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.

Electronic medication packaging devices and medication adherence: A systematic review

Importance  Medication nonadherence, which has been estimated to affect 28% to 31% of US patients with hypertension, hyperlipidemia, and diabetes, may be improved by electronic medication packaging (EMP) devices (adherence-monitoring devices incorporated into the packaging of a prescription medication).

Objectives  To investigate whether EMP devices are associated with improved adherence and to identify and describe common features of EMP devices.

Evidence Review  Systematic review of peer-reviewed studies testing the effectiveness of EMP systems in the MEDLINE, EMBASE, PsycINFO, CINAHL, International Pharmaceutical Abstracts, and Sociological Abstracts databases from searches conducted to June 13, 2014, with extraction of associations between the interventions and adherence, as well as other key findings. Each study was assessed for bias using the Cochrane Handbook for Systematic Reviews of Interventions; features of EMP devices and interventions were qualitatively assessed.

Findings  Thirty-seven studies (32 randomized and 5 nonrandomized) including 4326 patients met inclusion criteria (10 patient interface–only “simple” interventions and 29 “complex” interventions integrated into the health care system [2 qualified for both categories]). Overall, the effect estimates for differences in mean adherence ranged from a decrease of 2.9% to an increase of 34.0%, and the those for differences in the proportion of patients defined as adherent ranged from a decrease of 8.0% to an increase of 49.5%. We identified 5 common EMP characteristics: recorded dosing events and stored records of adherence, audiovisual reminders to cue dosing, digital displays, real-time monitoring, and feedback on adherence performance.

Conclusions and Relevance  Many varieties of EMP devices exist. However, data supporting their use are limited, with variability in the quality of studies testing EMP devices. Devices integrated into the care delivery system and designed to record dosing events are most frequently associated with improved adherence, compared with other devices. Higher-quality evidence is needed to determine the effect, if any, of these low-cost interventions on medication nonadherence and to identify their most useful components.

OECD Health Working Paper No. 105 (2018)

Despite  mounting  evidence, amassed  for more  than  four  decades, poor  adherence  to medications still affects approximately half of  the population that receives prescriptions, leading to severe  health  complications,  premature  deaths,  and  an  increased  use  of healthcare services. – – – – Poor  adherence is  estimated  to contribute to  nearly 200,000  premature  deaths  in Europe per year. Patients with chronic diseases are particularly vulnerable to poor health  outcomes  if  they  do  not  adhere  to  their  medications. Mortality  rates  for patients with diabetes and heart disease who don’t adhere are nearly twice as high as for those who do adhere.
– It  is  estimated  to  cost  EUR  125  billion in  Europe and USD  105  billion in  the United   States   per   year   in   avoidable   hospitalisations,   emergency   care,   and outpatient visits.
– The  three   most   prevalent   chronic   conditions – diabetes, hypertension, and hyperlipidaemia – stand  out  as  the  diseases  with  the  highest  avoidable  costs,  for which every  extra  USD  spent  on  medications  for  patients who  do  adhere can generate  between  USD  3  to  13 in  savings  on  avoidable emergency  department visits and inpatient hospitalisations alone.

The  prevalence  of medication non-adherence  varies  considerably  across  conditions  and patient groups. Most of the studies used different assessment methods making it difficult to compare adherence rates across health systems. Overall, among patients with diabetes, hypertension, and hyperlipidaemia:
– 4 to 31% of patients never fill their first prescription;
– of  those  who  do  fill  their first  prescription,  only  50  to  70%  are  taking  their medications regularly (i.e. at least 80% of the time); and
– less than half of these patients are still continuing to take their medications within two years of the initial prescription.