A Case Study Investigation into the Use of Multi-compartment Compliance Aids in Older People Resident in Very Sheltered Housing

Background: Multi-compartment compliance aids (MCAs) are repackaging systems for solid dosage form medicines, heralded by some as a solution to non-adherence but with little evidence of benefit. Objective: The aim was to use a theoretical approach to describe the behavioural determinants impacting the use of MCAs in older people from the perspectives of the individual and health and social care providers. Design: A case study investigation was conducted. Setting: The study took place in three very sheltered housing sites in North East Scotland. Subjects: Twenty residents (≥65 years) using an MCA for at least 6 months and 34 members of their care team [17 formal carers, eight general practitioners (GPs), eight pharmacists, one family member]. Methods: Semi-structured, face-to-face interviews with items based on the Theoretical Domains Framework were conducted. Interviews were audio-recorded, transcribed and analysed thematically. Results: Several behavioural determinants impacted the use of MCAs from the perspectives of the stakeholders involved. Goals of use related to promoting adherence and safety, with less emphasis on independence. Beliefs of consequences related to these goals and were considered of value, with additional consequences of concern around reduced awareness of medicines and complexities of changing medicines. There was a lack of clearly defined roles of professionals for all processes of MCA use, with evidence of blurring and gaps in roles. There were additional issues relating to capabilities of older people in using MCAs and capacity issues for pharmacy-supplied MCAs. Conclusions: Several behavioural determinants impacted the use of MCAs, and while MCAs were valued, there is a need to more clearly define, develop, implement and evaluate a model of care encompassing resident and medicines assessment, supply and ongoing review of MCAs.