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.


Toward inclusive pharmaceutical packaging: An innovation and design process perspective

Pharmaceutical packaging has an increasing importance in aging societies, where
people depend on medicines for their own care and well-being. Previous research shows that pharmaceutical packaging is a source of uncertainties, confusion, and daily struggles. The challenges experienced by users are extensive; the pharmaceutical industry needs to respond with packaging innovation. To address these complex challenges, more research is necessary on packaging that fulfills user needs and capabilities. This research purpose is to investigate innovation and design processes for pharmaceutical packaging, as well as to stimulate the uptake of inclusive design toward pharmaceutical packaging that meets society’s needs.



Statin non-adherence and residual cardiovascular risk: There is need for substantial improvement

Although statin therapy has proven to be the cornerstone for prevention and treatment of cardiovascular disease (CVD), there are many patients for whom long-term therapy remains suboptimal. The aims of this article are to review the current complex issues associated with statin use and to explore when novel treatment approaches should be considered.

Statin discontinuation as well as adherence to statin therapy remain two of the greatest challenges for lipidologists. Evidence suggests that between 40 and 75% of patients discontinue their statin therapy within one year after initiation. Furthermore, whilst the reasons for persistence with statin therapy are complex, evidence shows that low-adherence to statins negatively impacts clinical outcomes and residual CV risk remains a major concern.

Non-adherence or lack of persistence with long-term statin therapy in real-life may be the main cause of inadequate low density lipoprotein cholesterol lowering with statins. There is a large need for the improvement of the use of statins, which have good safety profiles and are inexpensive. On the other hand, in a non-cost-constrained environment, proprotein convertase subtilisin/kexin type 9 inhibitors should arguably be used more often in those patients in whom treatment with statins remains unsatisfactory.


Interventions for enhancing medication adherence

Ways to help people follow prescribed medicines

Background Patients who are prescribed medicines take only about half of their doses and many stop treatment entirely. Assisting patients to adhere better to medicines could improve their health, and many studies have tested ways to achieve this.

Question We updated our review from 2007 to answer the question: What are the findings of high‐quality studies that tested ways to assist patients with adhering to their medicines?

Search strategy We retrieved studies published until 11 January 2013. To find relevant studies we searched six online databases and references in other reviews, and we contacted authors of relevant studies and reviews.

Selection criteria We selected studies reporting a randomized controlled trial (RCT) comparing a group receiving an intervention to improve medicine adherence with a group not receiving the intervention. We included trials if they measured both medicine adherence and a clinical outcome (e.g. blood pressure), with at least 80% of patients studied until the end.

Main results The studies differed widely regarding included patients, treatments, adherence intervention types, medicine adherence measurement, and clinical outcomes. Therefore, we could not combine the results in statistical analysis to reach general conclusions, as it would be misleading to suggest that they are comparable. Instead, we provide the key features and findings of each study in tables, and we describe intervention effects in studies of the highest quality. The present update included 109 new studies, bringing the total number to 182. In the 17 studies of the highest quality, interventions were generally complex with several different ways to try to improve medicine adherence. These frequently included enhanced support from family, peers, or allied health professionals such as pharmacists, who often delivered education, counseling, or daily treatment support. Only five of these RCTs improved both medicine adherence and clinical outcomes, and no common characteristics for their success could be identified. Overall, even the most effective interventions did not lead to large improvements.

Authors’ conclusions Characteristics and effects of interventions to improve medicine adherence varied among studies. It is uncertain how medicine adherence can consistently be improved so that the full health benefits of medicines can be realized. We need more advanced methods for researching ways to improve medicine adherence, including better interventions, better ways of measuring adherence, and studies that include sufficient patients to draw conclusions on clinically important effects.


Economic impact of medication non-adherence by disease groups: a systematic review

Objective To determine the economic impact of medication non-adherence across multiple disease groups.

Evidence review A comprehensive literature search was conducted in PubMed and Scopus in September 2017. Studies quantifying the cost of medication non-adherence in relation to economic impact were included. Relevant information was extracted and quality assessed using the Drummond checklist.

Results Seventy-nine individual studies assessing the cost of medication non-adherence across 14 disease groups were included. Wide-scoping cost variations were reported, with lower levels of adherence generally associated with higher total costs. The annual adjusted disease-specific economic cost of non-adherence per person ranged from $949 to $44 190 (in 2015 US$). Costs attributed to ‘all causes’ non-adherence ranged from $5271 to $52 341. Medication possession ratio was the metric most used to calculate patient adherence, with varying cut-off points defining non-adherence. The main indicators used to measure the cost of non-adherence were total cost or total healthcare cost (83% of studies), pharmacy costs (70%), inpatient costs (46%), outpatient costs (50%), emergency department visit costs (27%), medical costs (29%) and hospitalisation costs (18%). Drummond quality assessment yielded 10 studies of high quality with all studies performing partial economic evaluations to varying extents.

