Brunenberg Cost effectiveness Medication events monitoring systems (MEMs) include a ‘smart 2007. of an pill’ container with a cap linked to a microchip that sounds an Netherlands, alert when it is time to take the medication. However, such randomised programme in devices are expensive and the study found no clear evidence controlled hypertensive that MEMs are cost effective. trial. patients Studies with implications for cost effectiveness Boeni 2014. Effect of drug Overall, the studies showed a positive effect of drug reminder Swiss. reminder packaging packaging on adherence and clinical outcomes. However, poor Systematic on medication reporting and important gaps limit the drawing of firm review of 30 adherence conclusions (see critique below). studies. Drug reminder packaging had a significant effect on adherence in a geriatric population [30], for chronic mental illness [31] and for cardiovascular disease [40]. Drug reminder packaging offers a broad field of application and is mostly used for polypharmacy. As a consequence, generalisable clinical outcomes like morbidity or rates would provide viable and comparable results rather than measures of disease-specific clinical parameters. Only two trials investigated such outcomes [44,58], with one showing that drug reminder packaging significantly reduced the mean hospitalisation rate (a study carried out in 2000 Boeni et al 2014, ref 44). – Critique: CRD* and the authors note that the overall methodological quality of the studies included is poor and thus evidence for the effect of drug reminder packaging on adherence is low. Mahtani Reminder Reminder packaging increased the proportion of people taking 2011. UK. packaging for their medications when measured by pill count; however, this Cochrane improving effect was not large. Some evidence was found that reminder review of 12 adherence to packaging may be beneficial in improving clinical outcomes such studies. as blood pressure. medications The authors concluded that reminder packaging for certain individuals may represent a simple method for improving the adherence to medications; further research is needed to improve the design and targeting of these devices. Connor Do fixed-dose Unit-of-use packaging (MDS) is likely to improve adherence in a 2004. New combination pills or range of settings, but the limitations of the available evidence Zealand. unit-of-use means that uncertainty remains about the size of these benefits. Systematic packaging improve review of 15 adherence? A randomised systematic review. trials (12 of unit-of-use packaging).
Brunenberg 2007. Netherlands, randomised controlled trial. Cost effectiveness of an programme in hypertensive patients Medication events monitoring systems (MEMs) include a ‘smart pill’ container with a cap linked to a microchip that sounds an alert when it is time to take the medication. However, such devices are expensive and the study found no clear evidence that MEMs are cost effective. Studies with implications for cost effectiveness Boeni 2014. Swiss. Systematic review of 30 studies. Effect of drug reminder packaging on medication adherence Overall, the studies showed a positive effect of drug reminder packaging on adherence and clinical outcomes. However, poor reporting and important gaps limit the drawing of firm conclusions (see critique below). Drug reminder packaging had a significant effect on adherence in a geriatric population [30], for chronic mental illness [31] and for cardiovascular disease [40]. Drug reminder packaging offers a broad field of application and is mostly used for polypharmacy. As a consequence, generalisable clinical outcomes like morbidity or rates would provide viable and comparable results rather than measures of disease-specific clinical parameters. Only two trials investigated such outcomes [44,58], with one showing that drug reminder packaging significantly reduced the mean hospitalisation rate (a study carried out in 2000 – Boeni et al 2014, ref 44). Critique: CRD* and the authors note that the overall methodological quality of the studies included is poor and thus evidence for the effect of drug reminder packaging on adherence is low. Mahtani 2011. UK. Cochrane review of 12 studies. Reminder packaging for improving adherence to medications Reminder packaging increased the proportion of people taking their medications when measured by pill count; however, this effect was not large. Some evidence was found that reminder packaging may be beneficial in improving clinical outcomes such as blood pressure. The authors concluded that reminder packaging for certain individuals may represent a simple method for improving the adherence to medications; further research is needed to improve the design and targeting of these devices. Connor 2004. New Zealand. Systematic review of 15 randomised trials (12 of unit-of-use packaging). Do fixed-dose combination pills or unit-of-use packaging improve adherence? A systematic review. Unit-of-use packaging (MDS) is likely to improve adherence in a range of settings, but the limitations of the available evidence means that uncertainty remains about the size of these benefits.
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