Background
Methods
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Adherence to medicines (using an objective measure (e.g. pill count or electronic monitoring);
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Health outcomes;
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Health related quality of life;
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Health or social care utilisation;
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Dispensing or administration errors;
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Costs associated with prescribing or medicine supply.
Search strategies and information sources
Study selection
Data extraction
Assessing risk of bias in individual studies
Data analysis
Results
Study selection
Overview of studies
First Author | Year | Design | Location | Condition | Setting | Age (mean, (range)) | Type of MOD (format) | Comparator | MOD filled by | Total n |
---|---|---|---|---|---|---|---|---|---|---|
Becker [20] | 1986 | RCT | USA | Hypertension | Hospital Outpatient | nr | Sealed. 28 consecutive-dose foil backed blisters (7x4). Packs were perforated so that blisters could be detached. | Standard packaging (bottles) | Automatic device | 165 |
Carruthers [32] | 2008 | Audit | Australia | Mixed | Care Home | nr | Sealed. 28 consecutive-dose foil backed blisters (7x4). Websterpaks | n/a | Pharmacy | nr * |
Crome [27] | 1982 | RCT | UK | Mixed | Hospital Inpatient | 80.29 (68-98) | Unsealed, 28 consecutive-dose compartments (7x4). Dosett® | Standard packaging (bottles) | Unclear | 78 |
Feetam [21] | 1982 | Prospective | UK | Mental Illness | Community | 42.40 (18-68) | Unsealed, 28 consecutive-dose compartments (7x4). Can be divided into single days for convenience. Medidos® | Standard packaging (bottles) | Unclear | 10 |
Huang [23] | 2000 | RCT | USA | Vitamin supplements in healthy volunteers | Community | 58.00 (nr) | Unsealed. Seven consecutive-dose compartments (7x1). | Standard packaging (bottles) | Patient | 183 |
Huang [23] | 2000 | RCT | USA | Vitamin supplements in healthy volunteers | Community | 65.00 (nr) | Unsealed. Seven consecutive-dose compartments (7x1). | Standard packaging (bottles) | Patient | 291 |
Levings [33] | 1999 | Audit | Australia | Mixed | Community | 78.00 (nr) | nr | nr | Various | nr Ɨ |
MacIntosh [28] | 2007 | RCT | Canada | Cancer | Hospital Outpatient | 64.00 (42-81) | Unsealed. 14 consecutive-dose compartments (7x2) | Standard packaging (nr) | Researcher | 21 |
McElnay [19] | 1992 | Cross-section | UK | None | Community | nr | Unsealed, 28 consecutive-dose compartments, various format: Medisystem® (7 of 4x1); Medidos® (7x4), Supercel (7x4, pouches); Dosett®(7x4); Pill Mill® (1x28, wheel-type); Medi-wheel® (4 of 7x1, stacked wheel-type). | n/a | Pharmacist/ technician | 6 |
Petersen [24] | 2007 | Prospective | USA | HIV | Community | 44.00 (38-49) | nr | Standard packaging (bottles) | n/s | 269 |
Rehder [25] | 1980 | RCT | USA | Hypertension | Hospital Outpatient | 51.35 (31-69) | Unsealed, 28 consecutive-dose compartments Mediset®(7x4) | Standard packaging (bottles) | Pharmacy | 50 |
Roberts [18] | 2004 | Multiple | Australia | Mixed | Community | 76.80 | nr | n/a | Pharmacy | 353 |
Ryan-Woolley [29] | 2005 | RCT | UK | Mixed | Care Home | 78.80 (67-92) | unclear | Standard packaging (nr) | Pharmacy | 62 |
Simmons [26] | 2000 | RCT | New Zealand | Diabetes | Community | 54.06 (nr) | Sealed. 28 consecutive-dose foil backed blisters (7x4). | Standard packaging (nr) | Pharmacy | 68 |
Skaer [31] | 1993 | RCT | USA | Diabetes | Pharmacy | 51.74 | Sealed | Standard packaging (nr) | Pharmacy or researcher | 131 |
Skaer [30] | 1993 | RCT | USA | Hypertension | Pharmacy | 56.49 (nr) | Sealed | Standard packaging (nr) | Pharmacy or researcher | 163 |
Stewart [34] | 2001 | Cross-section | UK | Mixed | Community | nr | nr | n/a | Nurses | 96 |
Wong [22] | 1987 | RCT | USA | Mixed | Community | 79.00 (66-90) | Sealed.^ 31 non-consecutive-dose foil-backed compartments. Each card serves one daily time point for one month e.g. breakfast. | Standard packaging (bottles) | Pharmacy or researcher | 17 |
Risk of bias
Items from Cochrane risk of bias tool | ||||||||
---|---|---|---|---|---|---|---|---|
Study | Study design | Randomisation procedure | Concealment of allocation | Blinding of assessors | Blinding of treatment providers | Attrition addressed | All outcomes reported | Other risks of bias |
Becker [20] | RCT |
?
