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Does packaging with a calendar feature improve adherence to self-administered medication for long-term use? A
Barbara K Zedler1, Priyanka Kakad, Susan Colilla
1Venebio, LLC, Richmond, Virginia 23225, USA. barb.zedler@venebio.com
Clinical Therapeutics
|March 15, 2011
Summary
Calendar packaging may improve medication adherence, particularly when combined with other strategies. However, current evidence is limited by methodological flaws, requiring further high-quality trials to confirm benefits and harms.
Area of Science:
- Pharmacology and Pharmaceutics
- Health Services Research
- Clinical Trial Methodology
Background:
- Medication nonadherence, averaging 50%, significantly limits therapeutic benefits of long-term self-administered drugs.
- Patient forgetfulness is a primary cause of unintentional nonadherence.
- Calendar packaging aims to enhance adherence by providing daily and date reminders.
Purpose of the Study:
- To systematically review randomized controlled trial (RCT) evidence on the adherence benefits and harms of calendar blister packaging (CBP) and calendar pill organizers (CPO).
- To evaluate the impact of CBP and CPO on self-administered, long-term medication use.
Main Methods:
- Systematic review following PRISMA guidelines.
- Searched MEDLINE, Web of Science, and Cochrane Library databases up to September 2010.
- Included RCTs of CBP or CPO for daily oral solid medications in adults, with quantitative adherence measures.
Main Results:
- Ten trials (1045 subjects) met inclusion criteria; 9 assessed clinical outcomes or healthcare utilization.
- Six trials reported improved adherence, but only one showed clinically significant benefit (50% seizure reduction with CPO).
- No study conclusively identified harms associated with calendar packaging.
Conclusions:
- Calendar packaging, especially with educational and reminder interventions, may enhance medication adherence.
- Methodological limitations (bias, small sample sizes, short duration, heterogeneity) prevent definitive conclusions on effectiveness and harms.
- High-quality, adequately sized, and powered trials are necessary to establish the clinical effectiveness of CBP and CPO.
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