Research database

This Research Database has been developed by HCPC Europe to create an overview of the available research in the field of patient-friendly and adherence packaging. The database is for all members of HCPC Europe. Members can register as a user to get access to the database. Is your organisation not a member yet? Then please register your organisation as a member or contact our Executive Director Ger Standhardt for more information.


Compliance aids: Do they work?

The decision to use a compliance aid will depend on the motivation of the patient, their specific medication regimen, and their physical and cognitive ability. The administration of oral medicines may be facilitated through the appropriate use of ‘organisers’ which act as aides memoire. ‘Medidos’ and ‘Dosett’ are the most frequently studied compliance aids and both have been shown to be beneficial to the elderly and to community-based psychiatric patients. Adherence to a medication regimen may be improved without the use of proprietary compliance aids by ensuring that the most appropriate traditional container is used and by paying attention to the highest standard of labelling on the medicine container. Gadgets that are designed to improve physical dexterity can be useful when applying topical preparations, administering insulin injections, operating pressurised inhalers or administering eyedrops. The accurate administration of eyedrops is particularly important when treating glaucoma and may be facilitated by using devices that are designed to help with aiming of the eyedrops (‘Easidrop’, ‘Mumford Auto-drop’, ‘Opticare’). If squeezing the eyedrop container is a problem the ‘Opticare’ device may be particularly suitable.

There may be value in the use of the compliance aids to provide assistance to carers who become involved with preparing medication for patients. Selection of an appropriate compliance aid is not likely to be the total solution to inadequate adherence and most patients will require a combination of strategies to facilitate adherence to treatment with medicines.


Self-application of single-use eyedrop containers in an elderly population: comparisons with standard eyedrop bottle and with younger patients

Purpose: To test whether patients aged ≥80 years can safely and successfully apply eyedrops from a single‐use eyedrop container without support, and to compare the results with those of younger patients using single‐use containers and older patients using standard eyedrop bottles.

Methods: Patients aged ≥80 years who had no physical or mental conditions hindering self‐application of eyedrops and actually did so because of glaucoma or dry eyes were included consecutively in the study group (n=44) in order to perform self‐application of eyedrops from single‐use eyedrop containers. Patients were observed meticulously by two investigators, who documented practical problems during the procedure in a checklist. In control group A (n=22), glaucoma or sicca patients aged between 50 and 65 years applied drops from single‐use eyedrop containers; in control group B (n=28), glaucoma or sicca patients aged ≥80 years used a traditional eyedrop bottle.

Results: Successful application of the drops into the conjunctival sac was achieved by 57% in the study group (95% and 89% in control groups A and B, respectively). Scratching of the eyedrop container along the conjunctiva or cornea was observed in 68% of the study group (41% and 61% in control groups A and B, respectively). Frequency of problems during opening and self‐application of single‐use eyedrop containers in the study group showed an inverse correlation to visual acuity in the better eye and previous experience with this kind of eyedrop container.

Conclusion: Older patients have massive problems in self‐administering eyedrops from single‐use containers. Factors influencing the success of self‐application may include the patient’s previous experience with this kind of eyedrop container and the patient’s visual acuity.


Improving adherence to glaucoma medication: A randomised controlled trial of a patient-centred intervention

Background:
Improving adherence to ocular hypertension (OH)/glaucoma therapy is highly likely to prevent or reduce progression of optic nerve damage. The present study used a behaviour change counselling intervention to determine whether education and support was beneficial and cost-effective in improving adherence with glaucoma therapy.
Methods:

A randomised controlled trial with a 13-month recruitment and 8-month follow-up period was conducted. Patients with OH/glaucoma attending a glaucoma clinic and starting treatment with travoprost were approached. Participants were randomised into two groups and adherence was measured over 8 months, using an electronic monitoring device (Travalert® dosing aid, TDA). The control group received standard clinical care, and the intervention group received a novel glaucoma education and motivational support package using behaviour change counselling. Cost-effectiveness framework analysis was used to estimate any potential cost benefit of improving adherence.

Results:

Two hundred and eight patients were recruited (102 intervention, 106 control). No significant difference in mean adherence over the monitoring period was identified with 77.2% (CI, 73.0, 81.4) for the control group and 74.8% (CI, 69.7, 79.9) for the intervention group (p = 0.47). Similarly, there was no significant difference in percentage intraocular pressure reduction; 27.6% (CI, 23.5, 31.7) for the control group and 25.3% (CI, 21.06, 29.54) for the intervention group (p = 0.45). Participants in the intervention group were more satisfied with information about glaucoma medication with a mean score of 14.47/17 (CI, 13.85, 15.0) compared with control group which was 8.51 (CI, 7.72, 9.30). The mean intervention cost per patient was GB£10.35 (<US$16) and not cost-effective.

Conclusions:
Adherence with travoprost was high and not further increased by the intervention. Nevertheless, the study demonstrated that provision of information, tailored to the individual, was inexpensive and able to achieve high patient satisfaction with respect to information about glaucoma medication. Measurement of adherence remains problematic since awareness of study participation may cause a change in participant behaviour.