Time for the Dosette Box to move into the 21st Century
How to help Patients take their medicines correctly?
Getting people to take their medicines on time is a complex issue that has pre-occupied the NHS and the Royal Pharmaceutical for some time. The World Health Organisation (WHO) and NHS recognise that only 50% of medication is taken as prescribed, resulting in poorer health outcomes and large system costs (over US$500 billion in North America and Europe). Academic studies have highlighted the many reasons why medicines are not taken ranging from health inequalities, technology literacy, complex drug regimes, cognitive ability, cultural factors and belligerence. Blister packs (also known as MCA and dosette boxes), where the pharmacist puts all the medicines that need to be taken at a particular time in convenient form, have been around for two decades. The data suggests that in a good number of cases, this might be the most effective way for people to take their medicines.
How a patient qualifies for an MCA is unclear and depends on many the recommendation of many people involved in their care (the GP, the Pharmacist, social workers, and even family members). Although the NHS has tried to set out the broad framework, there is no standard. The cost of MCA varies across the UK (NHS Scotland for example reimburses the cost, NHS England does not), and time is an important cost factor in providing this service. Pharmacists are often left to interpret differing viewpoints in order to provide the best care. The situation became particularly acute during Covid, when Pharmacists were over-worked and simply did not have the resources to meet every patient’s needs.
The NHS spends over £9.81 billion on medicines outside of hospitals (about 7% of total NHS spend), and there are 1.11 billion prescriptions dispensed by community pharmacies in 2019/20. Whilst estimates vary, community pharmacy provide MCA for over 1.5 million people every week. Not only is this essential for many people, but is an important aspect for Adult Social Services trying to support people in their care. In England and Wales, adult social care faces the brunt of poor medication management and will request an MCA for service users to support better medication management. The external benefits are felt by the NHS through lower hospital admissions and reduced demand for primary care. This disconnect needs addressing urgently.
MCA are now changing, as latest technology and behavioural psychology have shown they can influence how well people take their medicines. Technology now generates valuable data about when a patient accesses their meds, whether they forget or crucially take the wrong ones. None of this would be possible without some form of MCA. The data smart MCA systems generate perform an increasingly vital role in helping Adult Services to support people in their own homes whilst freeing up care capacity. Often the benefits of a technology are felt in less obvious ways – the creation of care capacity is vital for people to remain safe.
One example is YOURmeds which supports councils across the UK to support their service users with better medication adherence (over 85% adherence achieved). YOURmeds now works with 12 Councils across a number of different conditions, as well as internationally. Manchester City Council are using YOURmeds to support a Parkinson’s cohort that can have up to 9 medication rounds a day. Comments like “YOURmeds has saved my life” is often heard as people take charge of their own medication. Wigan Council are using YOURmeds to increase capacity in the stretched adult social care. Users are given their independence back with support from their domiciliary care providers, managing medication results in increased independence.
Post covid, the opportunity to provide remote health monitoring has now been accepted as the norm, as it allows people to become more independent and lead better lives in their own homes. Person centred care is not possible unless technology is properly embedded. The need to keep people independent for as long as possible, has at its core, whether the medicines they take are effective. If the question was rephrased from whether MCA are useful, to how best to achieve health outcomes, a more co-ordinated between the NHS, Social Services and the private sector, could deliver value for money for tax payers.