Complex medication regimens: supporting adherence

Managing complex medication regimens

Medication regimens can vary in their complexity, and the associated cognitive burden will also differ between individuals. If someone is showing signs of non-adherence with a complex regimen, it is important to first explore the reasons for this.

If it’s identified that simplifying the medication regimen would help, this can be achieved through a medication review, which can identify potential opportunities for deprescribing. Tools, such as pill organisers, can also be used to make the process associated with the medication regimen easier.

Medication review

There is evidence that reducing the number or frequency of medicines where possible can improve adherence. Healthcare professionals may find the SPS resources on polypharmacy useful when undertaking medication review.

Pill organisers

Weekly pill organisers filled by the patient, their relative or friend (not by pharmacy) helps to keep the patient in control and allows for changes to be made if the prescription changes.

A pharmacist should advise patients (or their relatives or friends) on the suitability of their prescribed medicines for a pill organiser. Pharmacists may need to provide support and training on selecting and using these organisers safely.

There are many types available, with varying numbers of compartments and generally enough capacity for one week’s worth of medication. They are widely available to purchase from local stores, pharmacies and online (search for ‘pill organiser’).

Various other compliance aids are available. Reminding to take medicines: supporting adherence (SPS page) provides information on interventions and tools to help improve medication adherence where memory issues have been identified as a factor.

Multi-compartment compliance aids

Multi-compartment compliance aids (MCAs) filled by pharmacists should not be used routinely. The risks of using MCAs are widely documented and their benefit in relation to medication adherence is unknown. Unless there is clear, explicit rationale for the use of MCAs, the default should be to supply medicines in their original packaging.

A small number of patients may be eligible to have an MCA filled by a pharmacy. For example, an older person with mild cognitive impairment who has a complex but stable medication regimen, limited support from family and friends and no carer may benefit from an MCA. Where more than one member of a household uses an MCA, each person’s MCA should be clearly labelled to facilitate differentiation. When changes are made to a medication regimen, it is important that steps are taken to avoid new MCAs being mixed up with MCAs containing the old medication regimen.

Different pharmacies provide various products, and options should be discussed directly with the chosen provider if a patient is assessed as being suitable for an MCA.

Visit our Medicines in Compliance Aids Stability Tool (SPS page) for stability recommendations for tablets and capsules.

The Royal College of Pharmacy have published an MCA Pharmacy Guide to further support people using MCAs.

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