medication adherance Flashcards
what does medication adherence compliance mean?
= any item which would help the user ‘comply’ with the correct taking of their medication
Facilitate the self-management of medicines
Used to simplify a medicine regimen
what is multi-compartment compliance aids (MCCAs)
commonly used in community pharmacy
these were used prior to when patient packs were introduced when the norm was for tablets and capsules to be dispensed from stock pots into identical brown bottles.
In this context, MCCAs provided a means to assist patients in taking their medicines but their role has not been formally reviewed since the introduction of patient packs.
what are the advantages and disadvantages of MCCA?
A:
Act as visual prompt/reminder to take medication
Reduce the complexity of adhering to a regimen
Promote independence
Can show that self-administration has taken place
Minimise dose, amount and timing errors
D:
Risk from secondary dispensing errors
Do not improve intentional non-adherence
Only suitable for certain solid dosage forms and regimens
Long term stability of medicines in the MCCA unknown
Potential hygiene problems for reusable MCCA
Manual dexterity issues
Others
Barrier properties
Unsealed MCCAs provide no significant barrier to water vapour or atmospheric gases such as oxygen
There is insufficient available evidence demonstrating the effectiveness of the barrier properties of sealed MCCAs
Potential interactions between medicines repackaged within MCCAs
Where multiple medicines are repackaged within a single MCCAs compartment, this can lead to the medicines interacting (may be chemical or physical)
stability of MCCA
There is insufficient data on the stability of all medicines when stored outside of the manufacturer’s original packaging
In general when applying for a MA, data must be provided on stability of medicines in its packaging – removal of a medicine from its original packaging and re-packaging into an MCCA will be an unlicensed use of the product
Pharmaceutical companies, in general, do not recommend use of their products in MCCAs. Therefore when re-packaging medicines, it is done at the pharmacists own risk. Should let the prescriber know about the use of MCCAs (partial liability will be with them), especially if cases of adverse effects or treatment failure reported
concurrent use of MCCA?
Risks of concurrent use of MCCAs and other systems of medicines administration
If other systems of medicines administration are required in addition to MCCAs, this introduces complexity and potential confusion, which may raise questions around the necessity of the MCCA
E.g MCCAs generally used for oral solid dosage forms and are usually restricted to medicines taken at regular times during the day
what products are unsuitable for MCCA ?
Products generally considered unsuitable for inclusion in MCCAs:
Effervescent or dispersible tablets
Buccal and sublingual dosage forms
Cytotoxic drugs and drugs that require safe handling
Products that require refrigeration
Dosage forms that will not fit into a compartment (suppositories, liquids, creams, ointments, eye/ear drops, inhalers, injections)
Medicines to be taken ‘prn’
Medicines such as warfarin, where the dose is likely to vary
Medicines that need to be taken in a specific way (E.g before or after food
Risks where an MCCA system cannot accommodate dosing instructions or cannot include all necessary information
Patients and carers should be able to identify individual medicines, which when made by appearance alone, is difficult when in an MCCA
Must supply a patient information leaflet (PIL) with every dispensed medicine included - if instalments then a PIL at each instalment (most MCCAs will be 7-day supplies)
Where there is adequate space for a dispensing label to be affixed a dispensing label must be generated for each item dispensed into the MCCA and this label attached directly to the container. Need a new label every time that medication is dispensed
Where there is inadequate space for the label: it is ONLY when patient care would otherwise be undermined that a pharmacist should contemplate filling an MCCA with limited space for a label.
Example procedures:
Dispense medication into normal dispensing containers and label fully as a dispensed medicinal product
At patients request, decant the dispensed medicine into the MCCA. Label the MCCA with “see original dispensing containers, dispensed on (date of dispensing) from (Pharmacy name)” for dosage instructions
OR a separate card containing the labels, which accompanies the MCCA
Keep records
patient assessments:
Involve the patient or carer in the decision-making process
Assess patient characteristics including a clinical review E.g medical history, physical and cognitive ability, dexterity, memory, visual impairment…
Check for non-adherence
Assess all alternative intervention options which can assist the patient to take their medicines
Ensure the carer (if one present) is adequately trained
Have an agreed plan, especially if using an MCCA and the patient needs medicines that can’t be incorporated in an MCCA
Involve follow up and regular review
Consider equality legislation
Record keeping to support decisions made
advice for patients and their carers about MCCA?
The MCCA is unlikely to be child-resistant and should be kept out of the sight and reach of children
They should be stored in a cool, dry place, out of direct sunlight (not bathrooms or kitchens)
Not try to make any changes to the contents. They should let the pharmacy know if the prescriber changes their medicines or doses
If the medicines are spilt or have moved compartments, not to put them back. Take them back to the pharmacy
Return any unused medicines back to the pharmacy for proper disposal
what considerations need to be considered about MCCA in practice?
Packaging considerations Labelling Record keeping Hygiene and contamination Delivery Frequency of supply PILs Understanding accountability Controlled drugs Identifying medicines within an MCCA
Expiry date (no real scientific evidence, but arbitrary dates)
8 week expiry for products in sealed MCCA (but check individual medicines)
Up to 7 days when in unsealed MCCA
what are adherence aids for people who has difficulty remembering to take medicine
Reminder systems which link in with a patient’s routine
Simplifying medication regimens
Telephone or text reminders
Medication reminder charts (MARS)
Alarm devices
Medication organisers which dispense medicines
Pill bottle top with last opened indicator and reminder alarms
Smart Phone medication reminder applications ‘Apps’
Multi compartment compliance aid (MCCA) filled by pharmacy
what are the adherence aid for people Difficulty understanding how to use or take medicines
Medication review
Inhaler guides
Injecting Insulin guidance
what are the adherance aids for people - Complexity of regimen is an issue
Medication review
Weekly pill organisers (not filled by pharmacy)
Multi compartment compliance aid (MCCA) filled by pharmacy
