Improving compliance through dosing aids
Dr Henk-Frans Kwint is A Care Community Pharmacist at Stevenshof Pharmacy affiliated with the SIR Institute for Pharmacy Practice and Policy.
A recent Dutch study on older patients receiving their drugs via a sophisticated dosing aid, called multidose drug dispensing, has shown a higher self-reported medication adherence compared to patients receiving manually-dispensed drugs, despite a lower knowledge and lower cognitive function among patients receiving these dosing aids. The research is published in Age and Ageing.
Dosing aids are frequently supplied to older patients who are considered to have problems managing their medication. A variety of dosing aids are used by older people in European countries. The most common is the dosset box (divided into days of the week, with several compartments for each day). These are suitable for tablets and capsules only.’. Drugs can also be provided in pre-packed reminder blister or bubble packs which are not reusable.
In the last decade, a new sophisticated dosing aid has been developed and trialed in the Scandinavian countries and The Netherlands, called multidose drug dispensing (MDD). All drugs intended for one dosing moment are gathered in disposable bags and labelled with patient data, drug contents, and the date and time for intake. The number of community-dwelling MDD-users in The Netherlands has increased steadily in recent years reaching 360,000 in 2011
Dr Henk-Frans Kwint of SIR Institute for Pharmacy Practice and Policy and colleagues conducted a study in 215 community-dwelling MDD-users over the age of 65 and using 5 medicines or more (polypharmacy). Patients using MDD were interviewed to assess their medication adherence and knowledge of indication of drugs. For comparison, patients with polypharmacy receiving manually-dispensed drugs were matched on age and gender and underwent the same interview. In both groups, cognitive function was assessed using the Mini-Mental State Examination (MMSE) for a sub-selection of patients.
Among the MDD-users 81% reported full adherence to all drugs compared to 58% for patients using only manually-dispensed drugs. However, only 40% of MDD-users had adequate knowledge of the indication of their drugs compared to 79% of patients using manually-dispensed drugs. The differences in adherence were independent of knowledge and MMSE-scores. This appears to be the first study of its kind that showed that self-reported medication adherence is higher for older patients using a sophisticated dosing aid like MDD compared to patients using manually-dispensed drugs. It was furthermore remarkable that most MDD-users seemed not to bother about the indications for their drugs.
The low medication knowledge among MDD-users may have important implications for clinical practice. This low knowledge may raise problems in case of medication changes. Furthermore, the patient’s indifference to their drugs may lead to insensible use of analgesics/sedatives or antihistamines that may lead to inadvertent addiction.
Future intervention studies are needed to determine whether dosing aids like MDD can increase adherence for older patients who are non-adherent on manually-dispensed drugs.