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.

Dispensing eye drops from flexible plastic dropper bottles. Part III: Comparison between volunteers and elderly patients

The delivery of drops from flexible plastic dropper bottles by ten healthy volunteers was compared to that by six elderly patients aged 50 years or older. During the dispensing of the drops the air pressure inside the bottle, the weight of the drops and the time necessary to dispense a drop were registered. The influence of the flexibility of the dropper bottle and the design of the dropper tip was investigated. In general, the drop delivery data of the elderly patients were comparable to those of the healthy volunteers. However, the patients squeezed the dropper bottles fitted with a special design dropper tip less strongly as the volunteers, resulting in a lower air pressure difference, but a higher drop weight. For one subject, a patient with severe arthritis, dispensing drops from this special design dropper tip was at the limit of the capability to squeeze. Overall, the stiffness of the dropper bottle had no significant effect on the delivery of drops by the volunteers or the patients. On the other hand, the smaller the inner aperture diameter of the dropper tip, the larger the air pressure difference created inside the bottle and the longer the dispensing time.

Determinants of eye drop size

Ophthalmic solutions are available for multidose or single-dose administration in a wide variety of glass and plastic dropper bottles which deliver drops with a volume between 25 and 70 μl. From a biopharmaceutical and economic point of view, however, smaller volumes of 5 to 15 μl should be instilled. In this review, the technical, pharmaceutical, and therapeutic aspects of eye drop formation and delivery are presented. The different types of containers are described and the determinants of eye drop size are discussed, such as the design and physical characteristics of the dropper tip and bottle, the physico-chemical properties of the solution, and the manner in which the patient dispenses the drops. Preferred and alternative instillation techniques and aids to facilitate the administration of eye drops by elderly patients are described.

Self-application of single-use eyedrop containers in an elderly population: comparisons with standard eyedrop bottle and with younger patients

Purpose: To test whether patients aged ≥80 years can safely and successfully apply eyedrops from a single‐use eyedrop container without support, and to compare the results with those of younger patients using single‐use containers and older patients using standard eyedrop bottles.

Methods: Patients aged ≥80 years who had no physical or mental conditions hindering self‐application of eyedrops and actually did so because of glaucoma or dry eyes were included consecutively in the study group (n=44) in order to perform self‐application of eyedrops from single‐use eyedrop containers. Patients were observed meticulously by two investigators, who documented practical problems during the procedure in a checklist. In control group A (n=22), glaucoma or sicca patients aged between 50 and 65 years applied drops from single‐use eyedrop containers; in control group B (n=28), glaucoma or sicca patients aged ≥80 years used a traditional eyedrop bottle.

Results: Successful application of the drops into the conjunctival sac was achieved by 57% in the study group (95% and 89% in control groups A and B, respectively). Scratching of the eyedrop container along the conjunctiva or cornea was observed in 68% of the study group (41% and 61% in control groups A and B, respectively). Frequency of problems during opening and self‐application of single‐use eyedrop containers in the study group showed an inverse correlation to visual acuity in the better eye and previous experience with this kind of eyedrop container.

Conclusion: Older patients have massive problems in self‐administering eyedrops from single‐use containers. Factors influencing the success of self‐application may include the patient’s previous experience with this kind of eyedrop container and the patient’s visual acuity.

Handling test of eye drop dispenser-comparison of unit-dose pipettes with conventional eye drop bottles

Purpose: The aims of this study were to investigate how elderly people handle single-use eye drop dispensers (unit-dose pipettes) and to compare the performance with conventional eye drop bottles.

Methods: In this open-label study, the handling of unit-dose pipettes and conventional eye drop bottles was compared in 41 elderly people who had little or no prior regular use of eye drop dispensers. The participants tested both types of dispenser once, and the following 7 variables were studied: ease/difficulty of opening the dispenser; influence of the size for handling of the dispenser; influence of the shape for handling of the dispenser; observation of the contents in the dispenser; the feeling of the dispenser in the hand; ease/difficulty of drop instillation on the eye from the dispenser; and overall performance of the eye drop dispenser. The dispensers contained isotonic saline, and a visual analog scale was used for assessment of each of the above variables.

Results: The mean age of the participants was 73 years. A statistically significant difference in favor of the unit-dose pipettes was found with respect to observation of the contents in the dispenser, ease of administration, and the overall performance. Women regarded the unit-dose pipettes generally better than the bottles, but such a difference was not seen in men.

Conclusions: The study participants managed the unit-dose pipettes at least as well as the conventional eye drop bottles. If anything, the unit-dose pipettes appeared to be easier to use.