Thinking Outside the Box: Patient & Carer perceptions of MCAs
Research type
Research Study
Full title
Thinking Outside the Box: exploring patient and carer perceptions of Medication Compliance Aids (MCAs)
IRAS ID
289976
Contact name
Rebekah Schiff
Contact email
Sponsor organisation
Guy's and St Thomas' NHS Foundation Trust
Clinicaltrials.gov Identifier
289976, IRAS Project ID
Duration of Study in the UK
1 years, 0 months, 0 days
Research summary
Summary of Research
Medication adherence – the extent to which a patient takes their medications as prescribed – is a global problem. Half of all medicines given to patients with long-term health problems are not taken properly by the patient. Older adults are also more at risk of harm from their medications as they tend to take more medicines than young people, and are less able to cope with their effects.There has been research into how to address these problems. One way has been through providing patients with a medication compliance aid (MCA), to help with taking their medications on time. MCAs are pre-packaged boxes containing tablets, grouped together according to the day and time the medication needs to be taken. Some patients buy the MCA and fill it themselves, other patients collect a MCA that their pharmacy makes for them.
There is not much proof that pharmacy-filled MCAs help patients, and some research suggests they may cause harm. The views of patients on MCA use have not yet been fully explored – it is not clear why some patients choose to stop using an MCA or refuse one when offered. Many patients with MCAs also have a family member or friend who helps them with their medication. No research has recognised the role of informal carers in helping patients with MCAs or asked them their thoughts.
This study aims to understand what patients, aged 65 and older, and their informal carers think about MCAs and how they affect their lives. It is a questionnaire study which will take place within an NHS hospital. It’s designed to take approximately 20 minutes, either face to face or by phone. We hope that the results from this study will help to inform how healthcare professionals use MCAs to the benefit of patients and their carers.
Summary of Results
Why did we do the study?
We wanted to understand patients’ and carers’ thoughts towards medication compliance aids (MCAs). These are boxes containing tablets which are grouped together according to the day and time the tablets are taken. They are often made up for patients by pharmacies, for example a blister pack. There is some research that suggests that pharmacy-filled MCAs (pMCA) may create problems for patients and can even cause harm. Another form of MCA used is a self-filled MCA (sMCA), when the individual buys their own reusable version and fills it with medications themselves. We needed a better understanding of the views of patients and their carers to find the best ways to help people manage their medications.What the study found
In total, we surveyed over 200 people about their experiences of using MCAs. This group included both users of MCAs and carers of people using MCAs. We also included those who discontinued using a pMCA, or declined one when they were offered it.
The main benefit of a pMCA was that it was a good way of organising large numbers of tablets. Some people took over 20 tablets a day, and found that when provided in a pMCA by their pharmacy or doctor it was an easier way for them to manage their medications. They preferred not having the responsibility of organising their tablets themselves.
Another benefit of a pMCA was the time it saved when compared to using individual medication boxes. Carers felt it freed up time to spend with their loved ones, rather than spending that time sorting out all their medications.
A disadvantage of using a pMCA was that people did not know exactly what tablets they were taking. It made them feel less independent and worried that mistakes might have been made by the pharmacy. People struggled with ordering medications and making sure that medications were changed when their prescription was updated. They often had difficulty getting through to their pharmacy or GP, and were concerned that having a pMCA meant that their prescription was reviewed less often by the doctor.
The design of pMCAs meant it could be difficult to use them, especially with conditions such as arthritis or poor eyesight. People described how tablets easily fell out of compartments or got stuck behind the sticky plastic covering. One person described how they were accidentally taking the wrong tablets as they had to turn the pMCA over to pop out the medications, but then couldn’t see the labels. People wanted an alarm to be built into the MCA, as usually family members or carers were needed to remind them to take their tablets.
Interestingly, people were very worried about the impact their MCA had on the environment. They felt it was important that MCAs could be recycled and that waste was reduced.
Conclusion:
Whether pharmacy-filled or self-filled, many people and their carers find these types of systems useful. However doctors and pharmacists need to recognise that there are many ways to help people manage their medicines and that providing a pharmacy-filled MCA is not the only solution. In particular medicines need to be regularly reviewed and systems to obtain the medicines need to be responsive to the needs of patients and carers. For instance, by ensuring all medicines are supplied at the same time for the same time period and when medicines are altered they are easily available.
Funding:
This study was sponsored by Guy’s and St Thomas’ NHS Trust and King’s College London, and funded by the Sir Halley Stewart Trust.REC name
South Central - Hampshire A Research Ethics Committee
REC reference
21/SC/0190
Date of REC Opinion
17 Jun 2021
REC opinion
Further Information Favourable Opinion