Aim: A structured literature review was undertaken to investigate the evidence associated with the use of multi-compartment compliance aids (MCAs) by older people, living in the community.

Method: Systematic searches of MEDLINE, CINHAL, EMBASE, PsychINFO, International Pharmaceutical Abstracts and Cochrane were carried out for the period 1982 to present. Both UK and international English language literature were searched. The keywords used were "patient compliance", "compliance aids", "drug packaging", "and reminder systems" and searches were limited to age over 65 where possible. Key words were combined and not all keywords produced results in each database. Identified papers were reviewed and those in which MCAs were the main focus of the study were obtained for further review and analysis. Hand searches were undertaken within the same parameters, as were bibliographies of identified papers and colleagues' personal collections.

Results: Twenty eight papers were identified by the above method, these papers could be could be classified according to the type of trial or study they described (see Table). The experimental studies were critically evaluated and the results determined. Seven randomised controlled trials were identified and of these three found that the use of an MCA improved compliance and four found no improvement.
The non-randomised controlled trial and the cross-over trial found that patient compliance was improved. Two cohort studies reported improved compliance, while two other studies looked at patient acceptability. Critical analysis revealed issues which might have a bearing on the trial results. The method of randomisation was described in only two of the randomised controlled trials. Outcome measures varied from measurement of blood pressure and plasma drug levels to self reported compliance and pill counts. The number of patients enrolled in the studies varied from 12 to 297. All the interventions described included a MCA but often also included counselling, charts or other instruction leaflets, therefore making it difficult to determine if the improvement was due to the MCA alone or the combination of interventions.

Discussion. A randomised controlled trial is usually seen as the gold standard of research into a particular intervention. The randomised controlled trials investigated were divided in the conclusions obtained and the number of trials identified was too small to provide evidence of effect. The other trials, although asserting that MCAs improved compliance, involved small numbers of patients or had multiple interventions making it impossible to determine which intervention had caused the improvement.

Conclusion: The available literature describing trials of the use of MCAs does not provide sufficient evidence for the general use of these devices in primary care. This is of concern bearing in mind the extent of their use across the UK (1) and the identification of possible negative effects associated with their use (2). More research is needed into the appropriate use of such aids.

1. Nunney JM, Raynor DK. How are multi-compartment compliance aids used in primary care? Pharmaceutical Journal 2001; 267: 784-789.
2. Nunney J, Raynor DK 'Mind the Gap – how compliance aids increase the distance between patients and their medicines'. International Journal of Pharmacy Practice 2001: 9: R46