While it may seem counterintuitive, research has shown that switching to a pill organizer can harm one’s health and even result in hospitalization for older patients.
How’s this possible? According to Debi Bhattacharya, PhD, from University of East Anglia’s School of Pharmacy, when patients only take their medication sporadically, their provider might increase the dose to help them achieve the desired results. But pill sorters help with adherence and can cause patients to take too much of their medicine, even though it’s technically the prescribed amount.
Bhattacharya has also seen some patients occasionally miss all their medications as a result of using pill sorter. This happens when the patient decides to skip a certain dose one day but then can’t tell which is which inside the organizer and doesn’t take any as a result.
What’s the purpose of the research?
That’s why researchers at the University of East Anglia have developed the first-ever guidelines, recently published in Research in Social and Administrative Pharmacy, for clinicians when deciding whether to recommend a pill organizer to a patient. The Medication Adherence Support Decision Aid (MASDA) incites a structured discussion between provider and patient that will ideally result in a personalized adherence solution.
The study authors report anywhere from 30 to 50 percent of patients prescribed medication for long-term conditions don’t take their medication as recommended. They divide the reasons why into two groups: practical barriers, such as getting to the pharmacy or being unable to swallow medication; and perceptual barriers, such as lack of motivation. As a result, the guidelines encourage providers to first understand patients reasons for not taking their medication.
What should clinicians know about recommending a pill sorter?
Overall, the authors note a pill organizer is not appropriate if the patient isn’t adhering due to perceptual reasons, but it may resolve practical barriers, provided other solutions don’t work first.
For perceptual barriers, MASDA offers the potential following solutions:
- Identify informal social support to boost confidence and allay anxiety.
- Demonstrate the method of administration and ask patient to rehearse.
- Provide information about medication benefits valued by the patient.
- Agree on goals.
- Seek alternative medication.
- Consider potential for de-prescribing.
For practical barriers, MASDA offers the potential following solutions:
- Provide medication in bottles without childproof closures or winged caps (prior to implementing a pill sorter).
- Use texture, color or letter‐coded bottles (prior to implementing a pill sorter).
- For patients with mild confusion, cognitive impairment or dementia, help develop routines and reminders, and review medication for opportunities to simplify regimen (ex. align dose timings) (prior to implementing a pill sorter).
- Do not let patients with severe confusion, cognitive impairment or dementia self-administer.
For older adults, it’s especially important to have a conversation about why they may not be adhering because 60 percent of them have made a conscious decision to not take their medication as prescribed, Dr. Battacharya tells Florence Health.
“This could be due to unacceptable side effects or no observable benefits,” she says. “The most important thing that any practitioner can do is discuss with a patient what their thoughts are about their medication. This will allow any inaccuracies in the patient’s knowledge to be rectified but also any potential changes to the prescribed medication to be considered.”
The biggest pitfall for clinicians is not listening to the patient, she adds: “It’s important to find out whether the patient has impaired manual dexterity, difficulty remembering, or visual impairments. Using a pill organizer may be appropriate in these cases, but it is important to seek other potential solutions.”