Intended for healthcare professionals

Practice Practice Pointer

Evidence and tips on the use of medication compliance aids

BMJ 2018; 362 doi: https://doi.org/10.1136/bmj.k2801 (Published 19 July 2018) Cite this as: BMJ 2018;362:k2801
  1. Daniel S Furmedge, consultant physician in geriatric and general internal medicine1,
  2. Jennifer M Stevenson, clinical pharmacy research fellow2,
  3. Rebekah Schiff, consultant physician in geriatric and general internal medicine1,
  4. J Graham Davies, professor of clinical pharmacy and therapeutics2
  1. 1Department of Ageing & Health, Guy’s & St Thomas’ NHS Foundation Trust, London, UK
  2. 2Institute of Pharmaceutical Science, King’s College London, London, UK
  1. Correspondence to D Furmedge daniel.furmedge{at}gstt.nhs.uk

What you need to know

  • Medication compliance aids (MCAs) such as Dossett boxes are used to support people taking medication who may find it difficult because of cognitive impairment or the complexity of their regimen.

  • There is little evidence to say whether these devices improve compliance, safety, satisfaction, or convenience taking medication.

  • Many commonly prescribed medicines may not be suitable for long term storage in a multi-compartment MCA because they can break down or expire when outside the standard sealed packaging. Drugs that are taken only when needed or those subject to frequent changes in dosage schedule are also unsuitable for multi-compartment MCAs.

  • Multi-compartment MCAs are often prepared in advance—make sure any changes in the medication regimen are clearly communicated to the pharmacist preparing the MCA.

  • Offer an annual medication review to all patients who are dispensed their medications in a multi-compartment MCA to minimise the chance that people continue inappropriate medication

Older people, and those with frailty and multiple comorbidities can have complex medication regimens, which can be challenging for patients, carers, and healthcare practitioners to manage. Some patients choose not to take all their medications (intentional non-adherence)—this accounts for approximately 50% of non-adherence in patients over the age of 65.123 Others, for example those with cognitive impairment, may forget or find it difficult to manage taking their medication (unintentional non-adherence).

To address unintentional non-adherence, patients can use electronic reminders and devices, support from carers, and medication compliance aids (MCAs) to help them follow their medication regimens.4 Use of multi-compartment MCAs seems to be increasing, although there are no reliable data on UK prevalence.5 Multi-compartment MCAs can be called multi-dose drug dispensing systems, or “Dossett Boxes” after one of the original marketed versions.567 Examples or other brands include NOMAD and Venalink. Importantly, these devices only store …

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