Packaging interventions to increase medication adherence: systematic review and meta-analysis

Abstract

Objective Inadequate medication adherence is a widespread problem that contributes to increase chronic disease complications and health care expenditures. Packaging interventions using pill boxes and blister packs have been widely recommended to address the medication adherence issue. This meta-analysis review determined the overall effect of packaging interventions on medication adherence and health outcomes. In addition, we tested whether effects vary depending on intervention, sample, and design characteristics. Research design and methods Extensive literature search strategies included examination of 13 computerized databases and 19 research registries, hand searches of 57 journal, and author and ancestry searches. Eligible studies included either pill-boxes or blister packaging interventions to increase medication adherence. Primary study characteristics and outcomes were reliably coded. Random-effects analyses were used to calculate overall effect sizes and conduct moderator analyses. Results Data were synthesized across 22,858 subjects from 52 reports. The overall mean weighted standardized difference effect size for two-group comparisons was 0.593 (favoring treatment over control), which is consistent with the mean of 71% adherence for treatment subjects compared to 63% among control subjects. We found using moderator analyses that interventions were most effective when they used blister packs and were delivered in pharmacies, while interventions were less effective when studies included older subjects and those with cognitive impairment. Methodological moderator analyses revealed significantly larger effect sizes in studies reporting continuous data outcomes instead of dichotomous results and in studies using pharmacy refill medication adherence measures as compared to studies with self-report measures. Conclusions Overall, meta-analysis findings support the use of packaging interventions to effectively increase medication adherence. Limitations of the study include the exclusion of packaging interventions other than pill boxes and blister packs, evidence of publication bias, and primary study sparse reporting of health outcomes and potentially interesting moderating variables such as the number of prescribed medications.

The Effectiveness of Medication Adherence Interventions Among Patients With Coronary Artery Disease

“…These positive findings are similar to prior meta-analyses examining MA outcomes from MA interventions among underrepresented groups and from packaging intervention effects. 46,47 Although poor MA has been linked to negative health outcomes in patients with CAD, 4,6,7 consensus on the how much MA is needed to improve varied CAD-related outcomes is not yet clear. Prior research exists exploring MA and blood pressure outcomes 48, 49 and cardiovascular disease risk.…”

Meta-analyses of Theory Use in Medication Adherence Intervention Research

“…Most meta-analyses have synthesized narrow sets of primary research focused on patients with specific diseases; 11–13 patients with certain demographic characteristics such as ethnicity or age; 14,15 interventionists such as pharmacists, physicians, or nurses; 16–19 and types of interventions such as dosing frequency, 20–22 reminder systems, 23 and packaging. 24,25 None of these focused meta-analyses nor the few broader meta-analyses 26–28 have addressed the theories or models used to develop interventions.…”

Study to Measure the impact of Pharmacists and Pharmacy Services (STOMPP) on Medication Non-Adherence: Medication Adherence and Clinical Outcomes

“…[18][19][20] This can replace pill boxes that patients or caregivers typically fill after receiving their prescriptions in pill bottles. 17 To reduce multiple trips to the pharmacy, pharmacies are able to synchronize patients' medications to be filled on one day. This program is called medication synchronization, or med sync.…”