A Case Study Investigation into the Use of Multi-compartment Compliance Aids in Older People Resident in Very Sheltered Housing

Abstract

Background

Multi-compartment compliance aids (MCAs) are repackaging systems for solid dosage form medicines, heralded by some as a solution to non-adherence but with little evidence of benefit.

Objective

The aim was to use a theoretical approach to describe the behavioural determinants impacting the use of MCAs in older people from the perspectives of the individual and health and social care providers.

Design

A case study investigation was conducted.

Setting

The study took place in three very sheltered housing sites in North East Scotland.

Subjects

Twenty residents (≥65 years) using an MCA for at least 6 months and 34 members of their care team [17 formal carers, eight general practitioners (GPs), eight pharmacists, one family member].

Methods

Semi-structured, face-to-face interviews with items based on the Theoretical Domains Framework were conducted. Interviews were audio-recorded, transcribed and analysed thematically.

Results

Several behavioural determinants impacted the use of MCAs from the perspectives of the stakeholders involved. Goals of use related to promoting adherence and safety, with less emphasis on independence. Beliefs of consequences related to these goals and were considered of value, with additional consequences of concern around reduced awareness of medicines and complexities of changing medicines. There was a lack of clearly defined roles of professionals for all processes of MCA use, with evidence of blurring and gaps in roles. There were additional issues relating to capabilities of older people in using MCAs and capacity issues for pharmacy-supplied MCAs.

Conclusions

Several behavioural determinants impacted the use of MCAs, and while MCAs were valued, there is a need to more clearly define, develop, implement and evaluate a model of care encompassing resident and medicines assessment, supply and ongoing review of MCAs.

This is a preview of subscription content, access via your institution.

References

  1. 1.

    COSLA, Scottish Government and NHS Scotland. Reshaping care for older people: a programme for change 2011–2021. Edinburgh: Scottish Government, 2011. Available at http://www.gov.scot/Topics/Health/Support-Social-Care/Support/Older-People/ReshapingCare. Cited Nov 2015.

  2. 2.

    Dewar B, O’May F, Walker E. Public attitudes to the provision of free personal care: older people’s focus group research. 2001, Scottish Executive Central Research Unit: The Stationery Office, Edinburgh. Available at http://www.gov.scot/Publications/2002/01/10579/File-1. Cited Nov 2015.

  3. 3.

    Gardner A. Personalisation in Social Work (Transforming Social Work Practice Series) 2014. Learning Matters: Exeter. ISBN 9781844457342.

  4. 4.

    Lymbery M. Social work and personalisation. Br J Soc Work. 2012;42(4):783–92.

    Article  Google Scholar 

  5. 5.

    Walden D. A better way back to everyday life. HSJ. 2011;121:26–7.

    PubMed  Google Scholar 

  6. 6.

    Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet. 2012;380:37–43.

    Article  PubMed  Google Scholar 

  7. 7.

    Ornstein SM, Nietert PJ, Jenkins RG, Litvin CB. The prevalence of chronic diseases and multimorbidity in primary care practice: a PPRNet report. J Am Board Fam Med. 2013;26(5):518–24.

    Article  PubMed  Google Scholar 

  8. 8.

    Payne R, Avery A, Duerden M, Saunders C, Simpson C, Abel G. Prevalence of polypharmacy in a Scottish primary care population. Eur J Clin Pharm. 2014;70(5):575–81.

    CAS  Article  Google Scholar 

  9. 9.

    Patterson SM, Cadogan CA, Kerse N, et al. Interventions to improve the appropriate use of polypharmacy for older people. Cochrane Database Syst. Rev. 2014. doi:10.1002/14651858.CD008165.pub3.

  10. 10.

    Kongkaew C, Noyce PR, Ashcroft DM. Hospital admissions associated with adverse drug reactions: a systematic review of prospective observational studies. Ann Pharmacother. 2008;42(7):1017–25.

    Article  PubMed  Google Scholar 

  11. 11.

    Brahma DK, Wahlang JB, Marak MD, Chsangma M. Adverse drug reactions in the elderly. J Pharmacol Pharmacother. 2014;4(2):91–4.

    Article  Google Scholar 

  12. 12.

    Vrijens B, De Geest S, Hughes DA, et al. A new taxonomy for describing and defining adherence to medications. Br J Clin Pharm. 2012;73(5):691–705.

    Article  Google Scholar 

  13. 13.

    Zedler BK, Kakad P, Colilla S, Murrelle L, Shah NR. Does packaging with a calendar feature improve adherence to self-administered medication for long-term use? A systematic review. Clin Ther. 2011;33(1):62–73.

    Article  PubMed  Google Scholar 

  14. 14.

    Vik SA, Maxwell CJ, Hogan DB. Measurement, correlates, and health outcomes of medication adherence among seniors. Ann Pharmacother. 2004;38(2):303–12.

    Article  PubMed  Google Scholar 

  15. 15.

