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What is the place for monitored dosage systems?
  1. Martin Duerden
  1. Bangor University, Centre for Health Economics and Medicines Evaluation, Ardudwy, Bangor University, Normal Site,, Bangor, Gwynedd, UK
  1. Correspondence to Dr Martin Duerden; m.g.duerden{at}bangor.ac.uk

https://doi.org/10.1136/dtb.2018.9.000004

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    Key learning points

    • Any patient who has problems taking their medicines should have an assessment to identify the best intervention to meet their needs.

    • Patients should be supported to be independent and to manage their medicines in a way that works for them.Prescribers should keep medication regimens as simple as possible.

    • There is a lack of high-quality evidence showing that monitored dosage systems (MDS) improve outcomes for patients.

    • Many patients using MDS will also be on medication that cannot be included in the system (eg, as required drugs, liquid formulations, formulations that are unstable outside their original packaging) so that several administration systems may be needed; this has the potential to cause confusion and error.

    • In care homes, training of staff on medication administration, and more formal ‘medication rounds’ may be a better and safer option than MDS.

    Introduction

    Monitored dosage systems (MDS), also known as multicompartment compliance aids, are medicine storage devices with compartments divided into days of the week and various times of each day. Although mostly used for solid oral medication, there are now systems that enable liquids to be supplied.1 MDS are intended to make it easier for the patient to take their medicines, or for others to administer their medicines, and act as a visual reminder to whether the drugs have been taken. However, there are concerns that MDS can cause harm in some circumstances and may be inappropriately used in care home settings.2 There is also potential for confusion if patients are also using separate treatments that cannot be placed in the MDS, or are on ‘as required’ treatment. Furthermore, MDS should not be used for drugs whose dose may vary (eg, warfarin) and drugs that are unstable outside their original packaging.3 This article examines the evidence behind MDS and considers the advantages and disadvantages …

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    Footnotes

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.