How do the attitudes and beliefs of healthcare professionals and older people impact on the appropriate use of multi-compartment compliance aids by older people living at home

Compliance with medication regimes is a widely researched topic within the field of healthcare. Older people are considered to be a greater risk of non-compliance due to multiple morbidities. Multi-compartment compliance aids are frequently issued to older people in an attempt to improve their medicines management. This thesis aims to determine whether the attitudes and beliefs of both the older people who use MCAs and the healthcare professionals who request their use, influence the use of such devices by older people living in the community. A preliminary study which investigated the use of MCAs in primary care is described. The findings suggested that over 100,00 people in the UK may be issued with a MCA despite little evidence for their efficacy. The literature review undertaken for this thesis concludes that very few studies have been undertaken in this area and those which have are mainly of poor quality. The results from these studies failed to conclusively support the use of these devices and further rigorous conducted studies are needed. The main study comprises qualitative, in-depth semi-structured interviews with older people, who are using a MCA and healthcare professionals. The interviews were analysed using a grounded theory approach. The study revealed that older people find MCAs easy to use and convenient although a minority of the participants did experience difficulties using the device. Maintaining independence and remaining in control was important for all the older people and this influenced their attitudes towards using their MCA. The healthcare professionals concurred with the observation that MCAs were convenient to use and despite a minority stating that MCAs assisted older people to remember to take their medication, the majority acknowledged that this was not the case. The healthcare professionals agreed that the decision to issue a MCA could be seen as paternalistic however there remained a belief that the issue of a MCA would assist the older person take their medication correctly. The thesis concludes by providing details of a proposed method for undertaking a holistic, patient-centred, multi-disciplinary assessment of older people's medicines management abilities.