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.

An ergonomics evaluation of a reclosable pharmaceutical container with special reference to the elderly

The British Standard on reclosable child resistant medicine containers stales that adults should be able to open such containers but fails to consider the special problems of the elderly.

This study compared the ability of 100 elderly people to open a particular child resistant container (CRC) with their ability to open conventional drug containers. Information on drug taking and on contact with children under 5 years was also collected, and indicated that 62% of the subjects were taking prescribed tablets and, of these, 70% came into contact with children under 5 years.

The results showed that, without a demonstration, over 20% of attempts to open the CRCs resulted in failure and even after a demonstration 16 5% of attempts were unsuccessful. Taking the frequency of contact with children into account, it was concluded that the elderly come into contact with young children sufficiently often to justify their tablets being dispensed in CRCs. Consequently it was felt that the special problems of the elderly need consideration in the British Standard and in the design of child resistant containers.

Compliance with prescribed medication by elderly patients

Factors contributing to improper use of medication were examined in 40 patients aged 65 years or more who were in a home care program. They reported taking an average of 3.8 prescription medications and 1.2 nonprescription medications each. Pill counts showed that they were actually taking 57% of the prescribed medications; compliance decreased with the number of medications concurrently prescribed. Poor labelling instructions, difficulty opening childproof containers and misunderstanding of verbal instructions contributed to this problem. The patients tended to rely more on physicians than on pharmacists or visiting nurses for advice problems with medication.

Assessment of a new calendar pack—the ‘C-Pak’

Seventy-eight elderly patients in hospital were studied for up to four weeks to assess drug compliance. Forty patients received medication from individualized calendar packs (‘C-Pak’) and 38 received medication from standard bottles. There was no difference in compliance between the two groups, the percentage error for each group being 26%. This result suggests that C-Pak is unlikely to improve drug compliance in unselected elderly patients.

Testing child resistant packaging for access by infants and the elderly

Accidental poisoning of young children by household products and medicines remains a serious problem in many countries. Child resistant packaging, i.e. packages of which the opening and closing mechanisme requires manipulation and/or forces beyond the limits of children’s exertions, has been developed to counter this problem. It is important to standardise field trials of such packaging to ensure adequate protection for the population at risk (the inquisitive and ingenious youngsters), while permitting access by adults. Testing variables which were studied were the age boundaries of the child panel and of the adult panel. Tests were conducted on four types of child resistant reclosable containers; two of the push-and-turn type, two of the squeeze-and-turn type. Inclusion of children between 24 and 41 months old in the test panel did not significantly affect the proportion of subjects who were able to gain access to the containers. However, the inclusion of adults, in the age-range 60–75 yr, in the test was found to provide the best safeguard against overcomplex and difficult packaging coming on to the market. Any standardised tests need to take into account the finding that in a testing situation most of the children between 42 and 51 months do not use their teeth. In normal situations nevertheless, children of one-two years old, the age group in which most of the poisoning accidents happen, frequently resort to using their teeth when they are unable to open containers by hand.

Drug noncompliance in the elderly

Drug noncompliance is a major therapeutic problem for clinicians who deal with the elderly. This group receives 25% of all prescriptions, although comprising only 11% of the population. Clinicians overestimate their patients’ compliance by 100%. One-third of patients always comply, one-third sometimes comply, and one-third never comply. Noncompliance can be determined by pill counts, timing of refills, blood and urine drug levels, and observation of therapeutic effect. Contributing factors to noncompliance include vision, hearing, and memory impairment, side effects, drug interactions, fear of drug dependency, difficulty in obtaining of taking medication, complicated regimens, and lack of confidence in the clinician. Recommendations are given to aid the clinician in overcoming noncompliance. The elderly benefit from verbal instructions reinforced in writing, frequent visits, simplified regimens, clearly labeled, non-childproof containers, and involvement of family members. An illustrative case study is presented.

Poison prevention in the elderly

Poison exposures in the elderly are largely unintentional and, therefore, amenable to prevention techniques. Based on an analysis of the major causes of unintentional exposures in persons age 60 years and older, injury control strategies are applied to poisoning. These strategies address pre-event, event, and post-event phases. Ideas for specific changes to protect the elderly, especially in the areas of labeling and packaging, are presented.

Tamper-resistant packaging: Is it elder-resistant, too?

A tamper‐resistant package has an indicator or barrier to entry that, if breached or missing, can reasonably be expected to provide visible evidence to consumers that tampering has occurred. Regulations to implement tamper‐resistant packaging on all over‐the‐counter drugs and certain cosmetics began in February 1983. Tamper‐resistant packaging, like child‐resistant packaging, may impede access by the elderly and other adults who have mental, motor, and/or sensory disabilities. This article describes: 1) the reasons for the increasing use of over‐the‐counter medications in the prevention and treatment of the major causes of morbidity and mortality in the elderly; 2) the types of difficulties encountered in opening tamper‐resistant packaging; 3) the causes of these inaccessibility problems; 4) the methods to correct them; and 5) testing procedures to determine whether the existing designs of tamper‐resistant packaging are accessible by the elderly and adults with selected disabilities. Testing of individual types of tamper‐resistant packaging, multiple types of tamper‐resistant packagings on the same container, and combinations of tamper‐resistant packagings and child‐resistant packagings on groups of normal elderly people and those with selected disabilities is necessary to guarantee accessibility to the growing number of therapeutically efficacious nonprescription medications used by these populations.

Factors contributing to medication noncompliance in elderly public housing tenants

A study examined the extent and correlates of noncompliance in 155 predominantly elderly public housing tenants. Data were gathered through in-home interviews; only data from tenants taking prescribed medications on a regularly scheduled basis (n= 140) were analyzed. Noncompliance was significantly (p<0.05) associated with taking more than five prescribed medications, an inability to read prescription and auxiliary labels, and difficulty opening flip-off type medication container lids.

The results indicate that attempts to reduce the total number of prescription drug products used in these elderly residents by carefully scrutinizing the need for each prescription drug may enhance compliance. Pharmacists could assist in the detection of elderly patients at risk for medication noncompliance (five or more total prescription medications) by assessing the patients’ ability to read labels on prescription containers for all new drug additions and refills, and by having them try to open a flip-off container lid.

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.