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.


The Relationship Between Hand Strength and the Forces Used To Access Containers by Well Elderly Persons

OBJECTIVE. This study extended previous work of Rice, Leonard, and Carter [AJOT, 52(8), 621–626] and examined the relationship between grip and pinch strengths and the forces produced while accessing common household containers in healthy, elderly persons.

METHOD. Forty-two women and 9 men 60 years of age and older were assigned randomly to one of four order groups in a counterbalanced, repeated-measures design. Grip strength was measured via a dynamometer and pinch strength via a pinch meter. The forces required to access six common household containers were measured with force sensing resistors applied to each container. Data analysis included Pearson product-moment correlations between the dependent variables of grip and pinch strength and force produced on the containers. Analyses of variance were used to determine differences by gender on the dependent measures and order of presentation of containers.

RESULTS. A fair relationship (r = .31 to .44) was found between grip and pinch strength and the ability to open three containers. Little or no relationship was found between grip and pinch strength and the ability to open the remaining three containers (r = −.03 to .25). Significant gender differences existed on overall strength and the force used to access two of the six containers. No order effects were found.

CONCLUSIONS. Strong relationships did not exist between the grip and pinch strength and the amount of force the elderly participants used to open the containers, which is similar to what Rice et al. found for younger persons. The participants appeared to use a greater proportion of their available strength when accessing the containers than did their younger counterparts previously studied. Further research is needed to determine at what level of weakness one would expect to see performance deficits in common daily occupations.


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.


Adherence to inhaled therapies, health outcomes and costs in patients with asthma and COPD

Suboptimal adherence to pharmacological treatment of asthma and chronic obstructive pulmonary disease (COPD) has adverse effects on disease control and treatment costs. The reasons behind non-adherence revolve around patient knowledge/education, inhaler device convenience and satisfaction, age, adverse effects and medication costs. Age is of particular concern given the increasing prevalence of asthma in the young and increased rates of non-adherence in adolescents compared with children and adults. The correlation between adherence to inhaled pharmacological therapies for asthma and COPD and clinical efficacy is positive, with improved symptom control and lung function shown in most studies of adults, adolescents and children. Satisfaction with inhaler devices is also positively correlated with improved adherence and clinical outcomes, and reduced costs. Reductions in healthcare utilisation are consistently observed with good adherence; however, costs associated with general healthcare and lost productivity tend to be offset only in more adherent patients with severe disease, versus those with milder forms of asthma or COPD. Non-adherence is associated with higher healthcare utilisation and costs, and reductions in health-related quality of life, and remains problematic on an individual, societal and economic level. Further development of measures to improve adherence is needed to fully address these issues.


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.


The difficulties of old people taking drugs

There is considerable interest in the problems of the elderly taking drugs correctly and appropriately. A recent survey (Parkin et al. 1976) showed that these problems that have long been known in geriatric practice have now been noted by general physicians. This review was undertaken when an occupational therapist in a geriatric unit team noted that, although patients and their relatives were taught methods of dressing, toileting, shaving, bathing, eating, walking, transferring to a chair, wheelchair mobility and communication by the occupational therapist, physiotherapist and speech therapist, no advice or teaching was given concerning the accurate taking of the drugs prescribed. The results of a detailed investigation are reported elsewhere (Atkinson, Gibson & Andrews 1978). Repeatedly, patients ready for discharge were handed a batch of drugs by a nurse at the last possible moment, even while sitting by their luggage awaiting the ambulance. Following this, special attention was paid to problems such as intellectual impairment, loss of memory and confusion, poor sight, inability to handle containers, failure to take drugs and lack of patient-education. During ward rounds, particularly when a geriatric health visitor was present, attention was drawn to special topics such as the number of patients who inadvertently kill themselves and the numbers needing readmission due to failure to take drugs, overdosage or underdosage or mixing of drugs (Wade 1972). Ferguson Anderson’s comment (1974) that 7.15% of hospital admissions are due to drug reactions was also noted.



Child-resistant containers for the elderly?

With the introduction of child-resistant medication containers, the geriatric patient has suffered another setback in an already poor record of medication compliance. Most physicians, while applauding the remarkable decrease in child poisonings resulting from safety closure devices, are not aware of the burden that child-resistant medication containers has imposed on the elderly. Nor are they aware of methods to correct the problem. Elderly patients, however, are keenly aware of the problems of child-resistant medication containers but are ignorant about methods to overcome the difficulty in opening and closing them.


Adherence of elderly patients to treatment with pentoxifylline

A study of adherence to treatment was conducted by 179 general practitioners in elderly outpatients with geriatric cerebral symptomatology treated with pentoxifylline. The drug was provided in 2 different randomized packages, with or without memory‐aid stickers (also randomized). Compliance was assessed by pill count after 1 mo of treatment. Clinical evolution was assessed by a digit‐span test, and by filling in 9 “relative” visual analogue scales of aggravation—improvement. Side effects were recorded from patient complaints. Leftover drug was brought back by 83.1% of patients, and this proportion was influenced neither by packaging type nor memory‐aid stickers. Compliance was considered good (fewer than 30 tablets returned) in 62% of patients, and was not influenced by either packaging types or stickers. Peaks of pill count were evident at multiples of packaging units (10 or 40 according to type). Compliance was not related to age or sex, but was related to memory score. There was a correlation between compliance and clinical improvement, and a significant inverse correlation between the former and the frequency of side effects.


Poison prevention packaging act, 1970: A human factors standard

This paper, the first of two, gives an account of legislation and regulations made in the USA requiring hazardous pharmaceutical and other household products to be packaged in child-resistant containers. Human factors test procedures and standards, in terms of which child-resistance is defined, are described. An account is given of those hazardous substances which regulations in the USA require should be packed in child-resistant containers. The paper concludes with a description of the effects of the regulations and of child-resistant containers in reducing mortality and morbidity associated with the ingestion of poisonous substances, particularly aspirin, in the USA.

The second paper will briefly describe the effects of legislation made in England and Wales requiring certain pharmaceutical products to be packaged in child-resistant containers. It will also give an account of experiments, carried out in England and Sweden, describing the difficulties and inconvenience which the elderly and disabled experience when they attempt to use such containers.