Conclusion Medication non-adherence places a significant cost burden on healthcare systems. Current research assessing the economic impact of medication non-adherence is limited and of varying quality, failing to provide adaptable data to influence health policy. The correlation between increased non-adherence and higher disease prevalence should be used to inform policymakers to help circumvent avoidable costs to the healthcare system. Differences in methods make the comparison among studies challenging and an accurate estimation of true magnitude of the cost impossible. Standardisation of the metric measures used to estimate medication non-adherence and development of a streamlined approach to quantify costs is required.


Adherence to long term therapy, evidence for action

This report provides a critical review of what is known about adherence to long-term therapies. This is achieved by looking beyond individual diseases. By including communicable diseases such as tuberculosis and human immunodeficiency virus/acquired immunodeficiency syndrome;mental and neurological conditions such as depression and epilepsy; substance dependence (exemplified by smoking cessation); as well as hypertension, asthma and palliative care for cancer, a broad range of policy options emerges. Furthermore, this broader focus highlights certain common issues that need to be addressed with respect to all chronic conditions regardless of their cause.These are primarily related to the way in which health systems are structured, financed and operated.


OECD Health Working Paper No. 105 (2018)

Despite  mounting  evidence, amassed  for more  than  four  decades, poor  adherence  to medications still affects approximately half of  the population that receives prescriptions, leading to severe  health  complications,  premature  deaths,  and  an  increased  use  of healthcare services. – – – – Poor  adherence is  estimated  to contribute to  nearly 200,000  premature  deaths  in Europe per year. Patients with chronic diseases are particularly vulnerable to poor health  outcomes  if  they  do  not  adhere  to  their  medications. Mortality  rates  for patients with diabetes and heart disease who don’t adhere are nearly twice as high as for those who do adhere.
– It  is  estimated  to  cost  EUR  125  billion in  Europe and USD  105  billion in  the United   States   per   year   in   avoidable   hospitalisations,   emergency   care,   and outpatient visits.
– The  three   most   prevalent   chronic   conditions – diabetes, hypertension, and hyperlipidaemia – stand  out  as  the  diseases  with  the  highest  avoidable  costs,  for which every  extra  USD  spent  on  medications  for  patients who  do  adhere can generate  between  USD  3  to  13 in  savings  on  avoidable emergency  department visits and inpatient hospitalisations alone.

The  prevalence  of medication non-adherence  varies  considerably  across  conditions  and patient groups. Most of the studies used different assessment methods making it difficult to compare adherence rates across health systems. Overall, among patients with diabetes, hypertension, and hyperlipidaemia:
– 4 to 31% of patients never fill their first prescription;
– of  those  who  do  fill  their first  prescription,  only  50  to  70%  are  taking  their medications regularly (i.e. at least 80% of the time); and
– less than half of these patients are still continuing to take their medications within two years of the initial prescription.



Toward inclusive pharmaceutical packaging: An innovation and design process perspective

Pharmaceutical packaging has an increasing importance in aging societies, where people depend on medicines for their own care and well-being. Previous research shows that pharmaceutical packaging is a source of uncertainties, confusion, and daily struggles. The challenges experienced by users are extensive; the pharmaceutical industry needs to respond with packaging innovation. To address these complex challenges, more research is necessary on packaging that fulfills user needs and capabilities.

This research purpose is to investigate innovation and design processes for pharmaceutical packaging, as well as to stimulate the uptake of inclusive design toward pharmaceutical packaging that meets society’s needs. The research is interdisciplinary with a qualitative, explorative approach based on three studies and five appended papers.

The first study explored state-of-art pharmaceutical packaging use by older patients. Physical constraints regarding packaging design features and the need to support medication management were identified. Subsequent studies were based on empirical investigations.

The second study investigated packaging innovation drivers based on a customer-supplier relationship case study of a brand-owner drug manufacturer, and a packaging supplier.

The third study expanded those findings, through an interview study with stakeholders (top management, mid-management, and specialists) with experience in pharmaceutical packaging innovation and design processes. As argued and shown in the empirical investigations, pharmaceutical packaging innovation is mainly driven by technology and legislation which reinforce standard and incremental packaging design. Furthermore, there are multiple stakeholders’ needs to be balanced.

Findings in this research suggest that if packaging design is to be user-centered and inclusive, stakeholders should be actively involved to broaden the spectrum of driving forces that lead packaging innovation and open up new business opportunities. The empirical studies also revealed different levels and modes of user involvement in pharmaceutical packaging design.

Overall, the research expands the rather technological focus of packaging toward the exploration of industry processes, opening the way for further studies on inclusive design and social aspects of pharmaceutical packaging innovation and design, being the collaboration and involvement of users in these processes also of great interest. Packaging practitioners can benefit from the results obtained to benchmark their own processes. Policy makers and health care providers can reflect about the dilemmas of innovating pharmaceutical packaging that is inclusive and user-centered, and can use the empirical evidence from this research to strengthen and pave the way for new regulations and guidelines. Future agendas may be leveraged from research to other spheres of society, increasing dialog about inclusively designed pharmaceutical packaging and better patient care.