Issue link: https://www.e-digitaleditions.com/i/678483
48 May 2016 Tablets & Capsules Why don't people take their med- ication as directed? Patient adherence, also known as pharmacocompliance, remains a big issue in healthcare cir- cles. In some cases, about 40 percent of patients are exposed to unnecessary risks because they don't understand or don't follow the prescribed treatment. According to one study, non-adher- ence causes 125,000 deaths annually in the USA [1]. That's frustrating because it should be obvious: If patients don't take their medication as prescribed, they won't receive the full benefit of the treatment. And partial compliance— taking a once-daily tablet every 2 days, for example—doesn't confer a proportional benefit. In fact, the medication may have no effect at all. Former Surgeon General Dr. C. Everett Koop said it succinctly: "Drugs don't work in patients who don't take them." Even people who actively seek a physician's care won't necessarily take what's prescribed to them. It's a puzzle because they have to jump through a lot of hoops to get that prescription. It might start with see- ing an ad for a treatment, after which the patient schedules an appoint- ment, gets the prescription, has it filled at a pharmacy, and takes it home. But then, after all that effort, they fail to follow the prescription. Attractive packaging and venomous snakes To improve compliance, several companies offer novel packaging [2]. But does packaging really influence behavior? Certainly, it plays some role. I've worked on the behavioral marketing of packaging in the food, beverage, and dietary supplement industries and design can influence buyer behavior. But most of the pack- ages I've studied were "in the wild." That is, they competed directly with other packages on store shelves. Thus, by their nature, these are fierce packages, ornately colored and adorned to draw attention. It's the inverse of how venomous reptiles signal would-be predators to stay away. In the realm of packaging, the bright colors say "pick me up." It's easy to assess these packages using a one-on-one analysis: Which influences behavior better, Package A or Package B? But it's not so simple with prescription packaging because it's not on a shelf with other packages and the patients/consumers see just that package, not other packaging they might prefer or that might improve adherence. Better adherence boils down to patient engagement. Having some- thing like a medical device (e.g., an auto-injector) that has unique char- acteristics will capture patients' inter- est and thus promote adherence. But that says more about the product and less about the package. Providing strong visual appeal and something pleasantly tactile (haptic) is a good place to start. Any package or prod- uct with a "smart" feature that reminds patients or tracks their data is likely to catch on as data privacy improves and people and physicians come to appreciate the benefits and/or convenience. But information security remains a risk. Thus, it's also possible that as packaging and devices become "smarter"—which means storing and/or transmitting patient data—people will reject them to preserve privacy. The future should be simpler I have one large caveat about pushing "smart" solutions to con- sumers and patients: Consider their personal landscapes. That is, con- sider how many different apps, gad- gets, and personal-care items/issues they're juggling. Clearly, collapsing complexity and reducing the number of "units" are paramount. While one insulin auto-injector may prompt consumers to engage more, offering them five similar items will add com- plexity, not reduce it. What really matters: How each competitive package works for real patients who must manage several comorbid conditions and drug thera- pies. When companies assemble focus groups to measure consumer perception of new packages or med- ical devices, the comparator is a dummy or an existing item. Neither is a substitute for the total number of possible packages that consumers may face. The long-term winners in packaging will be the companies that plan for a drug-filled future and can "model out" complexity. T&C References 1. Atreja, A. et al. (2005). Strategies to enhance patient adherence: Making it simple. MedGenMed 2005; 7(1): 4. http://bit.ly/Atreja05. 2. Bauer, E.J. Packaging's contribu- tion to adherence and cost contain- mente. Tablets & Capsules 2014 12(4) 8. http://bit.ly/Bauer14. Ben Locwin, Ph.D., MBA, is president of Healthcare Science Advisors, 959 Maple- wood Ave., Suite 2, Portsmouth, NH 03801. Tel. 603 397 7304. E-mail: ben.loc w i n @ h e a l t h c a r e scienceadvisors.com. b a c k p a g e Pharmaceutical packaging and adherence Consumers/patients respond to packag- ing that has strong visual appeal and is pleasantly tactile.