The Pharmaceutical Journal
Vol 278 No 7457 p735
23 June 2007

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• Supervision
• Counterfeit medicines
• Citric acid
• White Paper (2)
• The Council
• MDSs
• Pfizer (2)

Letters to the Editor

Monitored dosage systems (MDS)

Advantages outweigh the disadvantages

From Mr L. S. Sprey, MRPharmS

Although Lelly Oboh makes some important points about the complex needs of elderly patients with compliance problems, the advantages of a whole-systems approach and the provision of a broad variety of services to meet the patient’s needs (PJ, 26 May, p606), I do take exception to some of the disadvantages of medicines compliance aids (MCAs) quoted in the article.

Although MCAs are definitely not the “answer to all compliance problems”, I believe that they go a long way to solving the problems some patients face with taking their medicines. MCAs provide a valuable service to a vulnerable group of patients who have cognitive loss, visual impairment or loss of manual dexterity which prevents them from self-medicating in any other way. Evidence in both the UK and US clearly confirms this and I am sure that all the GPs, district nurses, carers and relatives who rely on MCAs would agree.

I have also noticed an increase in the number of patients living on their own in the community who require multi-compartment compliance aids and who would never be able to medicate themselves safely without one. Another important point to note is that often these patients receive support from social service care workers who are not allowed to assist patients unless the medicines are packaged in a multi-compartment compliance aid.

The advantages definitely outweigh the disadvantages for the vast majority of patients, as has been borne out by numerous independent studies and satisfaction questionnaires to the patients and carers, and doctors have shown that the MCA system is appreciated by the patients, carers and GPs who use this valuable service.

Our MCA system is valued and has won a prestigious government award for innovation in health care provision and so has been officially assessed by the Department of Health as being a useful tool to aiding compliance. I would make the following points:

• Almost by definition an MCA will aid compliance if patients forget to take their medicines. Patients are more likely to get into a regular routine and remember to take the medicines if they are all together in an easy-to-use pack with days of the week and times of the day on it. The patient or carer can immediately see if the medicine has been taken or if any doses have been missed. The alternative provision of large print labels, large bottles, easy-open tops, etc, does not provide the same level of assistance to the patient.

• Some medicines, such as liquids, soluble tablets and items that need to be stored in a refrigerator, are not suitable for inclusion in the pack but we enter details onto the reminder card part of the pack to help the patient or carer comply with the treatment regimen. In practice, we have found that this hardly ever results in a worsening of patient compliance.

• We have a dedicated team of staff who are used to packing and checking MCAs. Checking procedures are thorough and errors are rare and are no more common than dispensing errors for items not dispensed in MCAs.

• We have an extremely efficient system for short-term dosage adjustments, which is highly appreciated by the doctors who use it. Replacement packs are usually sent out the same day. Weekly supply results in much reduced waste compared with monthly supply if any adjustments have to be made.

Laurence Sprey
Ashton’s Pharmacy
Brighton

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