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.


Food Packaging Design Accessibility Guidelines

The Food Packaging Design Accessibility Guidelines were originally developed by Arthritis Australia and Georgia Tech Research Institute’s Principal Research Scientist Dr Brad Fain for HealthShare NSW. The guidelines were part of a program designed to address issues patients had with opening portion controlled food packaging, which impacted their independence and nutrition. The guidelines were a world first and are now used to assist brand owners and manufacturers to develop packaging that is easy to understand, read and open by consumers. This is achieved by assisting the packaging industry to understand consumer’s abilities to complete tasks, such as the amount of force consumers can exert when removing a seal or cap.


Verpackungen von Tabletten – Eine für alle?

Eine Verpackung soll ein Produkt zunächst umhüllen, um es vor äußeren Einflüssen zu schützen. Des Weiteren transportiert sie Produktinformationen zum Endverbraucher und vermittelt Markenbotschaften sowie einen möglichen Zusatznutzen. Einige Verpackungen enthalten sogar Hilfsmittel zum Entnehmen oder Dosieren des Produkts.

Oft ist das Erscheinungsbild einer Verpackung im Regal entscheidend für Impulskäufe. Allerdings machen es manche Verpackungen dem Endverbraucher schwer, an das Produkt zu gelangen. Besonders bei empfind­lichen Anwendergruppen wie den »Silver Agern«, den Konsumenten in einem fortgeschrittenen Lebensabschnitt, kann dies zur Ablehnung des Produkts führen.


Verpackungstechnologische Einflussfaktoren auf leichtes Öffnen und sichere Handhabung von Verbraucherverpackungen

Die vorliegende Arbeit soll sich hauptsächlich mit den Einflüssen der Verpackungsgestaltung auf die erforderliche Öffnungskraft, möglichen weiteren Faktoren wie Motorik und Kognition und die daraus resultierende Verbraucherzufriedenheit beschäftigen. Daraus soll die Bedeutung dieser Einflussfaktoren erstmals in einer der Lebenswirklichkeit von Verbrauchern angelehnten Situation für das Verständnis der Verpackungskonzeption ermittelt werden. Die Kenntnis der Zusammenhänge im Vergleich mit instrumentellen Untersuchungsmethoden eröffnet die Möglichkeit, mit Hilfe der erhaltenen Daten leichtes Öffnen und sichere Handhabung gezielt hinsichtlich bestimmter Merkmale planbar vorherzusagen und zu optimieren.

From the English summary that starts on page 118:
The studies comprise examination of various commercial packages based on target group testing according to CEN/TS 15945. The choice of packages based on the priorities of the BAGSO studies and suspected barriers during opening. The results of the test steps effectiveness and efficiency of the opening procedure and the evaluation of consumers’ satisfaction with the opening procedure  were decisive for the assessment as easy-to-open package. The tests took place under standardized conditions, which were modelled on the situation at domestic kitchen tables. The target group  comprised random samples of people who represent a wide range of life experiences and life situations. With participant’s approval hand movements during opening procedures were documented using videotapes in order to understand and recognize patterns. Instrumental measurements of selected packaging types acted as reference to investigate the required opening force and to detect a possible correlation with the results of the target group testing. The comparison of both methods showed that the required opening force or the applicable force to the packages correlated not primarily with the results of target group tests, they had only minor importance for the consumers ́ satisfaction with the opening procedure. A study of blister packages led to a surprising result: the packages affording greater applied force when opened were evaluated significantly better in target group study than a n equivalent package, which needed less opening force. Similar packages, which required the same maximum force to open, have been rated significantly different in target group testing.


Evaluation of multi-dose repackaging for individual patients in long-term care institutions: Savings from the perspective of statutory health insurance in Germany

Aims and objectives: Elderly people often have difficulty adhering to multi‐drug medication regimens. The current study aimed to evaluate whether multi‐dose repackaging for individual patients reduces medication expenses from the perspective of statutory health insurance in Germany.

Setting: A total of 307 residents, mean age 76.8 years, median age 80 years, from four long‐term care facilities were included in the prospective pre—post study conducted from September 2004 to December 2005. Minimum periods of 9 months prior to and 9 months following the introduction of multi‐dose packaging were compared at the individual level with respect to the expenses for medications that were repackaged in weekly blister packs.

Method: The main outcome measure was savings in medication expenses. Statistical evaluation was carried out using the program Rversion 2.1.0. Adjustments were made for effects of age and con currently increasing morbidity in so far as number of prescriptions were held constant at the individual level.

Key findings: In the subset of 181 people included in this analysis, approximately 6.0% (95% confidence interval, 5.1–7.0%; P < 0.001) of expenses for medication were saved: 2.0% (1.6–2.3%; P < 0.001) was due to price differences and 4.1% (3.2–5.0%; P < 0.001) to reduced wastage of prescribed medication. The probability of being prescribed a generic compared with a brand‐name medication was significantly lower prior to the introduction of repackaging (0.92, 0.89–0.94; P < 0.01), although this did not have any effect on turnover of medications (0.996, 0.988–1.005; P < 0.01).

Conclusion: Significant savings in medication expenses were found. Nonetheless, cost savings should not be the sole objective in reorganising drug dispensing.


