Medicines Compliance Aids (MCA’s) have many different names and brands (e.g., dosette boxes), but are generally reusable plastic containers for storing medicines, divided into compartments by day and/or time. MCAs can be supplied and filled by the patient/carer or dispensed prefilled by a pharmacy. They are often perceived as the preferred aid/adjustment for patients facing difficulties taking their medication and/or those taking multiple medicines (known as polypharmacy) – however following proper assessment other alternatives may be deemed more suitable.
Click here to access videos and free resources for healthcare professionals and patients, carers and families.
The decision to issue a prefilled MCA should rest with a pharmacist and be based on an assessment (for patients with a long-term disability) made in accordance with the Equality Act (2010). The assessment determines if an MCA is a ‘reasonable adjustment’ to enable the patient to take their medicines effectively. There are many ways to promote people’s independence and use of original packs of medicines including easy-to-open packaging, reminder sheets and/or large print labels. Currently, MCAs are often issued without pharmacist assessment or consideration of suitable alternative reasonable adjustments.
Both NICE and the Royal Pharmaceutical Society (RPS) advise:
- MCAs should only be considered following appropriate assessment, and
- original packaging is preferred in the absence of a specific need for an MCA.
Resources to support healthcare professionals
- Video for healthcare professionals: How healthcare professionals can support medicines compliance: reasonable adjustments.
- Step-by-step decision tree poster for display/use in primary/secondary care settings: Understanding your patient’s medicine needs: Patient Equality Act Assessment for Medication Reasonable Adjustment
- Portrait form for use by hospital/community pharmacy teams: Equality Act Assessment for Medication Reasonable Adjustment (portrait)
- Landscape form for use by hospital/community pharmacy teams: Equality Act Assessment for Medication Reasonable Adjustment (landscape)
Resources to support patients, carers and families
- Video for patients, carers and their families: Helping medications to be taken safely: advice for patients, families and carers about reasonable adjustments
What are the concerns about use of MCAs?
“MCAs do not always simplify how people take their medicines.
When people need additional medicines support to continue to be independent, it may be necessary to have a medication review to simplify their medicines regimen”.
Care Quality Commission: Multi-compartment compliance aids (MCAs) in adult social care (May 2022)
There is currently a lack of regulation around the use of MCAs, however both NICE and the RPS agree that there is not sufficient evidence that MCAs improve medication adherence for their widespread use to be recommended. Studies have shown there are a number of risks associated with their regular use, including pharmacist error and reduced stability of some medicines once removed from their original packaging.
Watch our video for healthcare professionals on reasonable adjustments, including MCAs:
National Reporting and Learning System (NRLS) data from the first half of 2018 showed 507 patient safety incidents involving MCA-related terms.
MCAs are also very labour intensive for pharmacists, who do not receive funding for preparing them as part of their contract. MCAs can produce unnecessary waste if changes are made to prescriptions.
MCAs can also cause confusion for patients, carers and families when there are changes to medication (for example after a new illness or hospital admission) and in situations where patients may only need to take medication for a defined period. Patients/carers can become confused about which tablet treats which condition and are therefore unable to reduce or stop the correct medication as a result. This can lead to the patient and/or their carer feeling a lack of ownership or control about their medication.
Watch our video for patients, carers and families on the importance of discussing any medication concerns, and potential reasonable adjustments, with pharmacy teams:
In this short video AHSN Network polypharmacy clinical lead and pharmacist, Clare Howard, highlights the value of our resources and signposting patients with questions or concerns about taking their medicines to community pharmacy.
Regional stakeholders, including within our Local Pharmaceutical Committees, are keen to promote the range of reasonable adjustments for eligible patients and improve patient safety around polypharmacy.
- Care Quality Commission: Multi-compartment compliance aids (MCAs) in adult social care (updated May 2022)
- NHS England NW: An interactive guide to: What good looks like for Assisted Medicines Taking (May 2022)
- Specialist Pharmacy Service (SPS) Summary of Guidance and Evidence for Use of Multi-Compartment Compliance Aids (MCCAs)
- North East & North Cumbria AHSN Medicines Adherence Support Project
- BNSSG CCG Managing Compliance Aids in Primary Care Advice for GP Practices
- NICE Quality and Productivity Case Study: Ensuring appropriate use of monitored dosage systems: reducing unnecessary pharmacy workload
Get involved in our medicines work
If you have any questions about our MCA project or the resources we have developed, please contact Chris Learoyd, Senior Project Manager.
You can also explore our polypharmacy project which includes a local community of practice and our current and past medicines optimisation work.
Please visit our events listings to find details of upcoming training and webinars.
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