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.

Quantifying the ease or difficulty older persons experience in opening medication containers

To compare the difficulty experienced by older persons in using various medication containers, 50 noninstitutionalized women and men over 60 years of age were timed while opening 15 containers. Pill and liquid medication bottles with and without child‐resistant closure mechanisms were tested. In addition, other types of medication packaging were evaluated, such as nitroglycerin patches.

All subjects could open each of the non‐child‐resistant containers, though none of the child‐resistant containers could be opened by all participants. For child‐resistant containers, dramatic differences were observed in the proportion of subjects who could open the various designs and in the amount of time required. Subjects’ comments and observations of subjects’ efforts provided possible reasons for some of these differences.

The results suggest that when child‐resistant containers are used, consideration of the type of medication container can significantly reduce inconvenience to older persons. Containers without child‐resistant mechanisms provide the best option for elderly people when access by small children is not an issue.

Opening medicine containers

In connection with self-administration of medicine for patients with rheumatoid arthritis, patients with weak hands and elderly patients in general, the design of many medicine containers makes them awkward to handle for the patients. In this investigation 12 different medicine containers were tested. The 12 containers represent the antirheumatic medicine containers available on the market in Denmark in 1988. Sixty patients participated in the investigation. Thirty had rheumatoid arthritis and 30 had normal hand function. The age range was 40-85 years The patients had the choice between five possible answers concerning each container. In all patients, grip strength was measured. The patients with rheumatoid arthritis were classified in four functional classes, and pulpa-vola distance end thumb–5th MCP point distance were measured. The opening mechanisms of 29% of the antirheumatic medicine containers are unacceptable; these are plastic containers with a “push-off” top and suppository packs. 46%–(containers with screw cap or pressure dispensing) are considered acceptable. For 25% (tablet and capsule blister packs) the patients’ estimate varied. It is important that medicine containers can be opened by the patients without difficulty, so that they do not present a hindrance to a correct intake of medicine or result in an unnecessary admission to hospital. The results of this investigation show that it is of continuous importance to encourage the production of medicine containers that comply with the requirements of the patients.

Unit dose calendar packaging and elderly patient compliance

A controlled trial of the effect of a unit dose system of tablet/capsule calendar packaging (Webster-Pak) on the rate of successful self medication both in hospital and after discharge to the community has been completed in a geriatric assessment and rehabilitation unit. Eighty-four elderly patients, 45 using calendar packs (study), and 39 using conventional bottles or packs (control), were followed for three months after discharge. There was a significant improvement in patient compliance in the study group over controls on discharge (86.7% vs 66.7%), 10 days (68.8% vs 41.0%), one month (64.4% vs 38.5%) and three months (48.9% vs 23.1%) after discharge. Unit dose packaging is a cost effective method of improving the delivery of medicine in elderly patients, and should be available as part of the health budget.

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.

Elderly patients and their medication: A post-discharge follow-up study

Fifty-six elderly patients (age range 65–98 years) discharged from a geriatric unit were visited at home on or after the 5th post-discharge day (median day 8) and their medication assessed.

By the day of the visit, 15 of the 56 had not had a new prescription issued (27%) and 27 patients (48%) had old prescribed medication at home. Forty-one new scripts, issued by general practitioners, should have contained 128 medications if the general practitioners wished to continue unchanged the medication given on hospital discharge. Fourteen drugs (11%) had been added and 17 drugs (13%) omitted. The number of prescriptions issued unchanged was 26/41 (63%). Inaccurately labelled containers and/or changed drug names were found in 28%. Contrary to hospital advice, 47% of medications were issued in childproof containers.

Poor communication between hospital and general practitioners is only part of the problem. Methods to expedite the delivery of new presciptions should be developed.

