Views of patients and professionals about electronic multi-compartment medication devices: a qualitative study

Problem

An estimated 17.5 million UK adults are living with chronic disease, 30% of whom have multiple-morbidity requiring polypharmacy. Medication adherence problems are common and have serious consequences. For people whose non-adherence is unintentional, who get confused about medication, a large number of medication dispensing and multi-compartment medication devices (MMDs) are available. More sophisticated electronic MMDs (eMMDs) are available that can prompt medication use, dispense medications at appropriate times, and contact caregivers by text/email if medications are not removed. However, it is not clear for which patients such devices are likely to be effective, or how these devices are perceived by pharmacists, clinicians and care-workers.

Approach

A qualitative design approach was adopted with focus groups of patients, carers and professional stakeholders, supplemented with individual interviews. A purposive sample of 15 community pharmacists distributed study invitation packs to people who were current users of an MMD or eMMD or identified as having adherence problems. Patients unable to provide consent or scored 24 or below on the mini-mental state examination (MMSE) were excluded. The researcher visited potential participants to assess eligibility. A maximum variation sample of 15 participants (and lay carers) was sought based on age, gender and deprivation. We invited a purposive sample of 25 community pharmacies to recruit up to 10 pharmacists. GPs, nurses and social-care managers were recruited by direct letter and personal contact to achieve a sample of 20 GPs/community nurses and 5 social care managers. Participants were first invited to explore eight commercially available devices with a variety of reminder and carer-connected features. Usability was assessed using a ‘think aloud’ technique. A topic guide based on the research questions was refined following initial interviews. Interviews were recorded, transcribed and analysed thematically around a framework of the research questions. Emergent findings were discussed with the wider research team and the coding reviewed and refined.

Findings

Patient and professional participants thought those most likely to benefit from an eMMD were patients with mild memory loss and that eMMDs were unlikely to be suitable for people with severe dementia. People with mental health problems or moderate learning disability were considered likely to benefit. Portable devices were preferred for ambulant patients and it was clear that the device had to be tailored to patients. Most were unsuitable for those with poor vision or manual dexterity. Pharmacists had reservations about filling the devices, about the stability of some medicines in them, and patients and carers sceptical that distant carers would take on a monitoring role.

Consequences

Before the use of eMMDs is rolled out at scale consideration is necessary to overcome barriers and engage all stakeholders in implementation. Patients need to be carefully selected and devices matched to their needs.