Intended for healthcare professionals

Rapid response to:

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

Rapid Response:

Re: Evidence and tips on the use of medication compliance aids

The Practice Pointer paper “Evidence and tips on the use of medication compliance aids” is a timely and helpful guide to using medication compliance aids (MCAs) and the authors have grasped many of the important concepts of MCAs but we suggest some important recent evidence has been overlooked.

Although there is little evidence per se that MCAs are effective in improving health outcomes [1], organisation devices may help unintentional medication non-adherence. The authors of the position paper seem to suggest MCAs may be useful for any type of unintentional non-adherence and did not mention the potential harm of significant and sudden adherence for people who previously have been non-adherent. A 2016 Health Technology Assessment reviewed the effectiveness of MCAs which informed a feasibility RCT [2]. The RCT concluded that MCA provision to unintentionally non-adherent older people may cause medication-related adverse events.

In addition, electronic MCAs were reviewed in a 2016 paper [3] and there was some evidence that these more sophisticated devices could be helpful in overcoming some of the issues identified with MCAs. The elderly with cognitive problems and patients with conditions where timing and adherence to medication regimes are critical were the groups most likely to benefit from these reminder devices.

The position paper indicates that to comply with the Equality Act there is 'little standardised assessment available. Therefore often with minimal background information about the patient, the pharmacist must provide such an adjustment......' The Identification of Medication Adherence Barriers Questionnaire IMAB-Q [4] is a standardised assessment that has been developed and validated to support patients and practitioners to identify barriers to adherence including practical difficulties (such as getting to the pharmacy or being unable to swallow medication) and/or perceptual barriers (such as lack of motivation or negative emotions). This questionnaire is freely available for pharmacists to use as required.

In summary, medication adherence is complex. Whilst there may be a benefit for some patients in using medicine compliance aids, they may not always be of benefit and indeed their use may sometimes have serious consequences. It is recommended that prior to recommending a medication compliance aid, the patient’s medication taking behaviour must be fully understood, ideally using standardised validated tools.

[1] Watson, S.J., et al., Systematic review of the health and societal effects of medication organisation devices. BMC Health Services Research, 2016. 16(1): p. 202.
[2] Bhattacharya D, Aldus CF, Barton G, Bond CM, Boonyaprapa S, Charles IS, et al. The feasibility of determining the effectiveness and cost-effectiveness of medication organisation devices compared with usual care for older people in a community setting: systematic review, stakeholder focus groups and feasibility randomised controlled trial. Health Technol Assess 2016;20(50)
[3] Paterson,M., Kinnear,M., Bond,C, McKinstry,B., A systematic review of electronic multi-compartment medication devices with reminder systems for improving adherence to self-administered medications, IJPP 2016
[4] https://www.uea.ac.uk/pharmacy/research/imab-q

Competing interests: No competing interests

08 August 2018
Mary Paterson
Research Fellow
Debi Bhattacharya, Clare Aldus, Christine Bond, Brian McKinstry
University of Edinburgh
Usher Institute, The University of Edinburgh, Edinburgh, EH16 4UX