Medication packaging: an impact on patient adherence
A White Paper released 2010 by the Center for Health Transformation’s 21st Century Intelligent Pharmacy Project in the US states in its introduction: Non adherence is a tremendous problem…, causing thousands of premature deaths and demanding care that would otherwise have been unnecessary. The estimated cost of patients not taking their medication as prescribed approaches $290 billion.1 Although we don’t have any reliable data for Europe we must assume that they are not very different from those in the U.S.
“The estimated cost of patients not taking their medication as prescribed approaches $290 billion.”
Patient compliance with medicinal therapy is the prerequisite of any successful treatment. It is furthermore the prerequisite for an economic and efficient way of curing illnesses or of improving the general level of human health. Yet compliance is not the rule but the exception. Non-compliance is an issue to individuals whose condition may worsen or who even may die if they fail to medicate correctly. It is however, just as much a concern for the public as non-compliance leads to losses in productivity and increased expenses for modern medication, for better and more efficient drugs. The higher the cost of medication, the higher the cost of non-compliance. It has to be added that the subsequent cost for non-compliance is not only that of the wasted medicines but is compounded by the cost of emergency and acute intervention when medication is not taken. “Increasing the effectiveness of adherence interventions might have a far greater impact on the health of the population than any improvement in specific medical treatment”.2
All this is not new. In 2003 the World Health Organisation published a report under the title: Adherence to Long Term Therapies – Evidence for Action. Derek Yach wrote in the foreword: “Over the past few decades we have witnessed several phases in the development of approaches aimed at ensuring that patients continue therapy for chronic conditions for long periods of time. Initially the patient was thought to be the source of the “problem of compliance”. Later, the role of the providers was also addressed. Now we acknowledge that a systems approach is required.” The report says further: “There is strong evidence that many patients with chronic illnesses including asthma, hypertension, diabetes and HIV/AIDS, have difficulty adhering to their recommended regimens. This results in less than optimal management and control of the illness. Poor adherence is the primary reason for suboptimal clinical benefit. It causes medical and psychosocial complications of disease, reduces patients’ quality of life, and wastes health care resources. Taken together, these direct consequences impair the ability of health care systems around the world to achieve population health goals.”³
“…the subsequent cost for non-compliance is not only that of the wasted medicines but is compounded by the cost of emergency and acute intervention when medication is not taken.”
One aspect of non-compliance, the accessibility of medicines, in particular the role of drug packaging and the effect it has on patients and their ability and willingness to comply with their therapy has received little attention. There is, however evidence that packaging contributes to improving compliance. In their report about infectious diseases, published in 1999, the World Health Organisation states: “Millions of people in developing countries are dying needlessly from diseases that could be easily treated with safe, inexpensive drugs… User-friendly packaging of drugs is a low-cost way of increasing compliance with antimalarial drug therapy. Studies in Ghana show that over 80% of patients given a course of anti malarial drugs packaged in a numbered blister pack finished the course of treatment. Of those receiving loose, unpackaged drugs – the way they are usually dispensed in developing countries – only 65% completed the treatment. A simple packet of fast acting drugs made widely available to parents – together with training to recognize malaria symptoms – could save the lives of many children with severe malaria.”4
What this report says about the treatment of malaria is just as true for most other diseases and is not restricted to the third world. The right way of drug packaging helps compliance. A study carried out by Professor Philip Schneider at the Ohio State University involving 88 Patients aged 65 and over illustrated the importance of calendarized blister packaging as a tool to support patients’ adherence. The percentage of on-time refills was significantly higher for the study group than the control group. The study further revealed that equally the clinical outcomes were significantly better in the study group. “If people can tell whether or not they have taken their medication on a particular day, it improves the chance that they will take the medicine properly.” 5
“The extra cost of printing the days of the week on the blister card and producing them in a way that they hold a week’s consumption or a multiple is so small that this argument cannot serve as an excuse to neglect the patients’ requirements…”
While most of the medicines in Europe are dispensed in blisters, only a small percentage of these are calendar packs. The extra cost of printing the days of the week on the blister card and producing them in a way that they hold a week’s consumption or a multiple is so small that this argument cannot serve as an excuse to neglect the patients’ requirements and ultimately costing the health care systems huge sums of money. Modern technology provides reminder packs at low cost including electronic devices which are capable to communicate with health care providers in order to monitor patients’ adherence and trigger interventions if needed.
Health insurers, health care providers and pharmaceutical companies are well advised to invest into better adherence in both, their own as well as the patients’ interest.
1. 2010 Benchmarks in improving medication adherence (210, May), Healthcare Intelligence Network. Retrieved from http://store.hin.com/2010-Benchmarks-in-improving-Medication-Adherence_p_4006.html .
2. Haynes R.B. et al.: Interventions for helping patients follow prescriptions for medications. Cochrane Database of Systematic Reviews. 2001
4. World Health Organisation Infectious disease report. Publication Code: WHO CDS99.1, 1999
5. Schneider, P., Murphy, L., &, Pedersen, C (2008) impact of Medication Packaging on Adherence and Treatment Outcomes in Older Ambulatory Patients. Journal of the American Pharmacists Association, 48(1), 58-63
About the author:
Tassilo Korab has been in the packaging industry for more than 20 years.
Tassilo Korab is Managing Director of TKM Handelsg.m.b.H., Vienna, Austria, a consulting company in the sector of Flexible Packaging for the pharmaceutical and healthcare industries.
He was one of the co-founders of HCPC-Europe, the Healthcare Compliance Packaging Council, a not-for-profit organization uniting the pharmaceutical industry, packaging materials suppliers, packaging machine manufacturers and patient organisations in their common endeavour to improve drug packaging design in the interest of the patients. He has been representing the organization first as funding member and member of the board and, since September 2005, as Executive Director. He can be contacted at the following email address: firstname.lastname@example.org
Tassilo will be speaking at the upcoming event – Pharma Packaging and Labeling Compliance Conference, 23 – 25 March 2011, Barcelona
Can we improve compliance with packaging?