    Kardas P, Lewek P, Matyjaszczyk M. Determinants of patient adherence: a review of systematic reviews. Front Pharmacol. 2013;4. doi:10.3389/fphar.2013.00091

  16. 16.

    The Royal Pharmaceutical Society. Improving patient outcomes: the better use of multi-compartment compliance aids. Available at: http://www.rpharms.com/support-pdfs/rps-mca-july-2013.pdf. Cited Nov 2015.

  17. 17.

    Lee JK, Grace KA, Taylor AJ. Effect of a pharmacy care program on medication adherence and persistence, blood pressure, and low-density lipoprotein cholesterol: a randomized controlled trial. JAMA. 2006;296(21):2563–71.

    CAS  Article  PubMed  Google Scholar 

  18. 18.

    Schneider PJ, Murphy JE, Pedersen CA. Impact of medication packaging on adherence and treatment outcomes in older ambulatory patients. J Am Pharm Assoc. 2008;48(1):58–63.

    Article  Google Scholar 

  19. 19.

    Mosca C, Castel-Branco MM, Ribeiro-Rama AC, Caramona MM, Fernandez-Llimos F, Figueiredo IV. Assessing the impact of multi-compartment compliance aids on clinical outcomes in the elderly: a pilot study. Int J Clin Pharm. 2014;36(1):98–104.

    CAS  Article  PubMed  Google Scholar 

  20. 20.

    Nunney J, Raynor DK, Knapp P, Closs SJ. How do the attitudes and beliefs of older people and healthcare professionals impact on the use of multi-compartment compliance aids? A qualitative study using grounded theory. Drug Aging. 2011;28(5):403–14.

    Article  Google Scholar 

  21. 21.

    Thomas G. How to do your case study: a guide for students and researchers. London: Sage; 2012.

    Google Scholar 

  22. 22.

    Yin RK. Case study research: design and methods. 4th ed. Thousand Oaks: Sage; 2009.

    Google Scholar 

  23. 23.

    Aberdeen City Council: Sheltered and Extra Care Housing. Available at: www.aberdeencity.gov.uk/housing/find_a_home/sheltered_housing/suh_Shel_Hous_Vac.asp. Cited Nov 2015.

  24. 24.

    Michie S, Johnston M, Abraham C, Lawton R, Parker D, Walker A. “Psychological Theory” Group: making psychological theory useful for implementing evidence based practice: a consensus approach. Qual Saf Health Care. 2005;14(1):26–33.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  25. 25.

    Cane J, O’Connor D, Michie S. Validation of the theoretical domains framework for use in behaviour change and implementation research. Implement Sci. 2012;37:1–17.

    Google Scholar 

  26. 26.

    Ritchie J, Lewis J, McNaughton Nicholls C, Ormston R. Qualitative research practice: a guide for social science students and researchers, 2nd ed. London: Sage; 2014.

  27. 27.

    Shenton AK. Strategies for ensuring trustworthiness in qualitative research projects. Educ Innov. 2004;22:63–75.

    Google Scholar 

  28. 28.

    Dyson J, Lawton R, Jackson C, Cheater F. Does the use of a theoretical approach tell us more about hand hygiene behaviour? The barriers and levers to hand hygiene. J Infect Prev. 2011;12(1):17–24.

    Article  Google Scholar 

  29. 29.

    Cane J, Richardson M, Johnston M, Ladha R, Michie M. From lists of behaviour change techniques (BCTs) to structured hierarchies: Comparison of two methods of developing a hierarchy of BCTs. Br J Health Psychol. 2015;20:130–50.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The research team gratefully acknowledges all research participants, Jeanette Lowe for transcribing all the interviews and Christine Filion-Murphy and Christie Craig for assistance with analysis. The study was conceived by DS, JM and KM; KM prepared the first drafts of all study materials, which were reviewed and final versions approved by DS, JM, KFM, VP, SC, AS and RL. JM recruited the residents, and all interviews were conducted by KM. The analysis was undertaken by KM, DS and KFM. DS, KM and JM wrote the first draft of the paper, which was reviewed and the final version approved by KFM, VP, SC, AS and RL.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Derek Stewart.

Ethics declarations

This work was supported by research funding from Aberdeen City Community Health Partnership. The funder played no role in the design, execution, analysis and interpretation of data, or writing of the study. This study had formal approval from the NHS North of Scotland Research Ethical Review Service (14/NW/1168) and NHS Grampian Research & Development Committee (2014RG002).

Conflict of interest

DS, KM, JM, KFM, VP, SC, AS and RL confirm that they have no conflicts of interest to declare.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

MacLure, K., MacLeod, J., Forbes-McKay, K. et al. A Case Study Investigation into the Use of Multi-compartment Compliance Aids in Older People Resident in Very Sheltered Housing. Patient 9, 583–590 (2016). https://doi.org/10.1007/s40271-016-0178-8

Download citation

Keywords

  • General Practitioner
  • National Health Service
  • Care Team
  • Formal Carer
  • Theoretical Domain Framework