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Medicines management: Are pill organisers a risk to patient safety?

Problems can arise when patients switch to medication compliance aids

Problems can arise when patients switch to medication compliance aids

Picture shows older woman taking medication from a dosette box.
Picture: iStock

Some interesting issues regarding the use of medication compliance aids have been raised by a study at the University of East Anglia.

Many patients in the UK use these aids – commonly known as dosette boxes or pill organisers – to help them ensure they take the right medicines at the right time on the right day.

The East Anglia research says pharmacies are giving out twice as many of these medication compliance aids as they were ten years ago, but that switching to the devices can do more harm than good.

According to the researchers, patients who switch from medication in packets to compliance aids are more likely to become unwell and, in some cases, be admitted to hospital.

Reasons why people don’t take their medicines as prescribed

Lead researcher Debi Bhattacharya, from the university’s school of pharmacy, explains: ‘This is likely because when the patient 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.

‘When these patients were switched to a pill organiser and suddenly started taking all of their medication as prescribed, they experienced side effects of the medication.’

We have been aware for many years that adherence to prescribed medications for patients with long-term conditions can be as poor as 50%. The many reasons why people don’t take their medicines as prescribed include not liking the side effects, taste or texture, and not noticing any improvement in their condition.

Dr Bhattacharya says: ‘With usual medication packets, if a patient doesn’t get on with a particular pill it’s easy to deliberately miss it. A drawback to organisers is that the patient can’t tell which pill they want to miss, so sometimes they stop taking all of their pills.

‘This can lead to serious health complications that wouldn’t have occurred if they had simply skipped that one tablet.’

‘Regular, comprehensive medication reviews are crucial, with the reasons behind potential non-adherence discussed with the patient so solutions can be found’

There can also be confusion if patients are switched to a generic medication or a different brand. Both the packaging and the tablets can look different, so if the medicines have a new shape or colour, the person dispensing the medicines needs to make this clear to the patient.

Clinicians’ false perceptions

If a patient is not taking their medication as prescribed but is still filling the prescription, they can end up stockpiling their medicines. Not only does this cost the NHS a fortune, it can lead to the clinician's false perception that the medicines are being taken by the patient.

Those of us who visit patients in their own homes should be able to see if medications are being over-ordered and discuss this with the patient and the prescriber. Issues can often be addressed with help from the prescriber and the patient’s support network.

Patients often don’t want to admit poor adherence with medication to their clinician. They may not want to appear to be a difficult patient or be perceived as not trusting the clinician, which could harm the therapeutic relationship. 

Picture shows pharmacist explaining medication to an older woman.
Picture: iStock

Encourage patients to be honest about medication use

It is vital that patients are encouraged to be as honest as possible when discussing the medications they are or are not taking.

Comprehensive medication reviews are crucial to this. These should be undertaken regularly, with the reasons behind potential non-adherence discussed with the patient so that solutions can be found.

‘Compliance aids can help some patients, and anyone using them without ill effects should continue to do so. It is the switching stage that appears to be the problem’

Non-compliance with medication can be intentional or unintentional, with intentional non-adherence often due to the patient’s perceived barriers. These can include lack of confidence or motivation, or unacceptable side effects, and the researchers say these patients are less likely to benefit from a pill organiser.

Barriers include poor dexterity, impaired vision and mild confusion

Unintentional non-adherence is often a result of practical barriers, including poor dexterity, impaired vision and mild confusion. If a patient is confused, they will need to be assessed to ensure it is safe for them to self-administer their medications, but the researchers say these patients can benefit from a medication compliance aid.

After assessing the patient, including any issues with medication compliance, if you think they will benefit from switching to a pill organiser this should be discussed with the patient and their family, where appropriate.

The risks and benefits of using medication compliance aids should be highlighted and the patient informed that if their health deteriorates it is vital that they contact their prescriber or relevant health provider to let them know that they have recently changed to a pill organiser system.

Caution when switching to medication aids

The study authors say that despite their findings medication compliance aids can help some patients take their medication as prescribed, and any patients already using them without any ill effects should continue to do so. It is the switching stage that appears to be the problem.

To help prescribers better understand which patients’ health could be put at risk by using a medication compliance aid, the research team has produced an online guidance tool, endorsed by the Royal College of Physicians and the Royal Pharmaceutical Society.

If prescribers and patients use this tool to discuss their medications in an open and frank manner, it is likely that fewer compliance aids will be required, more non-adherence issues will be ironed out and there will be less risk to patient safety.

Considering patient experience and evidence-based choice of medicines in medicines optimisation

Medicines management expert Matt GriffithsMatt Griffiths is visiting professor of prescribing and medicines management at Birmingham City University


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