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Letters to the Editor
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Monitored dosage systems (MDS)
We should think of MDS as an evolving service
From Mrs T. Orr, MRPharmS
It was interesting to read Tony
Schofield’s letter (PJ, 21 April,
p458) regarding my
article about monitored dosage systems (PJ, 7 April,
p398). His historical observations regarding the origins of this service
and how it was funded are totally correct because, initially, we were
paid one or more dispensing fees for the MDS prescriptions. However,
I believe we should think of MDS as an evolving service because it is
now 2007 and domiciliary MDS is not going to disappear.
We have to start thinking outside the box because pharmacy is changing.
No longer are people in the community taking simple drug regimens. Many
patients are on complex, potent drug regimens that pharmacists understand.
We can manage the supply of these and take responsibility for them. The
number of MDS boxes being supplied shows that pharmacy is not distancing
itself from this responsibility.
The service we are providing currently is OK, but it could be excellent.
I accept the point about governance, clinical or otherwise, but these
issues are there already and are being governed on an individual basis
either by the companies or the independent pharmacists involved.
Pharmacists are in an ideal situation for social services and carers
because we have the expertise and can give support. Saying that carers
only need to be able to read or be trained is simplistic. As one of my
colleagues commented, social services thinks about MDS in the same way
it thinks about microwave meals: if they are the only way that a person
can get a hot meal then they serve a purpose and, likewise, if MDS can
support people at home it is a valid service. And it is not only social
services that asks for MDS services. GPs, nurses and hospital pharmacists
ask me for them on a weekly basis, for various reasons.
Should we not be embracing responsibility for medicines? Are we not the
medicines experts? And why should we not be paid for what we know and
what we do?
I ask our pharmacy leaders to have a useful conversation with social
services, to understand their needs in all of this, because MDS is not
going to go away. Do not let this be a case of “if you do what
you've always done, you'll get what you've always got”.
Toni Orr
Kilmarnock,
Ayrshire
MDS have aided patients' compliance significantly
From Mr M. R. Eakins, MRPharmS
Although I tend to agree with parts of the letter “A
waste of time and money” (PJ, 21 April, p458), services offered to the elderly
vary widely from area to area and, in our area, care agencies will not
normally allow staff to go anywhere near a patient’s medicines.
Over the years I have found that monitored dosage systems (MDS) have significantly
aided patients’ compliance and also saved the NHS a lot of money.
More importantly, compliance is paramount in anticoagulation. Out of my
600 or more patients, approximately 80 receive their medicines in MDS.
This has, in many cases, allowed us to increase significantly the time
between INR tests, benefiting the patient and saving the NHS money.
The latest National Patient Safety Agency anticoagulant therapy information
sheet states that use of MDS for anticoagulants should be minimised. How
can you calculate the correct anticoagulant dose for a non-compliant, elderly,
confused patient on several “interactive” medicines without
using the aids to compliance that we have at our disposal?
M. R. Eakins
Hythe, Kent |
The
Pharmaceutical Journal