Aim: Multi-compartment medication compliance aids (MCAs) aim to support medication adherence and administration. Many older people have their medications supplied in a pharmacy-filled MCA (pMCA), despite growing evidence of increased risks of medication-related harm and inappropriate prescribing practices. Little is known about patients’ perspectives on the various MCAs and their impact. The aim was to determine patient views on pMCAs. Methods: A questionnaire-survey of adults over 65 years old, who use, have declined or discontinued a pMCA. Participants were recruited from inpatient, outpatient and community settings in central London. 88 participants were recruited. Responses were analysed using thematic analysis. Results: 61 participants used, 5 had discontinued and 22 had declined a pMCA. Those not using a pMCA often self-filled an MCA of their choice. Participants’ views on pMCAs fell into three themes: Polypharmacy and medication supply systems; Autonomy and independence; and Design of products. The majority of those using pMCAs would not revert to original medication packaging. For some, the convenience of the aid in managing polypharmacy overrode the loss of autonomy. Those who had stopped or declined pMCAs highlighted the importance of control and knowledge of their medications. The environmental impact of the devices caused concern across all groups. Conclusion: Whether self-filled or pharmacy-filled, MCAs were deemed useful in supporting adherence. An individualised approach to medication rationalisation would reduce the burden of polypharmacy and potentially the need for any form of MCA. Redesign of pMCAs and systems surrounding their use would be beneficial at an individual and global level.

Aim: Older adults are particularly affected by medication-related harm (MRH) during transitions of care. There are no clinical tools predicting those at highest risk of MRH post-hospital discharge. The PRIME study (prospective study to develop a model to stratify the risk of MRH in hospitalized patients) developed and internally validated a risk-prediction tool (RPT) that provides a percentage score of MRH in adults over 65 in the eight-weeks following hospital discharge. This qualitative study aimed to explore the views of hospital pharmacists around enablers and barriers to clinical implementation of the PRIME-RPT. Methods: Ten hospital pharmacists: (band 6 (n=3); band 7 (n=2); band 8 (n=5)) participated in semi-structured interviews at the Royal Sussex County Hospital (Brighton, UK). The pharmacists were presented with five case-vignettes each with a calculated PRIME-RPT score to help guide discussion. Case-vignettes were designed to be representative of common clinical encounters. Data were thematically analysed using a ‘framework’ approach. Results: Seven themes emerged in relation to the PRIME-RPT: 1. providing a medicine-prioritisation aide; 2. acting as a deprescribing alert; 3. facilitating a holistic review of patient’s medication management; 4. simplifying communication of MRH to patients and the multidisciplinary team; 5. streamlining community follow-up and integration of risk discussion into clinical practice; 6. identifying barriers for the RPTs integration in clinical practice and 7. acknowledging its limitations. Conclusion: Hospital pharmacists found the PRIME-RPT beneficial in identifying older patients at high-risk of MRH following hospital discharge, facilitating prioritising interventions to those at highest risk while still acknowledging its limitations.

Background: 64 million pharmacy filled multicompartment medication compliance aids (MCAs) are dispensed by pharmacies in England each year as a method to improve medication adherence. Despite the widespread use of MCAs and evidence that their use may be associated with harm there is no national consensus regarding MCA provision by acute hospital Trusts in England. Aim: To determine current practice for initiation and supply of MCAs in acute hospital Trusts in England and the potential consequences for patients and hospitals. Methods: A 26 item survey was distributed to all acute hospital Trusts in England. The questionnaire covered policy, initiation, supply and review of MCAs; alternatives offered; and pharmacy staffing and capacity related to MCAs. Results: 72 out of 138 (52%) Trusts responded to the survey. 60/70 (86%) had a policy for the provision of MCAs. 33/55 (60%) that supplied MCAs on discharge supplied a different prescription length for MCA vs. non-MCA prescriptions. 49/55 (89%) Trusts provided only one brand of MCA. 47/55 (85%) MCA-supplying Trusts identified frequent difficulties with MCAs and 13/55 (24%) reported employing staff specifically to complete MCAs. 30/35 (86%) MCA-initiating Trusts had an assessment process for initiation, with care agency request as the most common reason. Conclusion: There is a lack of a national approach to MCA provision and initiation by acute hospital Trusts in England. This leads to significant variation in care and has the potential to put MCA users at an increased risk of medication related harm.