How Using the Right Medication Pill Box Packaging can Dramatically Improve Medication Adherence, A Controlled Study

[youtube  id=Rze3hnYhp8Y?rel=0  width="600" height="338"] Poor medication adherence diminishes the health benefits of pharmacy medications. Elderly patients with coronary heart risk factors frequently require treatment using multiple medications.  This places them at a high risk for medication non-adherence. A study was conducted to test the benefits of using multimed blister packaging to improve medication adherence and its associated effects on blood pressure (BP) and low density lipoprotein cholesterol (LDL-C). The study was conducted at Walter Reed Army Medical Center from June 2004 to August 2006.  It centered around 200 community-based patients aged 65 years or older taking at least 4 chronic medications. After a 2-month run-in phase (measurement of baseline adherence, BP, and LDL-C), patients entered a 6-month intervention phase (standardized medication education, regular follow-up by pharmacists, and medications dispensed multimed blister packaging). Following the intervention phase, patients were randomized to continued pharmacy care vs usual care for an additional 6 months.  It’s Outcome Measures Primary end point of the observation phase was

fame-study-graphic change in the proportion of pills taken vs baseline; secondary end points were the associated changes in BP and LDL-C. Primary end point of the randomization phase was the between- group comparison of medication persistence. The Results for the 200 elderly patients (77.1% men; mean[SD] age, 78 [8.3] years), taking a mean (SD) of 9 (3) chronic medications were enrolled. Coronary risk factors included drug-treated hypertension in184 patients (91.5%) and drug-treated hyperlipidemia in162 (80.6%). Mean(SD) baseline medication adherence was 61.2% (13.5%).  After 6 months of intervention, medication adherence increased to 96.9% (5.2%; P.001) and was associated with significant improvements in systolic BP (133.2 [14.9] to 129.9 [16.0]mm Hg; P=.02) and LDL-C (91.7 [26.1] to 86.8 [23.4] mg/dL; P=.001).  The short version, medication adherence increased from 61.2% to 96.9%. Six months after randomization, the persistence of medication adherence decreased to 69.1% (16.4%) among those patients assigned to usual care, where as it was sustained at 95.5% (7.7%) in pharmacy care (P.001).  This was associated with significant reductions in systolic BP in the pharmacy care group (−6.9 mm Hg; 95% CI, −10.7 to −3.1 mm Hg) vs the usual care group (−1.0mm Hg;95% CI, −5.9 to 3.9mm Hg; P=.04), but no significant between-group differences in LDL-C levels or reductions.  The short version, for those patients that stopped using the blister packaging, medication adherence dropped to 69.1%.  Those that continued with their medications in blister packaging sustained their medication adherence at 95.5%. The Conclusion.  A pharmacy care program using multimed blister packaging led to increases in medication adherence, medication persistence, and clinically meaningful reductions in BP, whereas discontinuation of the program was associated with decreased medication adherence and persistence.

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