|
?
|
?
|
x
|
?
|
?
|
x
|
Carruthers [32] | Audit |
NA
|
NA
|
NA
|
NA
|
NA
|
?
| ✓ |
Crome [27] | RCT |
?
|
?
|
?
|
?
| ✓ |
?
| ✓ |
Feetam [21] | Prospective |
NA
|
NA
|
NA
|
NA
|
NA
|
?
| ✓ |
Huang [23] | RCT | ✓ | ✓ |
?
|
?
|
?
|
?
| ✓ |
Levings [33] | Audit |
NA
|
NA
|
NA
|
NA
|
NA
|
?
|
x
|
MacIntosh [28] | RCT | ✓ |
?
|
?
|
?
| ✓ |
?
| ✓ |
McElnay [19] | Cross-section |
NA
|
NA
|
NA
|
NA
|
NA
|
x
|
x
|
Petersen [24] | Prospective |
?
|
?
|
?
|
?
| ✓ |
?
| ✓ |
Rehder [25] | RCT |
?
|
?
|
?
|
?
|
?
|
?
| ✓ |
Roberts [18] | Cross-section, audit |
NA
|
NA
|
NA
|
NA
|
NA
|
?
|
x
|
Ryan-Woolley [29] | RCT |
?
|
?
|
?
|
?
| ✓ |
?
| ✓ |
Simmons [26] | RCT | ✓ |
?
|
?
|
x
| ✓ |
?
| ✓ |
Skaer [31] | RCT |
?
|
?
|
?
|
?
|
?
|
?
| ✓ |
Skaer [30] | RCT |
?
|
?
|
?
|
?
|
?
|
?
| ✓ |
Stewart [34] | Cross-section |
NA
|
NA
|
NA
|
NA
|
NA
|
?
| ✓ |
Wong [22] | RCT |
?
|
?
|
?
|
?
|
x
|
?
|
x
|
Effect of MODs
Health outcomes
Study | Design | Outcome measure | Change in outcome | n MOD | n control | p-value |
---|---|---|---|---|---|---|
Becker 1986 [20] | RCT | Diastolic blood pressure | β = 1.45 | 86 | 85 | 0.259 |
Huang 2000a [23] | RCT | Change in Vitamin C serum concentration | -0.9 (mg/dl) | 90 | 94 | 0.47 |
Change in Vitamin E serum concentration | -2.4 (mg/dl) | 0.06* | ||||
Huang 2000b [23] | RCT | Change in Vitamin E serum concentration | 0.9 (mg/dl) | 148 | 149 | 0.53 |
Petersen 2007 [24] | Prospective | Viral Load | 0.36 mean log10 copies/mL. Increased odds of viral load below 400 copies/ml OR 1.91 | <0.05* | ||
Rehder 1980 [25] | RCT | Change in diastolic blood pressure | 1 mm Hg | 25 | 25 | > 0.05 |
Change in systolic blood pressure | Not reported | > 0.05 | ||||
Roberts 2004 [18] | Cross-section | Number of adverse drug reactions (ADRs) | Non-MOD group reported more ADRs (47.79 %) vs non-pharmacist filled MOD group (43.24 %) and pharmacist filled MOD group (32.56 %) | 0.022* | ||
The 14 item Older Americans Resource Scale for Instrumental Activities of Daily Living (OARS-IADL) | Pharmacist filled MOD group had lower ability scores (10.25) vs non-pharmacist filled MOD group (12.70) and non-MOD group (12.34) | 0.001* | ||||
Simmons 2000 [26] | RCT | Change in diastolic blood pressure | -5.9 mm Hg | 36 | 32 | 0.0041* |
Change in systolic blood pressure | -1.0 mm Hg | 0.89 | ||||
Change in HbA1c | -0.8 % | 0.026* |
Medication adherence
Study | Design | Adherence measure | n MOD | n Control | Adherence MOD | Adherence control | p-value |
---|---|---|---|---|---|---|---|
Becker 1986 [20] | RCT | % participants taking > 80 % of doses | 86 | 85 | 84 | 75.3 | > 0.05 |
Crome 1982 [27] | RCT | % doses missed | 40 | 38 | 26.1 | 26.2 | > 0.05 |
Huang 2000a [23] | RCT | % participants > 90 % of doses | 90 | 94 | 91 | 94 | Not stated |
Median % of doses taken | 94 | 100 | 99 | 0.63 | |||
Huang 2000b [23] | RCT | % participants taking > 90 % of doses | 148 | 149 | 87 | 93 | 0.005* |
Median % of doses taken | 99 | 99 | > 0.05 | ||||
MacIntosh 2007 [28] | RCT | % participants taking 100 % of doses | 21 | 21 | 81 | 86 | Not stated |
