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.

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.

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.

Preliminary investigation of patient information leaflets as package inserts

In the United Kingdom, patient information leaflets (PILs) are now supplied with all medicines licensed or re‐licensed since January, 1994. This means that, by 1998, all medicines will come with one of these detailed leaflets inside the pack. In a preliminary investigation of the impact of these leaflets, 117 elderly inpatients were questioned on their experience of PILs prior to admission. Ninety‐one (78 per cent) said they had received a PIL and 57 (49 per cent) had read one. The main reasons for not reading a leaflet were the perceived difficulty in understanding and being put off by excessive information. Of the patients who had read a leaflet, 23 (40 per cent) reported difficulty in reading the small print and 26 (46 per cent) said they had difficulty understanding the content. Thirteen patients (23 per cent) reported having to seek help with reading a leaflet. Forty‐two of those who had read a leaflet rated it as helpful. Eleven patients said they had asked for advice from their doctor or pharmacist as a result of reading a leaflet. Nine patients said the leaflet had caused some anxiety, with two stopping their medicine as a result. The move to universal PILs in patient packs is a major development in the provision of information to patients about medicines. This study suggests that elderly patients have problems relating to understanding the content of PILs and reading the size of print used in these leaflets.

Pharmaceutical packaging and the elderly

The use of child resistant containers has been successful in reducing accidental poisoning of children. But it can present difficulties to vulnerable elderly patients who cannot extract their medication from the container. Patients must be encouraged to ask for non-CRCs if necessary and health care professionals must find ways of delivering medication in packaging which is appropriate for the elderly.

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.

‘Inclusive’ design for containers: Improving openability

For many years the standard engineering design approach has been to design for the most common size or ability and hence ensuring that your product is applicable to the broadest proportion of society. Recently, however, this approach has been seen to be flawed, particularly with regards to consumer packaging (although there many examples in other industries, such as transport). This paper outlines a new approach to packaging design that has been termed ‘inclusive’ design.