Pill organisers not for everyone, new guidance warns

Researchers have developed guidance to help prescribers and pharmacists decide which patients should use pill organisers.

A previous study from the University of East Anglia (UEA) team indicated that switching to using an organiser can do more harm than good.

However, the latest research – published in the Research in Social and Administrative Pharmacy journal – suggests pharmacies are giving out twice as many pill organisers as they were ten years ago.

It is hoped the new guidance will help prescribers better understand who could be put at risk by using an organiser.

Lead researcher Dr Debi Bhattacharya, from UEA’s School of Pharmacy, said: “A lot of people use pill organisers to help them take the right medication at the right time of the day.

“The fact that using a pill organiser could cause harm to patients sounds rather counter-intuitive.

“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 organiser.

“In some cases, older people can even end up being hospitalised.

“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.”

The scientists say that when these patients switched to the pill organiser and suddenly started taking the medication as prescribed, they experienced the medications’ side effects.

They describe a drawback of the organiser being that if a patient wants to miss a pill, they cannot tell which one it is, and consequently stop taking all their pills.

“This can lead to serious health complications that wouldn’t have occurred if they had simply skipped that one tablet,” said Dr Bhattacharya.

Researchers say pharmacists are not considering the risk of adverse events arising from a patient’s sudden increased adherence to their medication.

The guidelines for healthcare teams also suggest other solutions such as easy open medicine bottles or coloured labelling.

The Medication Adherence Support Decision Aid (MASDA) guidance has been endorsed by the Royal College of Physicians and the Royal Pharmaceutical Society.

The research team hopes it will be adopted by the NHS.

Dr Bhattacharya said: “Our new algorithm encourages prescribers to consider the emotional and practical barriers that might stop patients taking their medication correctly.”

Emotional barriers can include things like whether the patient is anxious or lacking confidence, lacking motivation or experiencing unwanted side effects.

This, says the guidance, is when medication compliance aids (MCAs) might not be appropriate.

Practical barriers include things like whether the patient has impaired manual dexterity, visual impairment or difficulty remembering.

The research suggests that in these cases, using an organiser may be appropriate but that it is important to first seek other potential solutions.

“People who are already using a pill organiser 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,” Dr Bhattacharya said.

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