Compliance Packaging Research Articles

A retrospective review of the impact of immunization eCare plans in community-based pharmacy setting

BackgroundThe Pharmacist Electronic Care (eCare) plan is an electronic documentation and billing platform that allows for exchanging and integrating pharmacy patient care information. eCare plans make it easier for pharmacists to track recommendations and referrals to both patients and providers and to bill for services. ObjectivesTo determine the impact on the type and number of vaccines administered after the completion of immunization eCare plans and to examine sociodemographic differences in patients who received immunizations were documented in an eCare plan in a community-based pharmacy setting. Practice DescriptionBremo Pharmacy is an independently owned pharmacy located in Richmond, Virginia. Bremo Pharmacy offers a medication synchronization program targeting patients for enrollment in compliance packaging and clinical services. Practice InnovationBremo Pharmacists use eCare plans to track patient and provider interactions, goals, and medication-related information. Pharmacists used eCare plans to document vaccine recommendations and interactions with patients as a tool to increase vaccinations. Evaluation MethodsReports were generated to extract data containing information from each eCare plan during the intervention period and the number and type of vaccines administered 1 and 2 years before the intervention. Percent change was used to calculate the change in vaccines administered between years. The sociodemographic data was analyzed using descriptive statistics and bivariate statistical analysis using SAS 9.0 (Cary, NC). ResultsThere were a total of 1105 immunization eCare plans completed. An increase of 136.6% in vaccines administered occurred after the implementation of the eCare plans. While the number of vaccines administered increased, no significant differences were found in vaccine uptake by gender or age. ConclusionImmunization eCare plans are a useful tool to help pharmacists increase the number of vaccines administered in an independent pharmacy.

Worth the wait: How South Africa's renewable energy auctions perform compared to Europe's leading countries

Auctions for renewable energy support allocation are on a triumphant global advance. We compare performance of renewable energy auctions in terms of effectiveness (realisation rate and period) and efficiency (price outcomes) from two world regions: South Africa and European countries (Germany, France, the Netherlands). We develop an assessment framework for compliance incentivisation in auction design, covering qualification criteria, penalties, and compliance monitoring. We find that a 100% realisation rate in South Africa is connected to a strong compliance package, while European countries have moderate realisation rates (23%–87%) with relatively lenient compliance packages. We observe that realisation periods are correlated with project size rather than granted realisation period. Although South African projects generally have longer realisation periods (34 months for PV and 40 months for onshore wind) than European projects (16.5–30 months for PV and 19–25 months for onshore wind), they perform comparably considering that they are 10–13 times larger. Comparing average auction prices with equivalent technology-specific LCOE estimates, we find a general convergence towards the global average, with South Africa having the sharpest price decline (75% PV and 54% onshore wind), albeit starting from the highest level. Our findings, especially on importance of compliance incentivisation and weak impact of granted realisation periods, are valid across world regions and can support policymakers everywhere in designing effective and efficient renewable energy auctions.

Patient Medication Adherence Among Pharmacies Participating in a North Carolina Enhanced Services Network.

