To compare adherence one year before and after blister pack implementation in America Indian and Alaska Native (AI/AN) patients and to describe the patient population who used blister packs in the outpatient setting.
Methods:
A retrospective analysis of AI/AN patients receiving blister packs was performed to determine medication adherence as measured by a variable medication possession ratio (MPR). Patient characteristics and the reason for blister pack initiation were also assessed.
Results:
Of the 25 patients receiving blister packs, 76% were female, 56% were elderly and 60% had cognitive impairment. The three most common types of medications used were hypertension meds, vitamins and diabetes meds. The average MPR one year before blister pack implementation was 67.4% and significantly increased to 86.0% one year after.
Conclusion:
Blister packs significantly increased the average MPR after one year of implementation in a small group of AI/AN patients. Blister packs were utilized most commonly in patients who were female, had cognitive impairment, and who were taking numerous medications with a high pill burden in the outpatient setting.
National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Population Health and Public Health Practice; Committee on Community-Based Solutions to Promote Health Equity in the United States; BaciuANegussieYGellerA, et al.Communities in Action: Pathways to Health Equity. Washington, DC: National Academies Press (US), The State of Health Disparities in the United States; 2017. Published January 11, 2017. Accessed May 15, 2019. https://www.ncbi.nlm.nih.gov/books/NBK425844/
9.
ZhangYBaikSH. Race/Ethnicity, disability, and medication adherence among Medicare beneficiaries with heart failure. J Gen Intern Med. 2014;29(4):602–607.
10.
SchmittdielJASteinerJFAdamsAS, et al.Diabetes care and outcomes for American Indians and Alaska natives in commercial integrated delivery systems: a SUrveillance, PREvention, and ManagEment of diabetes mellitus (SUPREME-DM) study. BMJ Open Diabetes Res Care. 2014;2(1):e000043.
11.
CookeCEBresetteJLKhannaR. Statin use in American Indians and Alaska Natives with coronary artery disease. Am J Health Syst Pharm. 2006;63(18):1717–1722.
12.
WongBSMNormanDC. Evaluation of a novel medication aid, the calendar blister-pak, and its effect on drug compliance in a geriatric outpatient clinic. J Am Geriatr Soc. 1987;35(1):21–26.
13.
SchneiderPJMurphyJEPedersenCA. Impact of medication packaging on adherence and treatment outcomes in older ambulatory patients. J Am Pharm Assoc. 2008;48(1):58–63.
14.
CampbellNLBoustaniMASkopeljaEN, et al.Medication adherence in older adults with cognitive impairment: a systematic evidence-based review. Am J Geriatr Pharmacother. 2012;10(3):165–177.
15.
ConnVSRupparTMChanKC. Packaging interventions to increase medication adherence: systematic review and meta-analysis. Curr Med Res Opin. 2015;31(1):145–160.
16.
HuangHMaguireMGMillerER III, et al.Impact of Pill Organizers and Blister Packs on Adherence to pill taking in two vitamin supplementation trials. Am J Epidemiol. 2000;152(8):780–787.
17.
WatsonSJAldusCFBondC, et al.Systematic review of the health and societal effects of medication organisation devices. BMC Health Serv Res. 2016;16:202.
18.
BoeniFSpinatschESuterK, et al.Effect of drug reminder packaging on medication adherence: a systematic review revealing research gaps. Syst Rev. 2014;3:29.
19.
BhattacharyaDAldusCFBartonG, et al.The feasibility of determining the effectiveness and cost-effectiveness of medication organisation devices compared with usual care for older people in a community setting: Systematic review, stakeholder focus groups and feasibility randomised controlled trial. Health Technol Assess. 2016;20(50):1–250.
20.
LinXFrech-TamasFMarrettE, et al.A medication adherence and persistence comparison of hypertensive patients treated with single-, double- and triple-pill combination therapy. Curr Med Res Opin. 2014;30(12), 2415–2422.
21.
ZedlerBKKakadPColillaS, et al.Does packaging with a calendar feature improve adherence to self-administered medication for long-term use? A systematic review. Clin Ther. 2011;33(1):62–73.
ChenSLLeeWLLiangT, et al.Factors associated with gender differences in medication adherence: a longitudinal study. J Adv Nurs. 2014;70(9):2031–2040.
24.
ManteuffelMWilliamsSChenW, et al.Influence of patient sex and gender on medication use, adherence, and prescribing alignment with guidelines. J Womens Health (Larchmt). 2014;23(2):112–119.
25.
WintersAEsseTBhansaliA, et al.Physician perception of patient medication adherence in a cohort of medicare advantage plans in Texas. J Manag Care Spec Pharm. 2016;22(3):305–312.
26.
AndradeSEKahlerKHFrechF, et al.Methods for evaluation of medication adherence and persistence using automated databases. Pharmacoepidemiol Drug Saf. 2006;15(8):565–574.
27.
KarveSClevesMAHelmM, et al.Good and poor adherence: Optimal cut-point for adherence measures using administrative claims data. Curr Med Res Opin. 2009;25(9):2303–2310.
28.
KozmaCMDicksonMPhillipsAL, et al.Medication possession ratio: implications of using fixed and variable observation periods in assessing adherence with disease-modifying drugs in patients with multiple sclerosis. Patient Prefer Adherence. 2013;7:509–516.
29.
TsangJHoC. Complexity and vulnerability of compliance pack preparation: a multi-incident analysis by ISMP Canada. Pharm Connect. 2014;Winter;32–37.
30.
RaynorDKNunneyJM. Medicine compliance aids are partial solution, not panacea. BMJ. 2002;324(7349):1338.
31.
NunneyJRaynorDK. Mind the gap: how compliance aids increase the distance between patients and their medicines. Int J Pharm Pract. 2001;9(suppl):R46.
