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.

Food Packaging Design Accessibility Guidelines

The Food Packaging Design Accessibility Guidelines were originally developed by Arthritis Australia and Georgia Tech Research Institute’s Principal Research Scientist Dr Brad Fain for HealthShare NSW. The guidelines were part of a program designed to address issues patients had with opening portion controlled food packaging, which impacted their independence and nutrition. The guidelines were a world first and are now used to assist brand owners and manufacturers to develop packaging that is easy to understand, read and open by consumers. This is achieved by assisting the packaging industry to understand consumer’s abilities to complete tasks, such as the amount of force consumers can exert when removing a seal or cap.

The Relationship Between Hand Strength and the Forces Used To Access Containers by Well Elderly Persons

OBJECTIVE. This study extended previous work of Rice, Leonard, and Carter [AJOT, 52(8), 621–626] and examined the relationship between grip and pinch strengths and the forces produced while accessing common household containers in healthy, elderly persons.

METHOD. Forty-two women and 9 men 60 years of age and older were assigned randomly to one of four order groups in a counterbalanced, repeated-measures design. Grip strength was measured via a dynamometer and pinch strength via a pinch meter. The forces required to access six common household containers were measured with force sensing resistors applied to each container. Data analysis included Pearson product-moment correlations between the dependent variables of grip and pinch strength and force produced on the containers. Analyses of variance were used to determine differences by gender on the dependent measures and order of presentation of containers.

RESULTS. A fair relationship (r = .31 to .44) was found between grip and pinch strength and the ability to open three containers. Little or no relationship was found between grip and pinch strength and the ability to open the remaining three containers (r = −.03 to .25). Significant gender differences existed on overall strength and the force used to access two of the six containers. No order effects were found.

CONCLUSIONS. Strong relationships did not exist between the grip and pinch strength and the amount of force the elderly participants used to open the containers, which is similar to what Rice et al. found for younger persons. The participants appeared to use a greater proportion of their available strength when accessing the containers than did their younger counterparts previously studied. Further research is needed to determine at what level of weakness one would expect to see performance deficits in common daily occupations.

Applying Universal Design to Child-resistant Packaging

The United States’ Consumer Product Safety Commission (CPSC) administers the Poison Prevention Packaging Act of 1970 (PPPA) in order to protect children from the inadvertent ingestion of dangerous household products, including pharmaceuticals. The current test protocol for child-resistance (CR) and “senior friendliness” indicates that people with “overt or obvious disabilities” or people that cannot open a non-CR package be excluded from testing. Although people with disabilities are significant consumers of prescription drugs, the protocol excludes them. The exclusion of this group from government-directed testing unfairly punishes the elderly, who are more likely to be afflicted by disability than younger consumers. This is despite the fact that this portion of the test is meant to be a test of senior friendliness. Difficulties encountered when using packaging have also been documented to impact patient compliance, which is recognized as a significant problem of the healthcare system in the US. This research hypothesizes that by using an interdisciplinary team and applying the concepts of universal design to CR packaging, users with a wider range of abilities can be accommodated. Inclusionary designs will improve products and benefit all users, not just those with disabilities. Background and significance Drug packages protect and deliver prescription and over the counter drugs (OTC’s), as well as communicate necessary warnings and directions to people so that the pharmaceuticals held within can be used to enhance health. This project addresses two major issues of concern in public health that are related to packaging design: patient compliance and child safety.

Verpackungen von Tabletten – Eine für alle?

Eine Verpackung soll ein Produkt zunächst umhüllen, um es vor äußeren Einflüssen zu schützen. Des Weiteren transportiert sie Produktinformationen zum Endverbraucher und vermittelt Markenbotschaften sowie einen möglichen Zusatznutzen. Einige Verpackungen enthalten sogar Hilfsmittel zum Entnehmen oder Dosieren des Produkts.

Oft ist das Erscheinungsbild einer Verpackung im Regal entscheidend für Impulskäufe. Allerdings machen es manche Verpackungen dem Endverbraucher schwer, an das Produkt zu gelangen. Besonders bei empfind­lichen Anwendergruppen wie den »Silver Agern«, den Konsumenten in einem fortgeschrittenen Lebensabschnitt, kann dies zur Ablehnung des Produkts führen.

Verpackungstechnologische Einflussfaktoren auf leichtes Öffnen und sichere Handhabung von Verbraucherverpackungen

Die vorliegende Arbeit soll sich hauptsächlich mit den Einflüssen der Verpackungsgestaltung auf die erforderliche Öffnungskraft, möglichen weiteren Faktoren wie Motorik und Kognition und die daraus resultierende Verbraucherzufriedenheit beschäftigen. Daraus soll die Bedeutung dieser Einflussfaktoren erstmals in einer der Lebenswirklichkeit von Verbrauchern angelehnten Situation für das Verständnis der Verpackungskonzeption ermittelt werden. Die Kenntnis der Zusammenhänge im Vergleich mit instrumentellen Untersuchungsmethoden eröffnet die Möglichkeit, mit Hilfe der erhaltenen Daten leichtes Öffnen und sichere Handhabung gezielt hinsichtlich bestimmter Merkmale planbar vorherzusagen und zu optimieren.