Improving medication adherence can reduce health care spending, and studies have demonstrated community pharmacists can positively affect adherence through the provision of enhanced services. The North Carolina (NC) Community Pharmacy Enhanced Services Network (CPESN) was formed in early 2014 with the goal of enhancing the care provided through its network pharmacies. To evaluate differences in medication adherence performance scores between pharmacies that participated in the NC-CPESN and control pharmacies in NC that did not. Medication adherence performance data for statins, renin-angiotensin system antagonists, oral diabetes medications, and a custom multiple chronic medication measure were gathered from quarterly reports between December 2014 and September 2016. Data for these quarterly reports were derived from NC Medicaid claims. These data were combined with pharmacy demographics and service offerings data from the National Council on Prescription Drug Plans dataQ database. Descriptive statistics were used to evaluate differences in demographics and service offerings between study cohorts. Generalized estimating equations were used to evaluate the relationship between medication adherence and pharmacy cohorts, demographics, and service offerings. There were 267 enhanced services pharmacies and 1,872 control pharmacies included in this analysis. Enhanced services pharmacies were much more likely to be independent pharmacies, located in rural counties, offer multidose compliance packaging, and offer delivery services, but were less likely to offer 24-hour emergency services. Persistently higher adherences scores were observed for enhanced services pharmacies, with differences across measures ranging from 3.0% to 7.2% (P < 0.001). In multivariable models, the difference between enhanced services and control pharmacies was explained by differences in offerings of multidose compliance packaging and delivery services, which were associated with 3.4%-8.2% and 3.3%-4.0% improvements in adherence, respectively (P < 0.001). This study found that enhanced services pharmacies had greater adherence performance scores for the NC Medicaid population. These differences appear to be due to CPESN enhanced services pharmacies' offering of multidose compliance packaging and delivery. Future work is needed to expand this analysis to other populations, as well as to explore the relationship between delivery and adherence. The project described was supported by Funding Opportunity Number 1C12013003897 from the U.S Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies. Ulrick reports consulting fees from Pharmacy Quality Solutions, unrelated to this work. Bhosle is an employee of Community Care of North Carolina, the not-for-profit company that sponsored the North Carolina enhanced services pharmacy network, and CPESN USA, a for-profit company that developed out of the original grant-funded project. Farley has nothing to disclose.

The SOLVIT Network: State of the Art and Possible Future Developments

After two decades from the first policy documents and the setting up of the SOLVIT network, the European Commission adopted an Action Plan on the reinforcement of SOLVIT, as part of a packageof measures aimed at enhancing compliance with EU law and at improving the functioning of the internal market (the 'compliance package'). With the Action Plan the Commission renews its commitment to improving the quality of SOLVIT's services by working from different viewpoints and in strict cooperation with the Member States and the other European institutions. Also, the Action Plan is leading the way towards future developments of the network, having regard to its relations with the Commission, its objectives and its role in the integration of the internal market. Most importantly, however, the Commission is making it clear that SOLVIT is, among other things, a mechanism to enhance 'compliance', in particular by ensuring the effective application of EU law by national public administrations and by helping citizens and undertakings to avail themselves of their European rights and liberties.

Innovative Packaging of Medicines

Packaging innovation has a large role to play in the pharmaceutical market. Whether it is to improve pack protection, deliver convenience and ease of delivery or encourage patient compliance, pharmaceutical packaging constant innovation is key to ensure patient safety. In the pharmaceutical industry, efficient and intelligent packaging has much more potential which includes, Compliance Packaging, Anti counterfeit packaging etc. Keeping drugs secure from young children while ensuring user-friendliness to seniors is one of the main objectives of pharmaceutical packaging companies. That is why the new packagings industries are trying to include smart solutions like Child-Resistant Packaging, Prefilled syringe, Diskus Inhaler Technique, Ecofriendly Packaging, CYPAK'S, Marijuanna Extract BilcareOptimaTM, Ecoslide, Catalent's Delpouch. In this series of packaging innovations, we bring to you the recent trends in the pharmaceutical packaging.

Clinical Quality Performance Measurement: An Example of a University Hospital

AIM:In our study, in terms of clinical quality measurement approach, we aimed to focus on whether there was a considerable difference between the treatment received and the treatment required to be taken by patients by using nine packages. METHODS: The research was conducted as retrospective study, which was carried out in a university hospital with 300 beds between January 01 and August 30, 2012. Patient records were determined by a random sampling method. The 9 performance measurement sets developed by were used as a tool of data collection, which consisted of heart attack care, intensive care, Childern’s asthma care, pnuemonia care, heart failure care, venous thromboembolism care, stroke care, perinatal care, and inpatient psyciatric care. The findings were analyzed in comparison with the findings of The Joint Commission RESULTS: The mixed compatibility rate of all packages was determined to be 55,33%. Only the pneumonia package package was determined to be incompatible with Turkey. The heart attack package was found to be very close to the average of the findings of The Joint Commission. Paralysis of the package was at least compliance package, which was found to be 20.08%. The average of pre-natal care (48,6 %) was found 0.5 point higher than the average of The Joint Commission. The only a heart attack package (%97,9) passed the threshold of 90 %. CONCLUSION: We determined that The Accountability Measures of the Joint Commission could be applied in the present conditions of Turkey. Only the Pneumonia package needs new requirements to be specified for Turkey. There is no need for a compatibility studies as for the others. Surgical care, heart attack, perinatal and venous thromboembolism packages are the ideal packages for Turkey.

