Improving Patient Compliance Through Packaging

The pharmaceutical industry embraces new and existing packaging technologies to address ever-growing adherence issues

By Sean Riley, Senior Director, Media and Industry Communications, PMMI, The Association for Packaging and Processing Technologies

There are countless reasons why a patient may not adhere to medication instructions. Multiple prescriptions can make it challenging to track doses, a topical medication may be difficult to apply and a busy schedule can cause even the most compliant patient to forget a pill. Medication nonadherence may account for up to 50 percent of treatment failures, around 125,000 deaths and up to 25 percent of hospitalizations each year in the United States.[1]

Efficacy requires adherence rates of 80 percent or more, but adherence to chronic medications is as low as nearly 50 percent. Moving from hospital care to home care could exasperate the problem as the responsibility to stay on schedule shifts from trained medical professionals to patients and their caregivers. However, a growing number of packaging solutions are on the horizon to improve adherence. Attendees at Healthcare Packaging EXPO (Sept. 23-25, 2019, Las Vegas Convention Center), co-located with PACK EXPO Las Vegas, can explore these innovations in unit dose packaging, serialization and aerosols, which show promise to enhance patient compliance and potentially save lives.

One Dose at a Time

In Oct. 2018, the Support for Patients and Communities Act became law. Aimed at combatting the opioid crisis, the act encourages specialized training for medical professionals and outlines solutions throughout the supply chain.[2] To mitigate opioid overuse and excess supply, it also recommends that unit dose packaging be used to supply initial pain treatment to patients only requiring short-term use, limiting the supply to a minimum of seven days.

Packaging that numerically identifies each dose, like blister packaging, helps eliminate the possibility of pill count errors. Calendarized birth control—adopted in 1960—is probably the best and most-cited example of unit dose packaging for patient adherence. According to data from the National Council on Patient Information and Education (NCPIE), the calendarized blister reminding the patient if they have taken their daily birth control pill has led to a compliance rate of 92-95 percent.  Another study of two groups of elderly patients found that those using unit-dose calendar packaging were more than twice as likely to comply with their medication schedule as their counterparts using non-calendarized packs or pill bottles.[3]

There is wide support for unit dose packaging’s effectiveness in improving patient adherence rates, and pharmaceutical packaging suppliers like Colbert Packaging Corporation provide creative packaging solutions to encourage patient engagement. Colbert’s MedLock® EZ is a patented locking mechanism that improves accessibility and dosage tracking. By fostering patient involvement in the process of taking medication, Colbert hopes to increase patient compliance.

Thanks to automation and machinery improvements, some pharmacists are able to create customized blister packs to help patients better manage multiple medications. Companies package pills into different blisters depending on which medications patients should take together and the time of day for consumption.

Another Side of Serialization

As the US government continues to expand serialization requirements to improve the integrity of the supply chain, pharmaceutical companies and packagers are finding other advantages to the technology. Some companies are using serialization to enhance compliance by tracking patient behavior. Software for tracking serial numbers can be used to establish a means for patients to record that they have taken their medication, and if not, the prescribing physician or caregiver can intervene.

Covectra provides serialization technologies for controlled substance adherence that enables rich information exchanges with patients beyond the examination room. The company’s ControlTrack uniquely serialized blister packaging verifies that the right patient is taking the correct dose over the right period of time, identifying patient issues before they escalate into something severe and costly. The ControlTrack Cloud platform creates evidence-based data, sharable across parties. Patients are enrolled in the cloud and assigned a profile that pharmacies can store as data in the cloud. Patients can connect with physician consultants for periodic consultations on dosages and outcomes can be reevaluated over platforms like Skype and FaceTime.

Adherence during clinical trials is particularly important to ensure the integrity of each drug study. Patients enrolled in a trial may be given a user-friendly mobile application that is programmed to remind them when to take their medicine, and data can be collected to determine overall patient adherence.

Spray It

Sometimes patient compliance issues stem not from forgetfulness or confusion, but from difficulty applying medications correctly, especially in patients with health and mobility issues. Aerosols can help patients with dexterity limitations apply a product without having the reach the application site. One area where aerosols have a major impact on adherence is in topicals, as demonstrated by the rapid growth of spray versions of many consumer healthcare products like antifungals, pain relief medications, antiseptics and sunscreen sprays.

The introduction of sprays can improve the consumer experience with antifungal treatments. Attributes like cooling or the absence of powders and creams on apparel offer a more pleasant application, and encourage effective antifungal use, which often extends well beyond the presence of symptoms. There are also a wide variety of other applications beyond topicals, including nasal sprays, ocular applications, proctofoams and oral forms and sprays. However, it is best to utilize spray formats for applications where product waste is not a concern in the event that the ointment or medication does not properly meet the application site.

Hundreds of lives and approximately $100 to $300 billion in healthcare costs could be saved annually by addressing medication adherence. Pharmaceutical industry professionals can find the latest solutions in unit dose packaging, serialization and aerosol packaging from more than 250 exhibiting companies at Healthcare Packaging EXPO 2019. Owned and produced by PMMI, the shows will also offer educational programming and opportunities to cross-pollinate ideas among industries. At the Innovation Stage, suppliers will address industry-specific solutions and best practices during 30-minute seminars. The Forum offers attendees a unique, interactive learning experience, with free 45-minute seminars sessions on the latest industry trends, including hands-on activities, small group discussions and Q&A sessions. For more information, visit hcpelasvegas.com.

Sean Riley is currently PMMI’s senior director, media and industry communications. He was editor-in-chief of PMMI’s Packaging Machinery Technology Magazine for nearly a decade and has over 20 years of experience working with and as a member of the packaging and processing media.

[1]  https://www.uspharmacist.com/article/medication-adherence-the-elephant-in-the-room

[2] https://www.asam.org/advocacy/the-support-for-patients-and-communities-act-(h.r.-6)

[3] https://advancedtissue.com/wp-content/uploads/HCPC-White-Paper-Improving-Medication-Adherence-with-Packaging.pdf