***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: An estimated 20 million Americans suffer from diabetes . Patients with non-insulin-dependent diabetes mellitus ( NIDDM ) comprise approximately 90 % of the diabetic population . An estimated 10 - 30 % of patients with NIDDM withdraw from their prescribed regimen within 1 year of diagnosis , and of the remainder , nearly 20 % administer insufficient medication to facilitate an adequate reduction in blood glucose . A r and omized trial was undertaken to discern the effect of pharmacy-based value-added utilities on prescription-refill compliance with sulfonylurea therapy and health service utilization . The subjects were 258 Medicaid beneficiaries from the state of South Carolina , previously untreated for NIDDM , prescribed 5 mg of the second-generation sulfonylurea glyburide twice daily  , and monitored with regard to prescription-refill compliance and health service utilization for 1 year . Subjects provided informed consent and were r and omly assigned to one of four experimental groups : ( i ) the control cohort received st and ard pharmaceutical care with each dispensing of glyburide ; ( ii ) the second cohort received st and ard pharmaceutical care and was mailed a medication-refill reminder 10 days prior to each sequential refill date ; ( iii ) the third cohort received st and ard pharmaceutical care and was provided unit-of-use packaging with each prescription-refill request ; ( iv ) the fourth cohort received st and ard pharmaceutical care , mailed medication-refill reminders , and unit-of-use packaging . Analysis of variance ( ANOVA ) procedures revealed that patients receiving mailed prescription-refill reminders , unit-of-use packaging , or a combination of both interventions achieved a significant ( P < or = 0.05 ) increase in the Medication Possession Ratio ( MPR ) for sulfonylurea therapy relative to controls . ( ABSTRACT TRUNCATED AT 250 WORDS BACKGROUND : Concordance , which involves prescribing with rather than for patients , should result in less drug wastage ( non-use ) , but is proving hard to put into practice . One possible way of easing elderly people and prescribers toward concordance is to use a medicines organizer ( MO ) . OBJECTIVE : To document medication wastage , using a pharmacy-prepared reusable MO , and explore , using a qualitative approach , use of this information on communication of individuals ' drug regimens . METHODS : Sixty-two sheltered housing residents , aged ⩾60 years , participated in an exploratory controlled , matched study . The intervention group received medication in the MO , and the control group continued with st and ard packaging . Community pharmacists recorded details of wasted drugs returned during the 3-month study and , for the intervention group , 6 , 9 , and 12 months after the study . Medicines management data were collected from participants . Qualitative interviews were conducted with a sample of general practitioners ( GPs ) and community pharmacists to explore views on the role of the MO . RESULTS : Intervention group wastage was reduced from 18.1 % ( pre study ) to 1 % at 12 months . No data on wastage were collected for the control group after the pre study assessment . Sixty-one percent more prescription changes , including significant decreases in the number of prescribed drugs and dosages , were reported for the intervention group . GPs and pharmacists reported improvements in communication concerning medication-related dialog . CONCLUSIONS : This small exploratory study has shown that a pharmacy-prepared reusable MO provided visual , objective insights into medication wastage . This result ed in improved communication of drug needs and reduced wastage — the foundation for concordance This article reports a r and omized controlled trial design ed to test the effects of special packaging of antihypertensive medication on compliance and blood pressure control . One hundred eighty subjects who had exhibited elevated blood pressure greater than 90 mmHg in the two years prior to the study were recruited from patients receiving care at a community hospital-based family medicine practice . After completing preenrollment interviews and blood pressure measurements , subjects were r and omly assigned to receive their antihypertensive medications either in the usual vials or in special unit dose-reminder packaging . Follow-up interviews  , pill counts , and blood pressure measurements were performed at three-month intervals . There were no statistically significant differences between the control and experimental groups with regard to age , sex , race , employment , education , marital status , insurance coverage , or blood pressure regimens . Prior to the intervention , the experimental group had slightly lower