Embodying the principles of clinical pharmacy

Recently my technician was upset about a call she received from a pharmacy benefi t manager (PBM) who wanted to know why we were fi lling a 30-day supply for a patient who had been getting a 90-day supply from another pharmacy. She explained that the patient, who has an intellectual disability, was referred to our pharmacy for assistance with medication adherence and specialized compliance packaging due to his nonadherence history and past challenges in managing his medications.

Pharmacists' performance of clinical interventions during adherence support medication reviews

In New Zealand, pharmacists are funded to provide adherence support to their patients via a service called "Medicines Use Review" (MUR). The service is based on the assumption that the medication regimen is clinically appropriate and therefore does not include a clinical review. However, whether or not pharmacists make clinical recommendations to patients during MUR is unclear. To identify the types of drug-related problems (DRPs) and interventions provided during MUR in order to understand whether clinical interventions occur. A single district health board that funds MUR services was identified. The MUR providers that conducted MURs during the period (from 2007 - December 2011) were invited to participate. All MUR consultation records were reviewed and the data extracted were categorized according to the DRP Classification Scheme v6.2 by Pharmaceutical Care Network Europe (PCNE). DRPs that did not fit into the criteria were documented separately. Consultation records for 353 individual patients were obtained from five MUR providers. Of these patients, 56.4% were female and the median age was 73years. A total of 886 DRPs were identified and resulted in a total of 844 interventions. During this period, 2718 medications were prescribed to these MUR patients. The most frequent DRPs identified were problems with "health literacy" and "non-adherence" to medications. However 18.1% (n=160) of the DRPs were perceived as a clinical review that went beyond the practice of MUR. The most common intervention was "patient counselling" (20%), "compliance packaging provided" (16%) and "recommendation to change medication" (11%). In this study, pharmacists perhaps based on ethical, legal and moral obligations provided clinical interventions that exceeded those expected and funded in a MUR. Since MUR detected a low number of clinical DRPs when compared to clinical medication review services conducted previously, a funding system that only supports MUR might not provide the important clinical support required by patients. Patients who receive only MUR may potentially be missing out on optimal care.

Community pharmacists’ perceptions of services that benefit older people in New Zealand

There is limited information in New Zealand about community pharmacists' perceptions of services that benefit older people. To explore the perceptions of community pharmacists' of services that benefit older people; the benefits perceived; and the experiences of pharmacists providing such services. Community pharmacies in New Zealand. A cross-sectional purpose-developed survey was carried out of all community pharmacies in New Zealand. This was followed by twenty qualitative telephone interviews of pharmacists identified as providing at least one specialized service. Interviews were recorded, transcribed verbatim, and coded for themes using constant comparison. Community pharmacists' opinions and perceptions in the cross-sectional survey and qualitative interviews. Responses were received from pharmacists in 403/905 evaluable pharmacies. All pharmacies provided some baseline services (advice, dispensing of prescriptions, medicines disposal) and 90% provided home deliveries of medicines. Adherence to medicines was supported by compliance packaging (96%), medication review (Medicines Use Review, MUR) (28%), and repeat prescription reminders (27%). Thirty-five percent provided screening (e.g. cholesterol, blood pressure), and 32% provided medicines education to community groups. Compliance packaging and home delivery were thought the services most beneficial for older people, and should help people adhere to their medicines. The 20 pharmacists interviewed by telephone provided 20 different specialized services (median 2, range 1-4). These included MUR, services to residential homes, visiting educators/special clinics, INR monitoring, services to hospices, and flu vaccination. Benefits perceived included improvements in adherence, patient safety, and patient-knowledge of medicines, and convenient access to services. "Patient need" was a frequent driver of services, and common facilitators for services were having appropriate training/skills, co-operation with health professionals, peer or expert support, sufficient time and funding. A lack of these facilitators were considered barriers as were resistance from general practitioners or the general public, or high set-up costs. Community pharmacists in New Zealand perceived they provide a range of services of potential benefit to older people for managing their medicines. Establishing new services requires cooperation from other health professionals, peer support, training, funding and time. Further research into patients' outcomes from new and established services is needed.

