All About the Box

Approximately 50 percent of patients with chronic diseases in developed countries do not take their medication as prescribed – a significant problem for both patients themselves and the healthcare sector overall. Shockingly, the percentage is even higher in developing countries. Research in the UK alone shows that non-adherence can cost the National Health Service £500 million a year – broadly equivalent to funding 30,000 kidney transplants or an additional 21,000 qualified nurses.

Patient adherence affects the whole industry, so every stakeholder should do their bit to help. Drug developers, for example, can design medicines that are easy to take with reduced side effects – but that may be easier said than done. So what else can be done to improve adherence? In my view, one of the simplest changes revolves around the practice of packaging design. If we provided patients with more digestible and accessible information on side effects, ingredients and how a treatment actually works, perhaps patients would be more inclined to take medicine adherence seriously because they would better understand that medicines only work if you take them correctly.

Typical primary packaging does not always have enough space for extra information, but it’s straightforward to supply multi-fold leaflets or extended contents labels. It almost goes without saying that all long-form information should be presented in the clearest format possible; text should be printed in a legible font face and size, and visual features, such as images or charts can be used to really help emphasize certain facts. All the information needs to be easy to navigate – the use of symbols, shapes and color can help in this regard by encouraging greater engagement and understanding.

In addition to a lack of knowledge, patient forgetfulness and time constraints also negatively affect patient adherence (how many of us have forgotten to take our medicine?). It is one thing to understand the need and benefits of taking medication at the correct intervals, but it is quite another to remember to actually consume them. In my opinion, too few manufacturers have considered smart packaging that indicates dosage unit and dates. What about calendarized packaging? What about intelligent packaging that monitors consumption and alerts consumers that haven’t taken their medicine through a smartphone app? And yes – these innovations do exist! The problem is that they are not considered often enough.

How innovative packaging design can be – particularly for prescription medicines – depends on legislation. For example, the EU’s Falsified Medicines Directive mandates the inclusion of a number of packaging features, which limit the amount of space for packaging manufacturers to be creative in their designs. However, I actually see this as more of an opportunity than a challenge because it really encourages creative thinking. Unlike over the counter packaging (where bright colors and designs that help medicines stand out on the shelf are the goal), the differentiation for prescription packaging should rely on value-add features that increase compliance and adherence.

Packaging itself has always played an important role in protecting medicine, but today there is growing recognition of the added value that good packaging can provide. In general terms, packaging should perform five simple tasks: hold its contents, physically protect its contents, communicate information about its contents, provide security to its contents, and aid in the transportation of its contents. Healthcare packaging must fulfil all of those qualities, whilst also trying to make the patient experience as easy as possible. And good pharmaceutical packaging should also ensure that patients are supported throughout every touch point. There are far more packaging options out there than you might expect to help you meet all the objectives – but note that there is rarely one ideal solution for all patients.

Last year, we developed a ‘Patient Adherence Pack’ to showcase some of the features that drug manufacturers could consider. It is not a commercial product, but rather an example of how packaging could help promote adherence using infographics, portable alert cards and other features. I believe it is vitally important to get the industry thinking more about what can be done to tackle the non-adherence issue – and packaging has a role to play.