diastolic blood pressure and reported better compliance than the control group . Analyses performed on 165 subjects completing the first follow-up visit revealed no significant improvements in blood pressure control or compliance for patients receiving special medication packaging . While some patients found it easy to remember to take pills packaged using this format , they also found the packages somewhat more difficult and inconvenient to use . In contrast to previously reported work , this study did not demonstrate any significant improvement in compliance with special packaging of antihypertensive medications Adherence to prescribed antihypertensive agents is critical because control of elevated blood pressure is the single most important way to prevent stroke and other end organ damage . Unfortunately , nonadherence remains a significant problem . Previous interventions design ed to improve adherence have demonstrated only small benefits of strategies that target single facets such as underst and ing medication directions . The intervention described here is informed by prospect i ve memory theory and performance of older adults in laboratory-based paradigms and uses a comprehensive , multifaceted approach to improve adherence . It incorporates multiple strategies design ed to support key components of prospect i ve remembering involved in taking medication . The intervention is delivered by  nurses in the home with an education control group  for comparison . Differences between groups in overall adherence following the intervention and 6 months later will be tested . Systolic and diastolic blood pressure levels also will be examined between groups and as they relate to adherence . Intra-individual regression is planned to examine change in adherence over time and its predictors . Finally , we will examine the association between executive function/working memory and adherence , predicting that adherence will be related to executive/working memory in the control group but not in the intervention group Adherence to medications is an important issue in oncology due to the increasing number of anticancer agents , such as targeted therapies , formulated for oral dosing . A prospect i ve , crossover design was utilized in which patients on capecitabine  were r and omly assigned to one of two packaging methods for one cycle , and then switched over to the alternate packaging method in the subsequent cycle . Twenty-five patients were accrued to this study .  Adherence rates were similar when using the daily pill boxes ( 17/21 = 81 % ) and when using the conventional pill bottles ( 18/21 = 86 % ) . However , more patients were satisfied with the daily pill boxes ( 61 % versus 11 % , P = 0.027 ) , preferred the daily pill boxes ( 61 % versus 17 % , P = 0.061 ) , and thought the daily pill boxes were more helpful in reminding them to take their medications ( 50 % versus 11 % , P = 0.070 ) . In conclusion , this small pilot study did not demonstrate that the use of daily pill boxes improved patient adherence with capecitabine , but patient satisfaction and preference for this packaging method were greater than for the conventional pill bottles . Further exploration of this intervention in a larger study is warranted A r and omised trial was undertaken to discern the effect of pharmacy-based value-added utilities on prescription refill compliance with antihypertensive therapy and subsequent health care expenditures . The subjects were 304 Medicaid beneficiaries from the state of Florida , previously untreated for mild to moderate hypertension , prescribed 240 mg of calcium channel antagonist verapamil once daily and monitored regarding prescription refill compliance and health service utilisation for one year . Subjects provided informed consent and were r and omly assigned to one of four experimental groups : ( 1 ) the control cohort received st and ard pharmaceutical care with each dispensing of antihypertensive therapy , ( 2 ) the second cohort received st and ard pharmaceutical care and was mailed a medication-refill reminder ten days prior to each sequential refill date , ( 3 ) the third cohort received st and ard pharmaceutical care and was provided unit-of-use packaging with each prescription-refill request and ( 4 ) the fourth cohort received st and ard pharmaceutical care , mailed medication-refill reminders and unit-of-use packaging . Analysis of variance ( ANOVA ) procedures revealed that patients receiving mailed prescription-refill reminders , unit-of-use packaging or a combination of both interventions achieved a significant ( P < or = 0.05 ) increase in the Medication Possession Ratio ( MPR ) for antihypertensive therapy relative to controls . Receipt of both interventions result ed in a significant ( P < or = 0.05 ) improvement