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How do patient and carer-held beliefs about medication administration in domiciliary care affect initiation and use of Multicompartment Compliance Aids?

Student thesis: Doctoral Thesis

Aim
To find out how Multicompartment Compliance Aids (MCAs) are initiated and used in practice.

Introduction
Evidence in the area of MCA use is scarce, and knowledge is largely anecdotal, yet they areused in health and social care as an aid for self or carer-led administration of medication. There is a lack of clarity regarding patient suitability for MCA use, in particular how initial assessment and ongoing monitoring take place for patients using MCAs. The evidence base regarding the use of MCAs in practice will be strengthened by exploring the experiences of patients who use MCAs, carers who use them to administer medicines, community health services staff and the community pharmacists who dispense MCAs.

Methods
A sequential mixed-methods study was performed; a quantitative scoping exercise where community pharmacists were surveyed was conducted and used to inform the topic guide for the next stages of qualitative enquiry. The survey contained a section for narrative response that was also themed and analysed. The qualitative stages began with a collective case study of MCA users with data analysed using framework analysis. Community Health Services (CHS) nurses and CHS pharmacists were then interviewed and data analysed using a thematic analytical model. In addition, medication policies were reviewed and analysed using codes based on predetermined medication themes.

Results
Community pharmacy involvement in MCA supply was mainly dispensing and delivery, which was inadequately resourced; there was little scope for assessing patient suitability under current arrangements. In the case studies, it was found that the value of the MCA was limited, that informed decision making encouraged medication adherence and patients were not involved in the decision to start a MCA. CHS nurses saw cases where care provided by agencies was deficient and unrelated to care agency medication policy and had little confidence in the social care system. CHS health care professionals (HCPs) thought that carers using MCAs may be safest and easiest only in the fragmented health and social care system they worked in.

Conclusion
There is an urgent need for guidance for pharmacists and other HCPs involved in the provision of MCAs to determine the suitability of MCAs for individual patients and their inclusion in the decision making process, appropriate remuneration sources, and monitoring patient success when using them. The message that MCAs are not a panacea needs to be re-iterated to healthcare professionals and the social care sector.
Original languageEnglish
Awarding Institution
Supervisors/Advisors
Award dateMar 2018

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