Does Better Packaging Equal Better Patient Compliance?

Researchers have confirmed a common-sense notion: patient compliance with a prescribed drug regimen increases when the packaging is easier to read and understand.

By Paul Thomas, Managing Editor

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If you make drug packaging easier to read and understand, you get better patient compliance and improved patient health. It sounds simple enough, but until recently there has been no solid research to support the assumption.

For the study, Prinivil was placed in blister packages with compliance-prompting features.

A study led by Dr. Philip Schneider and researchers at Ohio State University, in collaboration with Cardinal Health, provides data showing that patients who were given their pills in packaging specially designed to enhance compliance did indeed follow their prescribed regimen better than those in a control group that received medication from traditional prescription pill bottles. What’s more, the study group got healthier faster.

The study was conducted on patients 65 or older suffering from hypertension. The drug used was Prinivil (lisinopril), a hypertension medication manufactured and donated by Merck. The product was selected because its effects are not immediately felt by patients; adherence to regimens is often poor because patients may not sense improvement in their condition, or may forget whether they have taken their daily dosage or not.

The pills were placed in blister packages exhibiting what the researchers call “compliance-prompting features”:
  • A 28-day regimen (“pill calendar”), so that patients begin each new regimen on the same day of the week, making the start date easier to remember (see photo above);

  • A notation next to each pill specifying the day (e.g., Tuesday) on which it is to be taken, thus eliminating confusion over whether that day’s dosage has been taken;

  • Specific, clearly printed instructions on a fold-over blister card (see photo below) telling patients exactly what to do should they, for example, miss a dosage or fail to comply in some other way.
While the packaging had to be senior-friendly, it also had to be child-resistant. It required the patient to operate a trigger mechanism to remove a plastic barrier and gain access to the blister pack.

Among the study’s findings:
  • The Medication Possession Ratio (MPR), a measure of the proportion of days a patient has medication available to be taken, was 6.2% higher for the study group than the control group.

  • The percent of on-time refills was 13.7% higher for the study group.

  • At 12 months, a significantly greater proportion of patients in the study group had lower diastolic blood pressure than those in the control group.
The medication featured specific, clearly printed instructions on a fold-over blister card.

“We were very excited about the data,” says Renard Jackson, executive VP of sales and business development for Cardinal Health Packaging Services. “It shows that if you provide patients with compliance-prompting packaging, it assists in compliance, and improves healthcare.” Jackson has always had a hunch that this was true. Now he has some proof.

Other compliance studies have been done, Jackson notes, but none that actually tracked changes in patients’ health. In previous studies, compliance was measured by counting the number of pills that patients had left following their regimen, he says, but there was no way of knowing whether or not patients had engaged in what is known as “pill dumping.” By monitoring patient blood pressure throughout the study, the OSU researchers could, with a fair degree of certainty, know if pills were being ingested or thrown away.

Why should manufacturers care? Better compliance means a product’s effectiveness will increase. And greater effectiveness and user-friendly packaging mean more sales. “Manufacturers have been waiting to see data like this for a while,” Jackson says. They have been reluctant to spend the money to retrofit packaging lines without clear evidence of the benefits of compliance-prompting packaging, he adds.

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