in the MPR for antihypertensive therapy relative to all other groups no significant difference was discerned between groups receiving either mailed prescription-refill reminders or unit-of-use packaging . ( ABSTRACT TRUNCATED AT 250 WORDS Inappropriate prescribing is particularly common in older patients and is associated with adverse drug events ( ADEs ) , hospitalization , and wasteful utilization of re sources . We r and omized 400 hospitalized patients aged ≥65 years to receive either the usual pharmaceutical care ( control ) or screening with STOPP/START criteria followed up with recommendations to their attending physicians ( intervention ) . The Medication Appropriateness Index ( MAI ) and Assessment of Underutilization ( AOU ) index were used to assess prescribing appropriateness , both at the time of discharge and for 6 months after discharge . Unnecessary polypharmacy , the use of drugs at incorrect doses , and potential drug – drug and drug – disease interactions were significantly lower in the intervention group at discharge ( absolute risk reduction 35.7 % , number needed to screen to yield improvement in MAI = 2.8 ( 95 % confidence interval 2.2–3.8 ) ) . Underutilization of clinical ly indicated medications was also reduced ( absolute risk reduction 21.2 % , number needed to screen to yield reduction in AOU = 4.7 ( 95 % confidence interval 3.4–7.5 ) ) . Significant improvements in prescribing appropriateness were sustained for 6 months after discharge A prospect i ve , controlled , crossover study on drug compliance was initiated in 22 elderly patients from a geriatric clinic . Half of the patients received their pills from a commercially prepared calendar mealtime blister-pak ; the remaining patients received their medication from st and ard pill bottles . At the end of three months the two groups were crossed over . Pill count and issuance of a new drug supply were done monthly to assess compliance . It was found that the average noncompliance index was significantly decreased ( 9.17 to 2.04 ) with the blister-pak packaging system . The relationship of age , Folstein mini-mental status , overcompliance , frequency of dosing interval , and living situation were also explored The impact of pill organizers on pill taking was determined in the Trial of Antioxidant Vitamins C and E ( TRACE ) Study , a factorial trial of vitamin C and vitamin E supplementation  in 184 individuals . Participants were recruited in 1996 - 1997 and r and omized to one of two groups ( pill organizer or no organizer ) and to one of four supplement groups for 2 months . The pill count ( observed/expected X 100 % ) distribution was similar in the organizer and no organizer group for both vitamins . Mean differences in changes in serum vitamin levels between active and placebo groups did not differ by pill organizer use . The impact of pill organizers and blister packs was compared in another trial , the Vitamins , Teachers , and Longevity ( VITAL ) Study , in 297 individuals r and omized in 1993 - 1994 to receive study pills either in blister packs or in pill organizers and to take one of two supplements . Among those with lower adherence , the pill count distribution in the blister-pack group exceeded that in the organizer group . Mean differences in serum vitamin E levels between active and placebo groups did not differ by types of pill packaging . In summary , use of blister packs , but not pill organizers , improved adherence as measured by pill counts among those with lower adherence . Neither pill delivery system improved adherence as measured by serum vitamin levels OBJECTIVE To assess the impact of calendar blister pack ( CBP ) use on glycemic and blood pressure control . RESEARCH DESIGN AND METHODS We conducted an 8-month r and omized controlled double-blind study among diabetic patients with poor glucose control ( HbA1c > 9.0 % ) in an urban area of South Auckl and , New Zeal and , with a high proportion of Maori and Pacific Isl and s people . Subjects included 68 consecutive patients , of whom 50 % were prescribed three or more medications per day RESULTS HbA1c was reduced by 0.95+/-0.22 % in the CBP group and 0.15+/-0.25 % in the control group ( P = 0.026 ) . Diastolic blood pressure decreased 5.8+/-1.5 mm Hg in the CBP group and increased 0.1+/-1.9 mm Hg in the control group ( P = 0.0041 ) . Systolic blood pressure did not change significantly CONCLUSIONS CBPs should be considered among diabetic patients with poor glycemic control receiving multiple medications 
    Output:
    
Three studies reported health care utilisation data but overall results are inconclusive .
No optimal dispensing or supply procedures were identified .
Organisation devices may help unintentional medication non-adherence and could improve health outcomes .