Is multi-dose packaging really a solution to medication adherence?

By | September 8, 2015

Multi-dose packaging has been a part of pharmacy for longer than I’ve been a pharmacist. It’s mostly been limited to long term care (LTC), such as nursing homes, rehab facilities, etc. It’s not something that’s commonly used in acute care hospitals for a host of reasons, most notably medication regimens frequently change in acute care settings. Multi-dose packaging works best when the patient is stable and medications can be dispensed for multiple days, hence the popularity in LTC.

Recently articles have been cropping up for companies attempting to use multi-dose packing technology in the ambulatory care setting, i.e. outpatient pharmacy. The most recent of which is an article in the Tampa Bay Times, describing the M5000 robot (1) by MTS Medication Technologies, an Omnicell company. Check the video below.

I question whether this is a real solution to a problem, or more of a solution looking for a problem. The technology that’s covered in the video is nothing new; perhaps this particular robot, but not the concept of using technology to create multi-dose packets.

Several questions enter my mind when I see technology like this.

Is this technology less expensive than other options? Probably not, but someone would have to run the numbers over a 3-5 year period to see the return on investment for a million dollar robot. In addition to the cost of the robot, there’s the cost of disposables such as ribbon, packaging, etc. And regardless of what people think, most robots don’t fully automate a process. They may reduce some part of the labor equation, but someone has to operate the robot, fill it with medication, replace the blister packs or packaging tape, and so on. I’ve seen this firsthand while doing research on iv room robots.

Is this technology safer? Yes, no doubt in my mind. However, without studies to confirm my thoughts it’s only speculation. But when properly deployed, robots are insanely accurate. They do exactly what they’re supposed to do. The only weakness in robot accuracy that I’ve witnessed is when humans set them up incorrectly.

Is this technology faster? Without seeing the various methods in action I can’t really say, but I will say that to date I have not seen a pharmacy robot outpace a human technician. Pharmacy technicians can be quite fast, often performing tasks much faster than a robot. This is something I also witnessed during my research into iv room robots. However, I would be remiss if I didn’t say that technician speed comes at a price, i.e. more errors.

Is this technology effective in improving patient satisfaction and adherence? That’s really the question that needs to be addressed. It’s the elephant in the room. The concept of multi-dose packets may appeal to some, but to others it’s a nightmare. This is especially true when the patient has several disease states with multiple medications – something this article says is perfect for the MTM robot. I have my doubts.

The difficulty with complicated patients is the number of healthcare providers, the number of medications, and frequency in which these medications change. I witnessed this firsthand while caring for my mom during the last year of her life. She was a complicated patient, and her medication regimen changed frequently depending on which physician she was seeing, and which disease was the focus of treatment; the old whack-a-mole approach to medicine. Even as a pharmacist I found it difficult to keep her on track. There were times when I would re-sort and organize her weekly medications three times in a ten day period. What do you do if your medications are packaged together in a single packet? You either tear them out or throw them away and start over. Neither option is acceptable. With that said, there will certainly be patients that prefer multi-dose packets to dealing with loose tablets.

My opinion is that adherence strategies are still in their infancy. There are so many variables when it comes to ensuring that patients take their medications, least of which is getting the patient to take stake in their own disease management. That’s the primary goal to adherence, the rest is window dressing at this point.

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  1. There’s a video at the site showing a bit more detail – http://bcove.me/8u1r21sr. Couldn’t find a way to embed it in this post. Wish companies wouldn’t make it so hard to share their videos.

2 thoughts on “Is multi-dose packaging really a solution to medication adherence?

  1. Ray Vrabel, PharmD

    Jerry,

    I think you have “hit the nail on the head” with your assessment. The real question is what have peer-reviewed clinical studies looking at medication adherence in the post-hospital setting determined to be the factors that contribute the most to non-adherence? Do those studies exist? What are their findings? Did any of the studies look at multi-dose blisters as part of the adherence evaluation?

    I have a similar family experience when my father was in an assisted living center where he was allowed to take his own medications. In this case, I personally prepared the medication packets for him to take. While the packaging was helpful, his problem was “doing the right thing with the packages”. If too many packages were available to him at one time (i.e., more than the immediate dosage time), then the risk was he either open the wrong package or open more than one package. Actually, he did the later and consequently we have to move to a program offered my the Assisted Living facility where they had a person dispense his doses by time.

    What would have been ideal, in my personal case with my elderly father, would have been a “system” which only made available to him the doses he was to take at a given time. At the time, 15 years ago, that system did not exist. Interestingly, I have recently seen a system that is capable of doing this. It is called the Livi Home Dispensing System (http://liviathome.com/). This small, computerized, countertop device holds bulk medications and it dispenses the medications by time into a small cup for administration by the patient. Check out the video…

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