In most industries, product packaging is a means of protecting and preserving items contained within, as well as communicating marketing and regulatory information to consumers. In the pharmaceutical industry, perhaps above all others, effective and intelligent packaging has the potential to do so much more.

"The removal of pills is tracked and the information can be sent to an electronic database."

As the packaging industry continues to develop increasingly sophisticated concepts, big pharma is starting to embrace innovations in this field to improve patient adherence to drug regimens.

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It’s no exaggeration to say improvements in this area of pharmaceutical packaging have the potential to improve treatment outcomes and even save lives.

The issue of patient adherence

Patient adherence, also known as compliance, is the extent to which patients stick with medication they have been prescribed. For national healthcare systems, the problem of non-compliance costs lives and billions in unnecessary hospital treatment, while pharma companies lose revenue from lapsed prescriptions.

The extent of the problem is well-documented; several studies, backed up by the World Health Organisation, suggest that in developed countries, only around 50% of patients with chronic diseases take their medication as prescribed. These levels generally fall even lower in the developing world, with the poor disproportionately affected in both cases.

It has been estimated that 125,000 people die in the US each year as a result of failure to adhere to medication regimens, as well as costing the country’s health system nearly $300 billion. Meanwhile the pharmaceutical industry reportedly loses around $8 billion a year from unfilled prescriptions.

New innovations in intelligent packaging are being developed to buck this trend, and pharmaceutical companies are increasingly making use of these new concepts as the costs of patient non-compliance become clearer.

Encouraging compliance through packaging

Packaging strategies for increasing medication compliance vary in their methods, but the underlying theme throughout is helping patients keep track of their medication schedule, dosing levels and safety guidelines, allowing them to treat themselves with confidence.

On the simplest level, clear packaging design in itself can go some way towards achieving this. But more and more, designers of pharmaceutical packaging are embracing advances in printed electronics and internet connectivity to get the message across to people who might struggle with adhering to their regimens.

"125,000 people die in the US each year as a result of failure to adhere to medication regimens."

This connectivity is exemplified by pharmaceutical service company Catalent‘s Delpouch Starter Kit packaging system, designed for topical treatments. As well as incorporating compliance-encouraging design elements like day / night treatment schedule graphics and increased billboard space for extra information, Delpouch measures the right amount of topical cream or ointment to simplify the application process.

But perhaps the most forward-thinking feature of Delpouch is the inclusion of Catalent’s Media Enhanced Packaging technology, which allows patients to scan a digitally embedded watermark in the packaging with their smartphones to access extra product information, videos or even real-time safety updates.

This dense clustering of technology and design on a single pharmaceutical package is primarily intended to make patients more organised and confident when taking their medication, and it’s hoped these sorts of efforts will lead to higher numbers of compliant patients and better healthcare outcomes. In May 2011, Catalent was awarded the Innovative Design of the Year Award for the Delpouch Starter Kit by the Healthcare Compliance Packaging Council.

In the wake of receiving the award, the company’s product manager for adherence solutions Bill Hartzel recommended that a comprehensive approach to combating non-compliance, one that recognises the relationship between a package and the medication within.

"Too often we equate medication non-adherence to just forgetting to take our pills, but that is not the case. Medication non-adherence affects all different types of medication and there are a multitude of different factors that can influence it," he said. "Our approach is to evaluate the entire product from the dose format to the route of administration to the packaging."

Improving healthcare communication

As well as connecting to the internet, advanced packaging technologies can enable patients to communicate with healthcare professionals through printed technology. These technologies, such as Cypak’s advanced medication monitoring and report card systems, can record the time and date that a pill was taken based on when it is removed from its blister pack, as well as allowing patients to log their feedback on side-effects and treatment efficacy and upload it.

Although this technology holds significant potential for new levels of patient-doctor interface to work out best and most achievable treatment plan, sensor-based packaging concepts are perhaps best applied in clinical trials, helping drug developers to establish whether a drug is ineffective or simply not being taken properly.

Electronic compliance packaging Cerepak, developed by MWV using licensed Cypak technology, is primarily targeting the clinical trials market, as poor data resulting from non-compliance can be financially devastating in this context.

The means of transmitting electronic data of patients’ self-medication is rapidly advancing. In February 2011, Finnish packaging company Stora Enso unveiled the newest iteration of its adherence control packaging, Pharma DDSi Wireless. This technology is based on conductive ink on a carton board-based blister inlay, which is connected to a cellular module embedded in the package. The removal of pills is tracked and the information can be sent to an electronic database automatically via GSM or GPRS cellular networks.

By using cellular technology, this packaging concept adds a new level to improving patient compliance. While a doctor can simply use the packaging data to track a patient’s medication intake, the system can also issue phone calls and text messages to the patient, healthcare professionals and even relatives.

Advanced mobile technology like this could have particular applications for patients suffering from Alzheimer’s and other neurological conditions, who might require care-givers and family members to take a more active role in their treatment.

"Delpouch measures the right amount of topical cream or ointment to simplify the application process."

MDClick senior medical director Dr Thomas Bellavia, whose New Jersey-based company offers health information technology services, has hailed the device as a great step forward. "It is an important step in our transition to the Patient Centred Medical Home model in this new healthcare environment," he said.

Although the issue of patient non-compliance is one that continues to plague the pharmaceutical industry, packaging innovators are coming up with a seemingly endless stream of concepts. Even voice and sound-based packaging systems have been developed to help blind and illiterate patients take their medicines safely.

With this range of ideas transforming the way pharmaceutical products are packaged and presented, a larger proportion of patients should begin to see the full benefits of the medication that the pharmaceutical industry provides.