab at anything. Families can feel it reduces the stress on them.”

“Free service that seems to tick the box for providing support.”

“It’s an easy way to control which medications are being taken by patients and is an easy way to prevent carers having too much responsibility towards medication.”

“Patient and carer convenience.”

“Because our value is still based on items volume, not professional advice and service.”

“Because carers demand them so they can reduce the time taken to visit a patient.”

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“Some pharmacy’s offered this service purely to make money when we were paid for them.”

“To keep script numbers up. Pressure from patients and carers.”

“Hearsay.”

“Demanded by carers who are not suitable to give meds out of containers.”

“Mainly tradition. It is also significantly less expensive than any care package.”

“So carers can give people their medication.”

“Laziness in the main part. People think they look nice and want them. Also, the fear of someone asking, turning them down and then them making an error later on. Fear of discriminating against someone as it could be deemed against the disability act to refuse. Drs ask us to do them if there’s a tiny whiff of forgetfulness. Also, lack of home care for vulnerable people means that it’s more likely they’ll need their meds in such packs.”

“Guaranteed prescription volume.”

“Hospitals use them to discharge patients quickly. Families think they help granny take her meds. Care companies use untrained carers who cannot administer meds without an MCA.”

“Seen as an easy answer when patients actually need social care but there is no funding.”

“Is there weak evidence of benefit? I have patients/carers who have been very distressed, In many cases, a relative has been discharged from hospital and the thought of managing a complicated dosage regimen at an already stressful time adds to the distress. However, I think there was also some patients started MCAs who did not need them when the plus packs first became available I think they were overused.”

“Make life easier for carers.”

“Pressure From MDT. Competition for Rx’s. Patient demand. Means to secure business (new contracts) to make viable.”

“They come free and are popular with patients and carers who don’t understand their drawbacks and limitations.”

“Supports social services and family members.”

“It is viewed by some (eg district nurses, care companies) as the answer to all compliance issues.”

“Patients find them easier to manage their medicines.”

“Social services put pressure on community pharmacists as otherwise, carers can not prompt medicines.”

“Ease of use to patients and carers. In my area care services will only help with medications or administer meds if in an MCA. Used to be a way to keep loyalty if an MCA was to start.”