Quantifying and characterising multi-compartment compliance aid provision

Medication compliance aids (MCAs) to support adherence lack evidence for cost-effectiveness yet a 2001 survey in England estimated 100,000 patients receiving an MCA whilst living in their home.

(s): To obtain a contemporary estimate of MCA provision by community pharmacies in England and describe factors influencing pharmacist decision-making regarding MCA initiation.

A stratified random sample of two community pharmacies per county (n = 40) in England were surveyed by telephone and a more detailed postal survey sent to participants expressing an interest. Data were collected to determine magnitude of MCA provision and, professional and administrative factors influencing initiation were reported as percentage (95% confidence interval) respondents reporting a factor.

An estimated 273,529 MCAs are filled by community pharmacies in England with a median (IQR) of 20(10, 50) MCAs per pharmacy per month provided for patients living in their home. Practitioners' judgement of appropriateness for MCA initiation was reported by 51.3 ± 11% as the primary factor influencing decision-making relative to 16.3 ± 8% and 20 ± 8.8% reporting patient's and carer's opinion respectively. Some form of assessment tool was reported by 13 ± 7.3% respondents. Postal survey respondents (n = 31) indicated that decision-making regarding MCA initiation was often or always affected by suitability of medication for dispensing in an MCA by 58% ± 17% of respondents; 74.2% ± 15.4% and 53.3% ± 17.9% of respondents' decision-making was never or rarely affected by the risk of adverse events and reduced patient autonomy arising from an MCA respectively.

Provision of MCAs by pharmacies in England has more than doubled in the past decade. Beyond considering the practicalities of whether an MCA is suitable for a patient, there is limited evidence of pharmacists considering patient choice or risk of adverse events arising from sudden increased adherence prior to initiation.