How effective is safety packaging

Of 96 ingestions involving safety packaging, 82% involved misuse. The package in some way was unacceptable to the consumer–it was too difficult to open or too difficult to close. Nonacceptance by the elderly was not a significant factor. In only 18% of the safety packaged ingestions, did the child upen the package. The child was more likely to be able to open the screw-cap and the strip-pack. The pop-off and press-lift were not opened by any child but were types misused only by parents. The older child with a record of prior poisoning was most likely to open a safety package. These children would appear to represent a hard core of risk subjects refractory even to safety packaging. Safety packaging has had a dramatic effect on the morbidity and mortality of accidental poisoning. There are two remaining problems that require further study: 1. The analysis of technical factors impeding consumer acceptance and child proofing. The ideal package is so easily handled by the adult that misuse does not occur, but is too difficult for the child to open. 2. The personality characteristics of the safety-package-resistant child. Safety packaging, as implemented by the Consumer Product Safety Commission, has had remarkable success. Education did not reduce accidental poisoning; safety packaging does. Pediatricians, pharmacists, and toxicologists must work with industry and the Consumer Product Safety Commission to complete the goal of elimination of accidental poisoning.


Evaluation of a novel medication aid, the calendar blister-pak, and its effect on drug compliance in a geriatric outpatient clinic

A prospective, controlled, crossover study on drug compliance was initiated in 22 elderly patients from a geriatric clinic. Half of the patients received their pills from a commercially prepared calendar mealtime blister‐pak; the remaining patients received their medication from standard pill bottles. At the end of three months the two groups were crossed over. Pill count and issuance of a new drug supply were done monthly to assess compliance. It was found that the average noncompliance index was significantly decreased (9.17 to 2.04) with the blister‐pak packaging system. The relationship of age, Folstein mini‐mental status, over compliance, frequency of dosing interval, and living situation were also explored.


Medication cards for elderly people: a study

This study describes the benefits of providing patients aged 60 years and over with supplementary written information about their medication regimes. The aim of the study was to measure the effect of a personal medication record card on the information patients could recall about their medication following discharge from hospital. The results demonstrated that the card was favoured by patients and proved effective in assisting them to recall correctly information relating to the name, purpose and special instructions attached to their medicines, as well as helping to reduce errors in administration. The study also found that a significant number of patients from the control group reported difficulties in opening child-resistant medicine containers and to a lesser extent foil and blister packaging.


Medication compliance and the elderly

Elderly patient noncompliance is one of the most vexing and difficult aspects of the geriatric drug use process. Patient noncompliance in the elderly is a cause for concern that is present and growing. Impacts to improve elderly patient compliance are complex as well and will become more complex as the number and percentage of the elderly increase dramatically in the years to come. Individualized therapies; the provision of enhanced verbal and written patient counseling; and use of unit-dose, blister packaged, and specialized compliance packaging are proven means to the end-point of improvement of elderly patient compliance. All involved in the delivery of health care services to the elderly must realize that in order to improve elderly patient compliance, these and other techniques that allow patients to become and remain compliant must be continuously utilized in the growing geriatric population.


The impact of innovative packaging on adherence and treatment outcomes in elderly patients with hypertension

This study compares compliance rates of an antihypertensive drug administered to some elderly patients in a bottle and others in a blister. The results of this study continue to prove the point that calendarized blister packaging can provide increases in patient adherence. In the OSU research, 88 adults, all 65+ years of age, were included in the study. All had blood pressure readings of at least 140/90. Forty-eight participants received Prinivil in blister packs with compliance-prompting features. These partipants constituted the study group. Forty received Prinivil in traditional pharmacy vials and composed the control group. The patients were tracked for 12 months.
Over these months, the percent of on-time refills of the control group was only 66.1%, while the study group’s percent of on-time refills was 80.4%. Dramatic improvements in blood pressure were also measured in the study group. The change in DBP of the control group was -17% and SBP was -40%. For the study group , DBP was -50% and SBP was – 57%. The conclusions drawn by the researchers: “Patients in the study group had better adherence as
measured by: 1) Significantly more likely to refill prescriptions on time; and 2) Medication possession ratios significantly higher for study group (MRP = “proportion of days a patient has medication available to be taken”) and At 12 months, a significantly greater proportion of patients in the study group had lower diastolic blood pressure (compared to baseline) than patients in the control group.


The difficulty of opening medicine containers in old age: A population-based study

Objectives: To investigate elderly people’s ability to open medicine containers, and how this ability correlates to some common disorders that may cause functional or cognitive impairment.

Methods: Cross-sectional study of older people age 81 years and older, from the second follow-up (1994–1996) of the Kungsholmen project, a population based study of very old people in an urban area of Stockholm, Sweden. Six hundred and four persons (mean age 86.7 years) were tested for their ability to open three types of medicine containers. The disorders studied were rheumatoid arthritis, stroke, Parkinson’s disease, cognitive impairment (measured by mini-mental state examination, MMSE) and impaired vision.

Results: We found that 14% were unable to open a screw cap bottle, 32% a bottle with a snap lid, and 10% a blister pack. Female gender, higher age, living in an institution, Parkinson’s disease, rheumatoid arthritis, cognitive impairment and impaired vision were all associated with a decreased ability to open the containers. Less than half of the elderly people who were unable to open one or more of the containers received help with their medication. Among those living in their own homes only 27% received help.

Conclusion: Older peoples’ ability to open medicine containers is impaired by several conditions affecting physical and cognitive functioning. Many elderly people who are unable to open medicine containers do not receive help with their medication, particularly those living in their own homes.