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Table 2 Description and results of the studies on automated dose dispensing (ADD) in primary healthcare

From: Automated dose dispensing service for primary healthcare patients: a systematic review

Reference, country, and study design Aim of the study Description of automated dose dispensing (ADD) according to article’s texta Population and data collection Outcome measures Outcome specification and main results
Controlled studies
Sjöberg et al.[15], 2012, Sweden To compare changes in drug treatments within and outside ADD Level 2 154 community-dwelling or nursing home residents ≥65 years of age (patients using ADD n = 107, not using ADD n = 47). Data on drug treatments were extracted from the medical records (t = 0 months) and from the SPDR (t = 6 months). A multi-level analysis was performed, with drugs at the first level and individuals at the second. Number of changed (withdrawn, dosage adjusted, or newly prescribed) and not changed drugs. Appropriateness of medication use
Controlled register study      The risk of medication to be classified as unchanged was higher among ADD users (OR 1.66, 95% CI 1.20-2.31, adjusted for age, sex, cognition, year of data collection, subgroup of drug).
Sjöberg et al.[16], 2011, Sweden To investigate association between ADD and quality of drug treatment Level 3 All community-dwelling or nursing home residents from Västra Götaland ≥65 years of age in late 2007 and having ≥2 health care visits and ≥2 diagnosis in 2005–2007. Study group: ADD users (n = 4927). Control group: patients not using ADD (n = 19 219). Data were collected from the SPDR in 2007 linked with register data on patient diagnoses and residence. Five quality indicators for potential IDU: Appropriateness of medication use
Controlled cross-sectional register study     1. Use of ≥10 drugs ADD users had a higher prevalence of all indicators of potential IDU (5.9-55.1%) than the control population (2.6-4.9%) (P <0.0001). After adjustment for age, sex, burden of disease, and residence, risk of all indicators of potential IDU were higher among ADD users (ORs 1.36-5.48; 95% CI 1.18-6.30).
     2. Use of long-acting benzodiazepines
     3. Use of anticholinergic drugs
     4. Use of ≥3 psychotropic drugs
     5. Potential DDIs
Wekre et al.[17], 2010, Norway Impact of ADD on inconsistencies in medication records between GPs and home care services Level 3 A convenience sample of 59 patients. Medication records were collected 0.5 years before and 1 year after the ADD implementation. Number of discrepancies between the patients’ medication records at the GPs and at the home care services Medication safety
      ADD did not change the number of medication records with discrepancies (before 47 and after 45 out of 59, P = 0.774, n.s.), but reduced total number of discrepancies by 34% (P < 0.001).
Controlled before-after study      
Johnell and Fastbom[18], 2008, Sweden Whether the use of ADD is associated with potential IDU Level 2 All Swedes ≥75 years of age who were registered in SPDR. Study group: ADD users (n = 122 413). Control group: patients not using ADD (n = 608, 692). Data were collected from the SPDR in 2005. Four quality indicators for potential IDU: Appropriateness of medication use
      ADD users had a higher prevalence of all indicators of potential IDU (8.8-22.1%) than the control population (2.4-4.9%).
Controlled cross-sectional register study     1. use of long-acting benzodiazepines  
     2. use of anticholinergic drugs After adjustment for age and number of dispensed drugs, risk of using any IDU, anticholinergic drugs and ≥3 psychotropic drugs were higher among ADD users (ORs 1.43-4.93; 95% CI 1.40-5.17). Contrasting relationship prevailed for long-acting benzodiazepines among women and potentially serious DDIs among women and men (ORs 0.69-0.80; 95% CI 0.66-0.83).
     3. use of ≥3 psychotropic drugs  
     4. potential DDIs  
Uncontrolled studies
Olsson et al.[19], 2010, Sweden Extent and quality of drug prescribing in younger elderly (65–79 years) and older elderly (≥80 years) receiving ADD ADD is mentioned but no description is given. All residents of nursing homes and dementia special care units ≥65 years of age (n = 3705) from the County of Jönköping. Data on prescribed drugs were collected from the national pharmacy drug register. Five quality indicators for potential IDU: Appropriateness of medication use
Cross-sectional register study     1. Use of long-acting benzodiazepines Influence of ADD on potential IDU not studied. Potential IDU prevalences ranged from 7.6% to 41.2%. Prevalences of potential IDU were mainly higher among younger (65–79 years) than older (≥80 years) residents (not statistically tested).
     2. Use of anticholinergic drugs  
     3. drug duplications  
     4. Use of ≥3 psychotropic drugs  
     5. Potential DDIs  
van den Bemt et al.[20], 2009, the Netherlands Frequency of medication administration errors and potential risk factors for these errors in nursing homes using ADD Level 2 In all, 2025 administrations to 127 residents of three nursing homes were observed by one pharmacy technician. Medication administration error rates Medication safety
      Administration error rate for all administered medications observed (via ADD and without ADD) was 21.2% (n = 428 errors). Most common error type was wrong administration technique (n = 312). The risk for administration errors was higher when medicine was not supplied by ADD (OR 2.92; 95% CI 2.04-4.18).
Prospective observational study      
Bergman et al.[21], 2007, Sweden Quality of drug therapy among nursing home residents using ADD Level 1 All nursing home residents ≥65 years of age (n = 7904) from Gothenburg area. Data were collected from the Swedish national drug register for ADD users. Five quality indicators for potential IDU: Appropriateness of medication use
Cross-sectional register study     1. use of long-acting benzodiazepines Influence of ADD on potential IDU not studied. Potential IDU prevalences ranged from 12.1% to 45.2%. The proportion of potential IDU was higher among 65–79 year-old residents than those ≥80 years old (P 0.001-0.015).
     2. Use of anticholinergic drugs  
     3. Drug duplications  
     4. Use of ≥3 psychotropic drugs  
     5. Potential DDIs  
  1. ADD, Automated dose dispensing; DDI, Drug-drug interaction; GP, General practitioner; IDU, Inappropriate drug use; n.s., Not significant; SPDR, Swedish Prescribed Drug Register.
  2. a Levels of description: Level 1: Drugs are machine-packed into unit-dose bags. One unit-dose bag contains all the tablets that are administered to a patient at the same time; Level 2: In addition to level 1, each bag has a label with the following information: patient’s name, the name(s) of the medication(s), and the date and time of administration; Level 3: In addition to levels 1 and 2, a medication record was set up.