Multicompartment compliance aids: scoping barriers to their use in practice

Multicompartment compliance aids (MCAs) are widely used to assist patient medication adherence. However, there is limited evidence on the challenges associated with use. The aim of this review was to determine the barriers to the use of MCAs and propose how they can be overcome.

A methodical search strategy was conducted across Medline, Emcare, CINAHL, and Scopus (inception to June 2024), with articles screened against inclusion and exclusion criteria. Data analysis was guided by a multilevel, socio-institutional lens of mega-, macro-, meso-, and micro-perspectives.

Eleven studies were included in the review reporting on use in clinical and experimental settings, including in residential aged care, community pharmacy, independent at home use, and laboratory settings. At the mega-level, barriers have emerged including lack of guidelines and government funding, while at the macro-level miscommunication between prescribers and the pharmacy were identified. The lack of patient involvement in the decision to commence use and the perceived loss of autonomy, which increases a lack of adherence has been confirmed at the meso-level. The actual device which is neither designed to adequately protect the medicines from the environment nor fully consider the physical and cognitive impediments associated with advancing age and technological complexity has emerged as a barrier at the micro-level.

This review has identified that there are barriers to the use of MCAs. Current recommendations call for revision of multicompartment compliance aids service guidelines and remuneration to enhance their use through optimising multi-disciplinary communication, alongside device remodelling to improve medication stability and user uptake.