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Blister packs: Proof that good things do come in small packages?

With community pharmacy already feeling a services squeeze, more should be done to alleviate the strain of offering monitored dosage systems (MDSs), says Danny Bartlett

With an ageing population, an increasing number of patients are encountering concerns over juggling multiple medications for the multitude of conditions they have. In England, around 15% of people are currently taking five or more medicines a day, with 7% taking eight or more.

Increasingly complex medication regimes together with an increase in prevalence in diseases affecting memory and co-ordination mean more patients need help with taking their medications on time.

Dementia UK estimates the number of people with dementia in the UK is forecast to increase from over one million in 2021 to over two million by 2051.

Read more: Alzheimer’s medicines packs to become more 'user-friendly'

Blister-packing medications can really help patients keep track of their medications, when they have taken them, what time to take each one and, in certain circumstances, help maintain a patient’s independence before needing an escalation in care.

They are useful tools when used correctly but place a much larger time and workload constraint on community pharmacies.

Many pharmacies are struggling to take on new blister pack patients while keeping up to date on non-blister packed prescriptions. This means many patients who are looking to go over to blister-packed medication are struggling to find a community pharmacy with the capacity to offer them the service.

It’s no easy task for community pharmacies, especially considering there is no additional funding for delivering blister packs.

The latest Royal Pharmaceutical Society (RPS) guidance states that there may be limited evidence of additional benefit to patients in using blister-packed medications and that sometimes they may even cause harm – so there is unlikely to be a push for funding this service.

Read more: Are community pharmacies moving away from providing blister packs?

From a primary care point of view, the strain on pharmacies unable to take on new blister pack patients means there is a mixed offering of the service. It can cause tension between practices and patients and sometimes pharmacy colleagues as well.

In my view, one of the main reasons for this strain is the lack of information to patients on who and how they get put forward to have their medication dipsensed via blister pack. Many patients may have friends or family who are already established on the service so there is an expectation they will simply be able to access blister packs whenever.

This then leads to many patients requesting blister packs when they perhaps don’t need support with their medications and are just taking advantage of the service. This can be prevented by pharmacies and practices stringently assessing patients on their need for blister packs, meaning pharmacies only offer the service to those who are in need of this support.

So how could other strains on the system be alleviated? There are more centralised and hub-based blister- or-pouch packing companies that offer an alternative to local pharmacies taking on the service.

However, with the increasing demand and complexity of medications, it is essential that these large centralised companies are readily contactable and lines of communication with GP practices are easily facilitated to relay medication changes or stoppages in much the same way a practice would contact their local bricks-and-mortar pharmacy.

Read more: Invest in pharmacy blister pack services, AIMp urges commissioners

Overall, the jury is out on the advantages of blister-packing medications, and with an undoubted increase in workload, little to no additional funding available and an increasingly medically complex population, it is clear we need to limit the offer of the service to those in real need.

We can specifically target patients with stable medication regimes who are unlikely to change month to month to try and alleviate the strain on the system, with the potential to use centralised hub-based blister pack or pouch dispensing companies where necessary.

 

Danny Bartlett is a lead pharmacist at a PCN in West Sussex and a senior lecturer in medicines use

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