From the English summary that starts on page 118:
The studies comprise examination of various commercial packages based on target group testing according to CEN/TS 15945. The choice of packages based on the priorities of the BAGSO studies and suspected barriers during opening. The results of the test steps effectiveness and efficiency of the opening procedure and the evaluation of consumers’ satisfaction with the opening procedure  were decisive for the assessment as easy-to-open package. The tests took place under standardized conditions, which were modelled on the situation at domestic kitchen tables. The target group  comprised random samples of people who represent a wide range of life experiences and life situations. With participant’s approval hand movements during opening procedures were documented using videotapes in order to understand and recognize patterns. Instrumental measurements of selected packaging types acted as reference to investigate the required opening force and to detect a possible correlation with the results of the target group testing. The comparison of both methods showed that the required opening force or the applicable force to the packages correlated not primarily with the results of target group tests, they had only minor importance for the consumers ́ satisfaction with the opening procedure. A study of blister packages led to a surprising result: the packages affording greater applied force when opened were evaluated significantly better in target group study than a n equivalent package, which needed less opening force. Similar packages, which required the same maximum force to open, have been rated significantly different in target group testing.

Adherence to long-term therapies: evidence for action

This report is based on an exhaustive review of the published literature on the definitions, measurements, epidemiology, economics and interventions applied to nine chronic conditions and risk factors. These are asthma, cancer (palliative care), depression, diabetes, epilepsy, HIV/AIDS, hypertension, tobacco smoking and tuberculosis.

Intended for policy-makers, health managers, and clinical practitioners, this report provides a concise summary of the consequences of poor adherence for health and economics. It also discusses the options available for improving adherence, and demonstrates the potential impact on desired health outcomes and health care budgets. It is hoped that this report will lead to new thinking on policy development and action on adherence to long-term therapies.

Adherence to inhaled therapies, health outcomes and costs in patients with asthma and COPD

Suboptimal adherence to pharmacological treatment of asthma and chronic obstructive pulmonary disease (COPD) has adverse effects on disease control and treatment costs. The reasons behind non-adherence revolve around patient knowledge/education, inhaler device convenience and satisfaction, age, adverse effects and medication costs. Age is of particular concern given the increasing prevalence of asthma in the young and increased rates of non-adherence in adolescents compared with children and adults. The correlation between adherence to inhaled pharmacological therapies for asthma and COPD and clinical efficacy is positive, with improved symptom control and lung function shown in most studies of adults, adolescents and children. Satisfaction with inhaler devices is also positively correlated with improved adherence and clinical outcomes, and reduced costs. Reductions in healthcare utilisation are consistently observed with good adherence; however, costs associated with general healthcare and lost productivity tend to be offset only in more adherent patients with severe disease, versus those with milder forms of asthma or COPD. Non-adherence is associated with higher healthcare utilisation and costs, and reductions in health-related quality of life, and remains problematic on an individual, societal and economic level. Further development of measures to improve adherence is needed to fully address these issues.

Interventions to Improve Adherence in Patients with Immune-Mediated Inflammatory Disorders: A Systematic Review


In patients with immune-mediated inflammatory disorders, poor adherence to medication is associated with increased healthcare costs, decreased patient satisfaction, reduced quality of life and unfavorable treatment outcomes.


To determine the impact of different interventions on medication adherence in patients with immune-mediated inflammatory disorder

Evaluation of multi-dose repackaging for individual patients in long-term care institutions: Savings from the perspective of statutory health insurance in Germany

Aims and objectives: Elderly people often have difficulty adhering to multi‐drug medication regimens. The current study aimed to evaluate whether multi‐dose repackaging for individual patients reduces medication expenses from the perspective of statutory health insurance in Germany.

Setting: A total of 307 residents, mean age 76.8 years, median age 80 years, from four long‐term care facilities were included in the prospective pre—post study conducted from September 2004 to December 2005. Minimum periods of 9 months prior to and 9 months following the introduction of multi‐dose packaging were compared at the individual level with respect to the expenses for medications that were repackaged in weekly blister packs.

Method: The main outcome measure was savings in medication expenses. Statistical evaluation was carried out using the program Rversion 2.1.0. Adjustments were made for effects of age and con currently increasing morbidity in so far as number of prescriptions were held constant at the individual level.

Key findings: In the subset of 181 people included in this analysis, approximately 6.0% (95% confidence interval, 5.1–7.0%; P < 0.001) of expenses for medication were saved: 2.0% (1.6–2.3%; P < 0.001) was due to price differences and 4.1% (3.2–5.0%; P < 0.001) to reduced wastage of prescribed medication. The probability of being prescribed a generic compared with a brand‐name medication was significantly lower prior to the introduction of repackaging (0.92, 0.89–0.94; P < 0.01), although this did not have any effect on turnover of medications (0.996, 0.988–1.005; P < 0.01).

Conclusion: Significant savings in medication expenses were found. Nonetheless, cost savings should not be the sole objective in reorganising drug dispensing.

How effective is safety packaging

Of 96 ingestions involving safety packaging, 82% involved misuse. The package in some way was unacceptable to the consumer–it was too difficult to open or too difficult to close. Nonacceptance by the elderly was not a significant factor. In only 18% of the safety packaged ingestions, did the child upen the package. The child was more likely to be able to open the screw-cap and the strip-pack. The pop-off and press-lift were not opened by any child but were types misused only by parents. The older child with a record of prior poisoning was most likely to open a safety package. These children would appear to represent a hard core of risk subjects refractory even to safety packaging. Safety packaging has had a dramatic effect on the morbidity and mortality of accidental poisoning. There are two remaining problems that require further study: 1. The analysis of technical factors impeding consumer acceptance and child proofing. The ideal package is so easily handled by the adult that misuse does not occur, but is too difficult for the child to open. 2. The personality characteristics of the safety-package-resistant child. Safety packaging, as implemented by the Consumer Product Safety Commission, has had remarkable success. Education did not reduce accidental poisoning; safety packaging does. Pediatricians, pharmacists, and toxicologists must work with industry and the Consumer Product Safety Commission to complete the goal of elimination of accidental poisoning.