New guidance helps pharmacists decide which patients should use pill organizer

Researchers at the University of East Anglia have developed guidance to help prescribers and pharmacists decide which patients should use a pill organizer.

The team's previous research has shown that switching to using an organizer can do more harm than good.

Their latest study, published today, reveals that pharmacies are giving out twice as many pill organizers as they were ten years ago.

It is hoped that the new guidance will help prescribers better understand which patients' health could be put at risk by using an organizer. It will also help patients and their carers know what they can ask for to help with taking medicines as prescribed.

Lead researcher Dr Debi Bhattacharya, from UEA's School of Pharmacy, said: "A lot of people use pill organizers to help them take the right medication at the right time of the day.
"The fact that using a pill organizer could cause harm to patients sounds rather counterintuitive. But our research showed that patients were more likely to become unwell when they switched from taking their medication straight from the packet to using a pill organizer. In some cases, older people can even end up being hospitalized.
"This is likely because when the patients had been taking their medication sporadically, they weren't getting the expected health improvements. Their doctor may therefore have increased the dose of the medication to try to get the desired effect.
"When these patients were switched to a pill organizer and suddenly started taking all of their medication as prescribed, they experienced side effects of the medication.
"With usual medication packets, if a patient doesn't get on with a particular pill it's easy to deliberately miss it. A drawback to organizers is that the patient can't tell which pill they want to miss so sometimes they stop taking all of their pills. This can lead to serious health complications that wouldn't have occurred if they had simply skipped that one tablet."

The new study shows that the provision of organizers by pharmacies has more than doubled in a decade. But pharmacists are not considering the risk of adverse events arising from a patient's sudden increased adherence to their medication.

To combat these problems, the research team developed a set of guidelines for healthcare teams to work with patients to decide who might benefit from pill organizers and who may get better results with other solutions such as easy open medicine bottles or colored labeling.

The 'Medication Adherence Support Decision Aid' (MASDA) guidance has been endorsed by the Royal College of Physicians and the Royal Pharmaceutical Society. And the research team hope that it will be adopted by the NHS.

Dr Bhattacharya said: "Until now there has been no guidance about which patients should be using medication organizers.
"Our new algorithm encourages prescribers to consider the emotional and practical barriers that might stop patients taking their medication correctly.
"Emotional barriers to taking medication as prescribed can include things like whether the patient is anxious or lacking confidence, lacking motivation or experiencing unwanted side effects. In all of these cases, using a pill organizer is likely to be inappropriate.
"Better solutions are likely to be identifying social support to boost the patient's confidence, providing information on medication benefits, agreeing goals or even stopping the medication."
"Practical barriers include things like whether the patient has impaired manual dexterity, visual impairment or difficulty remembering. In these cases, using an organizer may be appropriate but it's important to first seek other potential solutions.
"These solutions could range from providing medication in bottles without childproof lids, using color coded bottles or helping the patient develop routines and reminders.
"When switching from usual packaging to a pill organizer, we recommend that patients speak to their GP or pharmacist to check that the doses of their medication are appropriate."
"People who are already using a pill organizer without any ill effects should not stop using it as they do seem to help some patients take their medication as prescribed. It's the switching stage which appears to be the danger."

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