May, Montori and Mair have identified a growing problem for people
with chronic conditions and a useful set of principles for helping resolve
it. They have not, however, mentioned treatment accessibility and
usability, a significant and increasing obstacle to adherence to treatment
regimens that could quite easily be removed.
All too often, the pharmaceutical industry seems oblivious to the
need for patients to be able to access and manipulate treatments. Evidence
of this is to be seen in the inexorable drive towards the provision of
pills, tablets and capsules in blister packs, which runs contrary to
patients’ interests. The problems posed by blister packs are often
exacerbated by the use of pills too small easily to be seen or handled.
Like increasing numbers of people, my step-mother is elderly,
determinedly independent, and has macular degeneration and moderate
arthritis in her fingers. She has been prescribed digoxin for arrhythmia,
taking two tablets daily to make up the total dose. The tablets are less
than 5mm in diameter. I watched recently when she insisted on accessing
them herself, waiting for a full five minutes as she wrestled with the
blister pack, becoming increasingly agitated and frustrated, and losing
one pill on the floor before eventually I intervened.
I myself have good eyesight and am reasonably dextrous. Even so,
trying to extract (5mm diameter) coversyl 2mg tablets and 25mcg thyroxine
tablets from blister packs is a frustrating chore. I have had capsules
break apart when being pressed out of blister packs. And I encountered a
pack recently on which the backing foil was so thick that it had to be cut
on three sides of each capsule before the capsule could be released.
Many less determinedly adherent patients would stop taking such
treatments rather than continue to wrestle with tiny pills and nigh-
impenetrable packaging.
The Association of the British Pharmaceutical Industry says that
blister packs facilitate the provision of patient information leaflets
with all medication, that they meet the requirement that medications
should be presented in as tamper-proof and as child-resistant a form as
possible, and that they make counterfeiting more difficult. That is
misleading. In reality, the regulations leading to the growth in the use
of blister packs were introduced solely for the benefit of the industry.
All of those objectives could as effectively be achieved with factory
-sealed bottles or containers with tamper-proof caps. The re-introduction
of such containers – and the bulking up of all pills to at least (say)
7.5mm in diameter - could significantly improve patients’ adherence to
agreed treatment regimens.
Rapid Response:
Treatment accessibility
May, Montori and Mair have identified a growing problem for people
with chronic conditions and a useful set of principles for helping resolve
it. They have not, however, mentioned treatment accessibility and
usability, a significant and increasing obstacle to adherence to treatment
regimens that could quite easily be removed.
All too often, the pharmaceutical industry seems oblivious to the
need for patients to be able to access and manipulate treatments. Evidence
of this is to be seen in the inexorable drive towards the provision of
pills, tablets and capsules in blister packs, which runs contrary to
patients’ interests. The problems posed by blister packs are often
exacerbated by the use of pills too small easily to be seen or handled.
Like increasing numbers of people, my step-mother is elderly,
determinedly independent, and has macular degeneration and moderate
arthritis in her fingers. She has been prescribed digoxin for arrhythmia,
taking two tablets daily to make up the total dose. The tablets are less
than 5mm in diameter. I watched recently when she insisted on accessing
them herself, waiting for a full five minutes as she wrestled with the
blister pack, becoming increasingly agitated and frustrated, and losing
one pill on the floor before eventually I intervened.
I myself have good eyesight and am reasonably dextrous. Even so,
trying to extract (5mm diameter) coversyl 2mg tablets and 25mcg thyroxine
tablets from blister packs is a frustrating chore. I have had capsules
break apart when being pressed out of blister packs. And I encountered a
pack recently on which the backing foil was so thick that it had to be cut
on three sides of each capsule before the capsule could be released.
Many less determinedly adherent patients would stop taking such
treatments rather than continue to wrestle with tiny pills and nigh-
impenetrable packaging.
The Association of the British Pharmaceutical Industry says that
blister packs facilitate the provision of patient information leaflets
with all medication, that they meet the requirement that medications
should be presented in as tamper-proof and as child-resistant a form as
possible, and that they make counterfeiting more difficult. That is
misleading. In reality, the regulations leading to the growth in the use
of blister packs were introduced solely for the benefit of the industry.
All of those objectives could as effectively be achieved with factory
-sealed bottles or containers with tamper-proof caps. The re-introduction
of such containers – and the bulking up of all pills to at least (say)
7.5mm in diameter - could significantly improve patients’ adherence to
agreed treatment regimens.
Competing interests:
None declared
Competing interests: No competing interests