title: Assessing the impact of multi-compartment compliance aids on clinical outcomes in the elderly: a pilot study.
abstract: BACKGROUND
  Medication non-adherence is a major problem for elderly people. Multicompartment compliance aids (MCAs) have been advocated as a solution for this problem.
  
  
  OBJECTIVE
  To assess the impact of using MCAs in self-reported adherence and clinical biomarkers of elderly patients followed in a community pharmacy.
  
  
  METHODS
  One community pharmacy at Sabugal (Portugal).
  
  
  METHODS
  A four-month prospective, non-randomised, controlled study was performed. Autonomous patients aged 65 or more using 3 or more medicines and under follow-up in the pharmacy were invited to participate. All patients were offered to receive their medication in MCAs prepared in the pharmacy. Patients refusing the MCA were used as control. The intervention consisted of providing 4 weekly MCAs during the monthly visit. All patients received regular pharmacy counselling. Blood pressure (BP), lipid profile and glycaemia were assessed at baseline and monthly for all the patients. Morisky self-reported scale was applied at baseline and at the end of the study. Bivariate analysis and generalized estimation equations (GEE) were used.
  
  
  METHODS
  Self-reported medication adherence, clinical biomarkers: BP, lipid profile, glycaemia.
  
  
  RESULTS
  54 patients between 65 and 90 years were under follow-up. 44 patients accepted the MCA, constituting the intervention group. No difference in the baseline biomarkers between both groups was found. The bivariate pre-post analysis yielded significant improvements in the intervention groups, but not in the control, for glycaemia (p < 0.001), HDL-c (p = 0.018), and systolic (p < 0.001) and diastolic (p = 0.012) BP. However, when introducing the 'time in follow-up' in the GEE model, all the differences became non-significant, except systolic BP, but the time remained significant for all the biomarkers.
  
  
  CONCLUSIONS
  MCAs apparently improve several clinical biomarkers in a cohort of patients under pharmacist's follow-up. When including the time in pharmacist's followup in a GEE, the effect of the MCA disappeared, remaining only the time as a significant variable. Not considering the time in follow-up may be overestimating the effect of MCAs.
authors.affiliation: Group of Pharmacology and Pharmaceutical Care, Center for Pharmaceutical Studies (CEF), Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal.
authors.forename: Carolina
authors.initials: C
authors.lastname: Mosca
authors.forename: Margarida M
authors.initials: MM
authors.lastname: Castel-Branco
authors.forename: Ana C
authors.initials: AC
authors.lastname: Ribeiro-Rama
authors.forename: Margarida M
authors.initials: MM
authors.lastname: Caramona
authors.forename: Fernando
authors.initials: F
authors.lastname: Fernandez-Llimos
authors.forename: Isabel V
authors.initials: IV
authors.lastname: Figueiredo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000523:psychology; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000032:analysis; D001794:Blood Pressure / Q000187:drug effects; D016022:Case-Control Studies; D003157:Community Pharmacy Services; D004349:Drug Packaging; D005260:Female; D006801:Humans; D008055:Lipids / Q000097:blood; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D010865:Pilot Projects; D011446:Prospective Studies; D057566:Self Report; D016896:Treatment Outcome; D016903:Drug Monitoring
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D008055:Lipids