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.

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.

Enhancing patient compliance in the elderly: Role of packaging aids and monitoring

Inadequate compliance with medications is a significant contributor to the costs of medical care in every therapeutic area. No matter how severe the consequence, there is no assurance that all patients will take their medications as prescribed. Elderly patients are a particular concern because of their common deficits in physical dexterity, cognitive skills and memory, and the number of medications that they are typically prescribed.

To overcome problems of compliance in the elderly, healthcare providers are advised to prescribe a simple dosage regimen for all medications to be taken (preferably 1 or 2 doses daily), to help the patient select cues that assist them in remembering to take doses (time of day, meal-time, or other daily rituals), to provide devices to simplify remembering doses (medication boxes), and to regularly monitor compliance.

A variety of compliance aids are available to help patients organise their medications (e.g. plastic boxes) or remember dose times (alarms). Medication packaged in standard pharmacy bottles should be identified with special labels, or dose charts can be provided to check the daily schedule. Single-unit doses, widely used in hospitals, may be cumbersome for elderly patients who have difficulty opening the foil-backed wrappers. Medication boxes with compartments that are filled weekly by the patient, family member or a home healthcare provider are useful organisers that simplify the patient’s responsibilities for self-administration. Microelectronic devices can provide feedback that shows patients whether they have been taking doses as scheduled. Some systems are also designed to notify patients within a day if doses were omitted. No system is optimal for all patients, but elderly patients deserve a comprehensive assessment of their needs to enhance medication compliance.

Reducing medication errors through naming, labeling, and packaging

Errors due to look-alike or sound-alike medication names are common in the United States, and are responsible for thousands of deaths and millions of dollars in cost each year. Up to 25% of all medication errors are attributed to name confusion, and 33% to packaging and/or labeling confusion. Thousands of medication name pairs have been confused based on similar appearances or sounds when written or spoken, or have been identified as having the potential for confusion. Systems and recommendations have been developed that may reduce the occurrence of such errors.

Importance of calcium co-medication in bisphosphonate therapy of osteoporosis: An approach to improving correct intake and drug adherence

Background and objective: In all of the large, pivotal, multicentre trials of bisphosphonate therapy, patients have received added calcium in amounts ranging from 500 to 1000 mg/day above individual dietary intake. Accordingly, calcium supplements or calcium/vitamin D combinations are currently recommended as co-medication with anti-resorptive therapy in all recently published guidelines on the treatment of osteoporosis. However, the consistent use or effectiveness of calcium may be impaired by several factors in the individual patient, including low prescription rate or lack of advice to purchase calcium, reduced adherence because of the complexity of the regimen, and incorrect intake (e.g. taking calcium with bisphosphonates at the same time). Patients with osteoporosis who adhere to drug therapy experience a significantly lower fracture rate. Therefore, there is a need to improve correct intake of bisphosphonates together with calcium supplementation, which may enhance adherence. The dosage regimen could be simplified by providing the two compounds in an integrated pack. Such a pack, containing one tablet of risedronic acid and six calcium carbonate tablets (Actonel®, Procter & Gamble Pharmaceuticals, Weiterstadt, Germany), has been developed to facilitate correct intake. In this study, the impact of this fixed-combination pack on patient understanding of dosing instructions and on preference was tested by comparing the fixed combination with separate risedronic acid and calcium packages.

Patients and methods: A new blister strip was developed containing one tablet of risedronic acid 35mg and six tablets of calcium carbonate 1250mg (500mg elemental calcium), representing 1 week of therapy; the control was the same medications in separate packaging. The study was conducted in a cohort of 164 postmenopausal women (mean age 69 years). Half of the participants were bisphosphonate users (n = 83). The combined understanding of five instructions — risedronic acid intake in the morning, only with water, without food, without other medication, and separate from calcium — was tested in a crossover design. Participants were also asked to state their preference for the combination packaging versus separate packs.

Results: Understanding of the five instructions for the separate packaging was 70%. The combination pack significantly improved understanding of these instructions to 80% (p < 0.05). Eighty-three percent of participants preferred the combination pack over separate packs (p < 0.05). The most frequently given reasons for preferring the combination pack were prefer one pack over two packs, easy/convenient to use/practical/handy, easy to understand/less confusion, and easier to remember/less likely to forget.

Conclusions: The availability of a fixed-combination pack of risedronic acid 35 mg/week and calcium tablets can increase the likelihood that postmenopausal osteoporotic patients will receive both a bisphosphonate and calcium, which in turn is likely to enhance the correct intake of combination therapy.


Identifying compliance issues with prescription medicines among older people: A pilot study

Background: Older people are at greater risk from polypharmacy and adverse effects due to interactions and altered pharmacokinetics. They may also have greater difficulty managing their medicines and complying with dosage regimens for various reasons.

Objective: To identify the types of medicine compliance issues that occur among older people.

Method: The study was undertaken in suburbs of the city of Auckland, New Zealand. A sample of 31 older people (≥65 years of age) living in the community consented to participate in the study. Semi-structured interviews and observation were used to determine how older people were managing their medicines. Observation of the interaction between the pharmacist and older person was performed to gather baseline information and semi-structured interviews were undertaken within 1 month to determine how older people were using their medicines and to identify compliance issues surrounding their use of medicines. Observation of the pharmacist-older person interaction was undertaken in the pharmacy where the older people usually collected their medicines, and participants were subsequently interviewed in their homes. The main outcome measure was compliance issues associated with the use of medicines.

Results: The main issues identified were alteration of labelled medicine instructions; transferring medicine into other containers and the associated labelling and safety issues; and patients not taking medicines for various reasons, including swallowing difficulties, expense, difficulty in opening packaging, confusion about the regimen and adverse effects experienced and personal reasons. There was an average of five compliance issues per participant.

Conclusion: This study identified intentional and non-intentional compliance issues that could hinder the optimal use of medicines by older people who are at greater risk of medicine-related adverse effects. Large quantities of medicines, confusion, and lack of knowledge as to why a medicine had been prescribed contributed to non-compliance. Appropriate communication between the pharmacist and patient, patient education and aids such as medication cards and referral for medication review could improve compliance in this age group.