Petersen 2007 [24] | Prospective | Increase in % doses taken | 4.1 % | - | < 0.05* | ||
Rehder 1980 [25] | RCT | % participants taking > 95 % of doses | 25 | 25 | 89 | 47 | < 0.01* |
Wong 1987 [22] | RCT | % doses missed | 17 | 17 | 2.04 | 9.17 | < 0.01* |
Healthcare utilisation
Study | Design | n MOD | n Control | Healthcare Utilisation Measure | Healthcare Utilisation MOD | Healthcare Utilisation Control | p-value |
---|---|---|---|---|---|---|---|
Roberts 2004 [18] | Cross-section | 209 | 144 | Mean no. consultations with a different prescriber | 2.02 (pharmacist supplied) | 2.41 | 0.012* |
2.91 (non-pharmacist supplied) | |||||||
Mean no. prescriber consultations in previous two months | 2.54 (pharmacist supplied) | 3.05 | 0.03* | ||||
2.05 (non-pharmacist supplied) | |||||||
Mean no. hospital admissions in previous 12 months | 1.36 (pharmacist supplied) | 0.78 | 0.001* | ||||
0.56 (non-pharmacist supplied) | |||||||
% patients hospitalised in previous three months | 59.54 % (pharmacist supplied) | 35.14 % | |||||
35.14 % non-pharmacist supplied) | |||||||
Ryan-Woolley 2005 [29] | RCT | 31 | 31 | Mean no. prescriber consultations | 1.5 | 1.3 | 0.07 |
Mean no. prescribed medicines | 4.2 | 4.8 | 0 .024* | ||||
Skaer 1993 [31] | RCT | 85 | 78 | Mean healthcare spending (Medicaid archive data) | $13.66 per patient increase compared to control group | > 0.05 | |
Skaer 1993 [30] | RCT | 53 | 78 | Mean healthcare spending (Medicaid archive data) | $22.94 per patient increase compared to control group | > 0.05 |
Dispensing errors
Study | Design | Error Type | Error rate |
---|---|---|---|
Carruthers 2008 [32] | RCT | Omission of a medicine | 99/297 (33.3 %) |
Supplying a medicine discontinued by the general practitioner | 37/297 (12.5 %) | ||
Wrong strength | 32/297 (10.8 %) | ||
Incorrect instructions | 32/297 (10.8 %) | ||
Failure to deliver medicines | 13/297 (4.4 %) | ||
Wrong medicine | 12.297 (4.0 %) | ||
Wrong label | 7/297 (2.4 %) | ||
Other/Unknown | 65/297 (21.9 %) | ||
General practitioner error | 79/297 (26.6 %) | ||
Pharmacy error | 125/297 (42.1 %) | ||
Not attributable | 93/297 (31.3 %) | ||
Roberts 2004 [18] | Cross-section, audit | Missing tablets | 75/190 (39.5 %) |
Extra tablets | 46/190 (24.2 %) | ||
Tablet in wrong position | 23/190 (12.1 %) | ||
Medication changes not made | 17/190 (8.9 %) | ||
Labels incorrect | 9/190 (4.7 %) | ||
Wrong tablet | 7/190 (3.7 %) | ||
Pack/sachet/drug damaged | 6/190 (3.2 %) | ||
Special medications not packed correctly/packed when should not be | 4/190 (2.1 %) | ||
Authority script required | 2/190 (1.1 %) | ||
Wrong colour card | 1/190 (0.5 %) |
Supply procedures and costs
MOD | Time taken | Perceived ease |
---|---|---|
(minutes: seconds) | (1 - favourable to10 - unfavourable) | |
Dosset | 1:45 | 8.3 |
Pill Mill | 2:27 | 5 |
Round tray 4 compartments 7 days | ||
Medsystem Week Pouch | 2:48 | 7.7 |
Daily boxes with four compartments in a pouch | ||
Medidos | 2:52 | 7.8 |
Stacked wheels 4 compartments 7 days | ||
Medi-Wheel | 3:20 | 7.5 |
Stacked wheels 4 compartments 7 days | ||
Supercel | 9:59 | 1.5 |
Seven by four pouches on a card |