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

Vicki S Conn¹, Todd M Ruppar, Keith C Chan

¹University of Missouri , Columbia, MO , USA.

Current Medical Research and Opinion

|October 22, 2014

Summary

Packaging interventions like pill boxes and blister packs significantly improve medication adherence. These methods are most effective when using blister packs in pharmacies, benefiting patients with chronic diseases.

Keywords:

Intervention Medication adherence Medication compliance Meta-analysis

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Area of Science:

Pharmacology and Health Services Research
Evidence-Based Medicine
Patient Adherence Studies

Background:

Inadequate medication adherence is a major contributor to chronic disease complications and increased healthcare costs.
Pill boxes and blister packs are widely recommended packaging interventions to improve adherence.
This meta-analysis evaluates the effectiveness of packaging interventions on medication adherence and health outcomes.

Purpose of the Study:

To determine the overall effect of pill box and blister pack interventions on medication adherence.
To investigate how intervention, sample, and design characteristics moderate the effectiveness of these packaging interventions.

Main Methods:

A comprehensive literature search across 13 databases and 19 registries, supplemented by hand searches.
Inclusion of studies utilizing pill boxes or blister packs to enhance medication adherence.
Random-effects meta-analysis to calculate effect sizes and perform moderator analyses on data from 22,858 subjects across 52 reports.

Main Results:

Packaging interventions demonstrated a significant positive effect on medication adherence, with an average adherence of 71% in treatment groups versus 63% in control groups (effect size 0.593).
Blister packs delivered in pharmacies showed the greatest effectiveness.
Interventions were less effective in older adults or those with cognitive impairment, and studies with continuous data outcomes or pharmacy refill measures yielded larger effect sizes.

Conclusions:

Meta-analysis findings support the use of pill boxes and blister packs to effectively increase medication adherence.
Limitations include the exclusion of other packaging types, potential publication bias, and sparse reporting of health outcomes and moderating variables in primary studies.