Dispensing of medicines in compliance packs

Poor patient compliance is increasingly being stressed as the ‘missing link’ in optimal medication usage. Poor compliance is particularly problematic in the elderly population who, due to multiple pathology, often require complex medication regimens. One approach towards the improvement of patient compliance is the use of specially designed compliance packs. The present study was designed to measure the extra time required to dispense typical medication regimens into the compliance packs available in the UK and to examine, via a postal survey, the beliefs and attitudes of pharmacists about compliance tissues. A time and motion study in which five community pharmacists and a pharmacy technician dispensed one week’s supply of medicines (each of three drugs) for five hypothetical patients into each of six different compliance packs (Dosett®, Medsystem®, Week Pound, Pill Mill®, Medidos®, Medi-Wheel® and Supercel® pouches) was carried out. A large variation in the time required to fill the different compliance packs was noted, ranging from 1 min 45 s ± 32 s (mean ± SD; n = 30) for the Dosett to 9 min 59 ± 2 min 16 s for the Supercel pouch system. The survey methodology involved mailing a 10 item questionnaire to all community pharmacists in Northern Ireland (520). The response rate to the survey was 66.5%. Many respondents (84%) felt that non-compliance was a significantly problem in the elderly population. The majority of respondents felt that the best approach towards improving compliance was via the use of a memory/compliance aid, coupled with patient counselling. About one fifth of the responding pharmacists had promoted compliance aids in their pharmacies, while only 9.5% felt that they had a good knowledge of the compliance packs available. Most respondents (93.9%) indicated that they would be willing to dispense medicines for selected elderly patients into compliance packs. There was an almost unanimous opinion that the National Health Service (NHS) should pay for the service.

Medication compliance in elderly outpatients using twice-daily dosing and unit-of-use packaging

Objective: To determine the effect of unit-of-use drug packaging of medications on compliance among elderly outpatients treated with complex medication regimens.

Design: Nonblind, randomized, clinical trial.

Setting: Geriatric outreach health centers in urban public housing units for independent-living elderly people.

Patients: Thirty-one patients (aged ≥60 y), each taking three or more prescribed medications. Patients were randomly assigned to one of three study groups: Group 1 (n=12), no change in dosing or packaging; group 2 (n=10), conventional packaging with twice-daily dosing; group 3 (n=9), unit-of-use packaging with twice-daily dosing.

Intervention: A unit-of-use package consisting of a two-ounce plastic cup with a snap-on lid containing all medications to be taken at the time of dosing.

Main outcome measures: Medication compliance was assessed monthly for six months using tablet counts.

Results: Medication compliance was significantly better in group 3 (92.6 percent) using unit-of-use packaging compared with either group 1 (79 percent) or group 2 (82.6 percent) (p=0.017). Compliance did not differ between groups 1 and 2.

Conclusions: In this small study of elderly outpatients taking three or more medications, unit-of-use packaging and twice-daily dosing improved medication compliance compared with conventional packaging.


Functional ability of patients to manage medication packaging: A survey of geriatric inpatients

This study measured the prevalence of difficulty experienced by elderly inpatients in opening and removing tablets from a range of common commercial medication packagings and in breaking a bar-scored tablet in half. One hundred and twenty elderly patients admitted to a teaching hospital acute geriatric service were tested for their ability to open the container and remove a tablet from it. They were rated as ‘able’ or ‘unable’ to do so. In all, 94 patients (78.3%) were unable to break a tablet or open one or more of the containers. Of the 111 patients taking medication at the time of their admission, 46 (41.4%) were unable to perform one or more tasks necessary to gain access to medications in their own treatment regimen. The factors that were significantly and independently associated with inability to open containers were poor vision, impaired general cognitive function, and female sex. Many of the drug packagings in common use significantly impede access by elderly patients to their medications.

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.

Compliance devices preferred by elderly patients

Many elderly patients take several medications for chronic conditions, a situation which causes problems in compliance with drug regimens. This study surveyed patients’ preferences among four devices designed to make compliance easier: rub-off reminder labels, medication organizer trays, a container cap with a modified alarm clock, and a digital elapsed timer. Thirty-one enrolled patients used each device for one month then reported their ratings of four device attributes–clarity of directions for use, ease of use, convenience, and effectiveness in preventing dosing errors. The patients showed a strong preference for the medication organizer tray and generally preferred less-complex devices to those that were more difficult to learn to use.