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Letters to the Editor
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Monitored dosage systems (MDS)
Monitored dosage systems can cause more problems than they solve
From Dr B. P. Curwain, MRPharmS
I was pleased to see Lelly Oboh’s thoughtful Broad
spectrum piece
(PJ, 26 May, p606) making it clear that monitored dosage systems (MDSs)
are not the panacea for medicines-taking problems that some people seem
to think they are. There are substantial problems of drug instability
after removal from packaging and of prn medication, as well as specific
issues around, for example, bisphosphonates. As a patient’s mental
faculties decline, there is, in reality, a narrow period when an MDS
may be helpful.
There are other ways to improve things. For many patients and their carers
the provision of medication charts, such as are used in hospitals, may
be most helpful. In West Hampshire, we have worked hard with social services
and with care home owners to provide pharmaceutical support and training.
We deliver significant training to care home staff and social services
staff, and earn money for the primary care trust in so doing.
Crucially,
a senior PCT medicines management pharmacist has, for a considerable
time, been engaged with Hampshire social services colleagues and the
result is that they now have a rewritten medicines policy. This permits
care assistants to remind residents to take their medicines without requiring
an MDS. The policy has been approved by social services’ lawyers
and is now in place. We have also been commissioned to write materials
and deliver training on medicine-taking to those who train the care assistants,
and to provide ongoing support as needed to these trainers.
We are certainly not against the appropriate use of MDSs, but we are
against the indiscriminate use of a tool which sometimes causes more
problems than it solves. Brian Curwain
Hampshire Primary Care Trust
MDS not the only solution in care of the elderly
From Mr P. A. Williams, MRPharmS
Further to the article
by Lelly Oboh (PJ, 26 May, p606) there are a
great many issues that have been associated with the provision and use
of monitored dosage systems (MDSs).
I would agree that there is still great contention in terms of the funding
available for MDSs. As many pharmacists and other health professionals
could attest, the use of MDSs with patients has provided beneficial outcomes.
Historically this is anecdotal, and the provision of an MDS is one of
the many solutions that pharmacists can provide to enhance the likelihood
of patients being more compliant with their treatment regimen, among
other issues. Poor adherence is a growing problem given the increasing
cost and the increased adverse health outcomes, including accident and
emergency department visits and potential admission to hospital, if medicines
are not taken.
Until fairly recently this has not been documented. I would like to point
Ms Oboh, and other pharmacists involved in the provision of MDSs, to
an article that was originally published online by JAMA on 13 November
2006, a report of which appeared in The Pharmaceutical Journal (18
November 2006, p597). This study is the first clinical trial specifically to address
medication non-adherence in the elderly population and is one of few
randomised controlled studies to demonstrate improvement in both adherence
and health outcomes with the use of reminder packing (MDSs) in a comprehensive
pharmacy care programme.
This study used MTS’s concordance support packaging as part of
the study. The results were that the use of such a compliance device
increased greatly the adherence of the patient. These patients were all
selected as having more than four items of medication to take each day
(a common enough occurrence in the UK).
These findings concluded that, where typically adherence rates for patients
would normally decrease to 40.5 per cent at the three-month interval,
and then to 32.7 per cent at six months and, thereafter, stabilise,1 with the use of an MDS as part of a pharmacy care package, adherence
levels of up to 96 per cent were achieved and sustained. The study also
states that “these findings are consistent with the known transient
effect of medication education and imply that the continued provision
of blister-packed medications was a key component of the medication adherence
programme.”
I realise that the provision of MDSs is time-consuming and more costly
than traditional dispensing; however we are embracing robotics and automation
within the traditional dispensing role. So why not embrace automation
within this aspect of pharmacy? Hopefully by doing so we can supply MDSs
to patients that will increase their adherence to medication and also
release much needed expertise to provide the “pharmacy care package” that
we all strive to provide.
Peter Williams
Managing Director
MTS Medication Technologies
Reference
1. Chapman RH, Benner JS, Petrilla AA, Tierce JC, Collins SR, Battleman
DS et al. Predictors of adherence with antihypertensive and lipid lowering
therapy. Archives of Internal Medicine 2005;165:1147–52. |
The
Pharmaceutical Journal