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.

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.

Medication cards for elderly people: a study

This study describes the benefits of providing patients aged 60 years and over with supplementary written information about their medication regimes. The aim of the study was to measure the effect of a personal medication record card on the information patients could recall about their medication following discharge from hospital. The results demonstrated that the card was favoured by patients and proved effective in assisting them to recall correctly information relating to the name, purpose and special instructions attached to their medicines, as well as helping to reduce errors in administration. The study also found that a significant number of patients from the control group reported difficulties in opening child-resistant medicine containers and to a lesser extent foil and blister packaging.

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.

Problems of geriatric patients with managing drug containers

The purpose of the study was to measure the prevalence of difficulties in elderly inpatients in opening a range of common commercial drug packagings, in breaking a bar-scored tablet, and in reading medication instructions. Sixty-seven patients (female: 47; male: 20, mean age: 81.6 +/- 6.1) who reported that they had managed their medication independently before hospital admission, underwent a comprehensive geriatric assessment. They were also asked to remove tablets and drops from various commercial drug packagings and a “dosett”, to break a tablet, and to read medication instructions enclosed in the packings. Only 21 patients (31%) were able to perform all tasks. Thirty-one patients (46.3%) failed in opening the “push and turn” bottle and 44 patients (65.7%) were unable to open the flip-top container. There were significant differences (p < 0.05) in age, cognitive capacity, handgrip, and manual dexterity between the patients who were able to perform all tasks, and those who were not able to do so. Many of the common medication packagings impede a reliable management of drugs by elderly patients.

Medication compliance and the elderly

Elderly patient noncompliance is one of the most vexing and difficult aspects of the geriatric drug use process. Patient noncompliance in the elderly is a cause for concern that is present and growing. Impacts to improve elderly patient compliance are complex as well and will become more complex as the number and percentage of the elderly increase dramatically in the years to come. Individualized therapies; the provision of enhanced verbal and written patient counseling; and use of unit-dose, blister packaged, and specialized compliance packaging are proven means to the end-point of improvement of elderly patient compliance. All involved in the delivery of health care services to the elderly must realize that in order to improve elderly patient compliance, these and other techniques that allow patients to become and remain compliant must be continuously utilized in the growing geriatric population.

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.