The perceived value and effectiveness of Monitored Dosage System (MDS) dispensed for domiciliary use by hospital and community pharmacies.

Focal Points • To explore with pharmacy staff, patients and carers, their view of the value and effectiveness of Monitored Dosage Systems • Pharmacy staff recognised the value of MDS but lacked confidence that simpler strategies to improve adherence had not been tried before introducing MDS. • Service users and carers expressed relief that MDS reduced anxiety and saved them time in order to ensure medicines were administered correctly. • A formal assessment of adherence needs of patients and carers may enable MDS to be deployed more efficiently within the available human resource. Introduction: The CHUMS report 1 raised questions as to whether MDS was the best solution to improve adherence and safety in care homes. Dispensing errors for MDS are greater than for traditional prescriptions but there is some evidence that the administration of medicines is safer using MDS2. MDS is now widely dispensed by both community and hospital pharmacies for people living in their own homes. The aim of this study was, therefore, to find out the extent to which community and hospital staff valued MDS in domiciliary settings and also to ascertain the views of patients and carers who use MDS. Method: The study was conducted in the Midlands at a busy teaching hospital pharmacy and in a rural community pharmacy. A qualitative approach was adopted based on a phenomenological epistemological stance designed to understand and portray the ‘lived experiences’ of the participants. Eleven semi-structured interviews were audio recorded and transcribed verbatim. Reading and re-reading the transcripts led to a system of coding resulting in two overarching themes – ‘resources for dispensing’ and ‘value of MDS as an aid to improve adherence’. Participants included four pharmacists (two from the community) and three pharmacy technicians (one from the community), b) one hospital discharge nurse, two patients and one carer. The carer and patients were recruited as a convenience sample via the community pharmacy. Topic guides were used to ensure a standard approach and enabled flexibility in clarifying or probing views. The NHS Research Ethics Service confirmed that ethical approval was not required. Results: ‘Resources for dispensing’: MDS dispensing was considered to be labour intensive by both hospital and community pharmacy staff. It had an impact on other work (e.g. dispensing or medicines use reviews) in the pharmacy due to a) the complexity of dispensing and checking process, b) lack of advance notice of exact prescription (e.g. upon discharge from hospital), c) lack of staff resources and bench space. Good use of skill mix of pharmacy technicians and pharmacists enabled MDS to be managed within a busy environment. ‘Value of MDS as an aid to improve adherence’: some pharmacy staff lacked confidence that patients would benefit from MDS especially if they intentionally did not take their medicines. By contrast, carers of patients expressed relief that complex dosing had been ‘sorted’ by the pharmacy. They also considered that a small fee charged by the community pharmacy for dispensing MDS was good value. Discussion Pharmacy staff were not convinced that MDS was always of value and felt that the service increased pressure on other pharmaceutical care commitments. Service users and carers, however, greatly valued MDS because it saved time and reduced the onus upon them to organise the safe administration of medicines. These findings suggest that a formal assessment of adherence needs should be introduced in order to ensure that patients or carers are likely to benefit from MDS. Consideration should also be given as to whether MDS should be funded through the NHS rather than to assume that pharmacies will absorb the cost with or without the assistance of patients. References

1. Alldred DP, Barber N, Buckle P et al. (2009). Care Home Use of Medicines Study (CHUMS). Report to the patient safety research portfolio, Department of Health.
2. Alldred DP, Standage C,Fletcher O et al (2011). The influence of formulation and medicine delivery system on medication administration errors in care homes for older people. BMJ Qual Saf.doi:10.1136 bmjqs.2010.046318