Medication Adherence: The Role of Packaging

Up to 70% of patients in Canada do not take their medications as directed, depending on the condition.¹*

Despite advances in treatment, medication adherence remains a significant challenge for the healthcare system.

There are many reasons for medication non-adherence. Yet one factor is too often left out of the conversation, even though it is present every time medication is taken: packaging.

Quick Navigation

• Main causes and consequences of medication non-adherence
• Can packaging be a barrier to medication adherence?
• The safety-accessibility paradox
• Our solution
• Frequently Asked Questions

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What is medication non-adherence?

Medication non-adherence occurs when a patient does not follow their treatment as prescribed. It can take many forms, including forgetting or skipping a dose, intentionally reducing the dosage, or stopping treatment early.

It can be occasional or progressive, intentional or unintentional.

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Main causes and consequences of medication non-adherence

There are many reasons why patients stop or modify their treatment.
They generally fall into three main categories:

• Knowing: Difficulty understanding or remembering instructions.
• Wanting: Refusal of treatment, personal beliefs, fear or concern about side effects, or feeling better and deciding to stop treatment.
• Being able: Medication costs that are too high or physical limitations, such as reduced dexterity or difficulty accessing a pharmacy.

Medication non-adherence is a major public health issue. Interrupted or incomplete treatments can lead to more hospitalizations and avoidable costs for society as a whole.

But these factors do not tell the whole story. Some barriers are more subtle and, importantly, less studied.

One of them is rarely suspected: packaging.

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Can packaging be a barrier to medication adherence?

In 2022, the international clinical geriatrics journal Age and Ageing published an article identifying difficulty opening medication packaging as a potential barrier to medication use.

The researchers specifically highlighted the challenges associated with medication vial closures. They need to be child-resistant while remaining sufficiently easy to open for older adults and people with reduced fine motor skills.

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The safety-accessibility paradox

“Granny Syndrome” refers to the accidental poisoning of a child who ingests medication found among their grandparents’ belongings. Unfortunately, this is a common occurrence and highlights a well-known paradox for prescription medication packaging manufacturers.

When a child-resistant cap is too difficult to open, some patients may resort to unsafe workarounds, such as leaving medication vials open at all times or transferring their medication to another container that is too easy to open.

In doing so, they may:

• Lose the label containing important instructions or warnings.
• Increase the risk of accidental ingestion by a child or pet.

For too long, the delicate balance between safety and accessibility limited opportunities to improve medication vials. Their basic design remained largely unchanged for decades.

There’s a reason for this: designing pharmaceutical packaging means meeting several stringent requirements at once, including regulatory, safety and compliance requirements.

So, how can we improve the patient experience without compromising child safety?
And how can we make pharmacy workflows more efficient while maintaining a high level of compliance?

If this challenge remained overlooked for so long, it is because there was no obvious solution.

A medication vial closure needs to resist the efforts of a four-year-old while still being manageable for an 84-year-old.
Make it too difficult to open, and it can become a barrier for the patient.Make it too easy, and safety may be compromised.

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Our solution

At EcoloPharm, this challenge led us to develop a dual-purpose closure that allows pharmacy teams to adapt medication accessibility to the patient’s needs while maintaining required levels of safety and compliance (CSA, FDA).

One of the solutions we developed is a medication vial with a dual-function cap that can be configured according to the patient’s needs. When appropriate, the pharmacist can quickly switch to an easy-open configuration without slowing down dispensing.

Preferences also vary from one pharmacy to another. To better accommodate different pharmacy workflows, we have developed a range of ergonomic opening mechanisms.

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Different pharmacies, different preferences.

Medication adherence depends on many factors, several of which are beyond a pharmacist’s control. But some barriers can be avoided.

Pharmacy teams have opportunities to identify potential barriers to adherence. ISMP Canada recommends that community pharmacy teams ask patients to demonstrate how they plan to take a new medication. This approach helps confirm their understanding and identify potential difficulties before they return home.

That same attention can, and should, extend to the packaging. A vial that is difficult to open can create an avoidable barrier to medication adherence.

Packaging is obviously not the solution on its own, but it remains one part of the treatment experience that can be improved.

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Packaging is part of the solution

Packaging alone cannot solve medication non-adherence, but it remains an important part of the treatment experience and one that can be improved.

As pharmacy moves toward more personalized care, medication containers should evolve too, with the needs of both patients and pharmacy teams in mind.

For pharmacy teams interested in exploring different approaches, compare the different types of medication vials available or try them directly in your pharmacy.

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*Because there is no single method for determining whether medication is taken as prescribed, medication non-adherence remains difficult to measure precisely. Estimates therefore rely on different indicators and may vary depending on the condition, treatment and assessment method used.