Multidose drug dispensing for older patients in primary care: for older patients in primary care

Abstract

Pharmacists can support patients with their medication with the use of multidose drug dispensing (MDD) systems. Despite the widespread application, the evidence is limited. Therefore, we have studied the use of MDD systems in primary care. MDD systems are intended for patients with a reduced medication management capacity. Our study shows that patients who are about to start with an MDD system are often frail (63%) or suffer from impaired cognition (42%). Based on our screening instrument, 70% of the patients indeed have a reduced medication management capacity. As a result, overuse of MDD system is prevalent. However, underuse was also prevalent. However, the decision to start with an MDD system should not be based on a screening instrument but is ideally a joint decision between patient and healthcare provider. 76% of the MDD users indicated that they indeed were involved in the decision to start with an MDD system. The main reasons for starting were a reduced medication management capacity (50%), convenience (19%) and forgetfulness (15%). It can be concluded that for the majority of patients MDD systems are indeed indicated. A drawback of MDD systems is the high prevalence of potentially inappropriate medication (PIMs) use. We showed that patients who started with an MDD system differed from matched control patients already months before the start of an MDD system. They already use more drugs and PIMs. To determine the effect of the start of an MDD systems, a randomized controlled trial (RCT) was conducted with 179 patients. The intervention resulted in a significant increase in the intervention group. However, the intervention was not equally effective for all patients. Patients with a reduced medication management capacity, frail patients, patients ≥ 80 years of age or those non-adherent to mainly benefitted from the initiation of an MDD system.