Evaluation of the Accuracy of the Saskatchewan Health Pharmaceutical Information Program for Determining a Patient’s Medication Use Immediately before Admission

The Pharmaceutical Information Program (PIP) administered by Saskatchewan Health provides records for individual patients of prescription medications and some over-the-counter products obtained with a prescription and processed through the provincial drug plan. Use of the PIP to assist in obtaining a medication history on admission to hospital has been advocated; however, the accuracy of the database has never been investigated. To quantify the extent of agreement between a patient's PIP profile and a Best Possible Medication History (BPMH) for determining the patient's prescription medication use on admission to hospital. General medicine patients admitted to 1 of the 2 clinical teaching units at the authors' hospital were reviewed for eligibility. A copy of the patient's PIP profile was printed, reviewed, and used in the course of obtaining a BPMH from consenting patients. The number and type of medication discrepancies and the time required to complete medication histories were documented. Fifty patients were interviewed. For 39 patients (78%), one or more prescription discrepancies were identified between the PIP profile and the BPMH (mean 2.0, standard deviation 2.3, range 0-6). The top 3 prescription discrepancies were medication incorrectly appeared inactive in the PIP profile (49/101 discrepancies [49%]), dosing discrepancy (28/101 [28%]), and medication did not appear in the PIP profile (13/101 [13%]). The most common reasons for prescription discrepancies were recent change in dosage or medication (18 [18%]), compliance packaging (13 [13%]), noncompliance (12 [12%]), and entry error at the dispensing pharmacy (12 [12%]). Mean total time to prepare for and conduct interviews was 22.5 min (range 10-54 min). A patient's PIP profile may contain incomplete, inaccurate, or misleading information. Although the profile may be used to prompt the health care provider during a BPMH interview, it should never be used as a substitute for communicating directly with the patient.

Compliance packaging for over-the-counter drug products

In view of the serious health risks and high costs to the health-care system of misuse and abuse of over-the-counter (OTC) analgesics, this article describes a rationale and prototype for new safety or compliance packaging for OTC drug products that are sold in pill form (e.g., tablets, caplets and gelcaps) inside blister packs. The proposed packaging is not simply promoting the use of blister packs for pills; that utility is already well known. It is an integrated system in which blister packs of pills can, themselves, be packaged, labeled and sold, offering a dose-directed unit-of-use design with enhanced warnings and directions to help prevent consumers from taking more than the instructed dose of pill-form medicines. Literature and information searches were conducted in publicly available databases and websites to (1) assess safety problems (serious adverse events and fatalities) associated with OTC analgesics and (2) determine public perceptions and knowledge about their use. Each year in the US, there are an estimated 100,000 hospitalizations and 16,500 deaths due to NSAID overdosing, and 26,000 hospitalizations and 1,600 acute liver failure cases due to acetaminophen poisoning. Many adults take more than the recommended dose and in some cases use multiple products containing acetaminophen and ibuprofen. Risk factors, such as alcohol use or pre-existing liver disease, exacerbate problems associated with acetaminophen misuse and abuse. In pediatric cases, dosing errors are often related to confusion over different product formulations, dosing strengths, and the use of inappropriate dosing devices. Consumers are often unaware of the active ingredients in, and correct doses of, drugs they are taking; they underestimate the risks associated with misuse of OTC medicines, and they frequently discard the packaging on which the drug’s directions, warnings and dosing instructions are located. Optimal compliance packaging should (1) keep the instructions, warnings and dosing directions attached to the blister card of pills at all times, thus avoiding the problem of cartons and package inserts being thrown away once the package is opened; (2) increase the surface area of the packaging, without adding bulk, to provide space for the use of larger font sizes and enhanced directions and warnings that are more conspicuous, explicit and memorable; (3) organize the pills into logical, unit-of-use (per-dose maximum and per-day maximum) sets or rows; (4) limit the number of pills in a unit-of-use package to coincide with the instructed maximum dose and maximum days of use for a specific product.

