Packing medications in blister packs, prefilled boxes, or containers with built-in alarms yields small but significant improvements in adherence and clinical outcomes in patients with chronic disease, according to a new systematic review of evidence.
Between 40% and 60% of patients do not take their medication as directed, authors reported in the September issue of The Cochrane Library. Forgetfulness, changes in dosing schedules, and busy lifestyles are common reasons patients don't follow their doctors' orders. Packages designed to jog the memory could help the health care system recoup some of the annual costs of nonadherence, which the New England Healthcare Institute estimates to be $290 billion.
For the study, lead author Kamal Mahtani, MD, of Oxford University, and colleagues examined the findings from 12 randomized controlled trials involving nearly 2,200 participants. Examples of the simple reminder tactics used in the studies include picture-based dosing instructions, packages equipped with daily alarms, prefilled pillboxes, and foil-backed blister packs.
Many of these techniques are already in use by pharmaceutical manufacturers. Also called “compliance packaging” or “adherence packaging,” the containers deliver single doses of medication in unique configurations. According to the Healthcare Compliance Packaging Council (HCPC), packaging gives drug makers an opportunity to engage patients with “compliance-enhancing formats” that “remind people whether they have taken their medications.”
The evidence to support such packaging is promising, but inconclusive, according to the Cochrane review. Just 4 of the trials counted the number of pills patients took—a crucial piece of data in determining whether the reminder systems had a measurable impact on adherence. Among the studies that did provide pill counts, however, reminder packaging increased the number of pills patients took by 11% to 13%.
Examining a pair of hypertension trials led the researchers to another discovery: reminder packaging resulted in better diastolic blood pressure readings. They observed no change in systolic blood pressure, which is the more important determinant of cardiovascular risk in patients older than 50. The evidence of clinical improvement is still worth noting, as few studies have focused on this outcome, according to the reviewers.
“There continues to be an overall paucity of high-quality trials carried out in this subject area,” Dr. Mahtani and coauthors wrote. Testing reminder systems is especially difficult, they explained, because patients who participate in trials may not be those who would benefit most from adherence interventions. They hope the comprehensive review will stimulate more research on the benefits of reminder packaging, especially for patients with hypertension.
“There's no point in developing more medications if people are only taking 50% of the pills,” said Dr. Mahtani. “We need to take a step back and think about how we're delivering the medication in the first place.” To learn more about counseling patients to take medications as directed, read "Counseling for Medication Adherence," published in the September 2011 Pain Awareness issue of Pharmacy Times.
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