Detection methods and strategies for improving medication compliance

The reliability of compliance detection methods and practical strategies for improving patient compliance with drug therapy are reviewed. Detection of noncompliance is a necessary prerequisite for adequate treatment. Noncompliance can be detected by indirect methods (e.g., self-report, interview, therapeutic outcome, pill count, computerized compliance monitors) or direct methods (e.g., biologic markers, tracer compounds, biologic assay of body fluids). In general, the direct methods of detection have a higher sensitivity and specificity than the indirect methods. Computerized compliance monitors are the most recent and reliable of the indirect-detection methods. Strategies for improving compliance involve identification of risk factors for non-compliance; development, with the patient's participation, of an individualized treatment plan that simplifies the regimen as much as possible; education of the patient, including information about his or her illness, instructions on how to take the prescribed medication correctly, and an explanation of the benefits and possible adverse effects of the therapy; and, if necessary, use of compliance aids such as medication calendars, special containers, caps, and dispensing systems, or compliance packaging. The patient should be taught to monitor his or her own treatment regimen. Follow-up monitoring by health-care professionals, including pharmacists, will also help ensure that the patient is complying with the treatment regimen. Health-care practitioners need to understand factors that contribute to noncompliance and to use effective methods for assessing and monitoring compliance in conjunction with strategies aimed at increasing compliant behavior.

No Clinical Effect of Back Schools in an HMO A Randomized Prospective Trial

In a prospective trial, 222 adults with low-back pain of at least 2 weeks' duration in a Health Maintenance Organization (HMO) were randomly assigned to usual care (UC), a 4-hour back school psychoeducational session (LBS), or the same back school plus a 1-year "compliance package" program designed to encourage appropriate self-management for back pain (CP). Sixty-four percent of LBS and CP subjects attended their back school sessions. Follow-up measurement of pain level (using the Visual Analogue Scale), functional status (using the Sickness Impact Profile), and various other indicators of health status showed no measurable effect of either treatment condition (LBS or CP) compared with UC at 3, 6, 12, and 18 months after entry into the study. Initial disability resolved by 3 months in most patients, and a minority of subjects (10-15%) showed residual or recurrent functional impairment 1 year after entry. Health care utilization tended to be slightly higher after intervention in the CP group. With or without follow-up encouragement, back school instructions given in a single 4-hour session had no measurable impact on the comfort or functional status of the majority of patients with new onset back pain in this HMO.

Compliance Packaging: A Patient Education Tool

As a direct response to the profound negative impact that the high rate of noncompliance is having on therapeutic efficacy and total health-care costs, some pharmaceutical manufacturers have taken steps to develop compliance packaging for some products prescribed for ambulatory patients. The purpose of compliance packaging is to serve as a patient-education tool for health professionals and to make it easier for patients to remember to take their medications correctly at home. The ideal compliance package will be developed according to patient-education guidelines. Compliance packaging holds promise as a significant patient-education tool when health professionals combine it with personalized patient counseling and well-written medication instructions. Well-controlled cost-effectiveness studies are needed to determine the impact of compliance packaging on reducing total health-care costs.