Effect of drug reminder packaging on medication adherence: a systematic review revealing research gaps

Abstract

Background: This was a systematic review of the literature in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Evidence mapping was used to reveal the effect of drug reminder packaging on medication adherence, to identify research gaps and to make suggestions for future research.

Methods: PubMed, Embase, CINAHL and PsycINFO were searched with an end date of September 2013 using the Medical Subject Headings (MeSH) term 'medication adherence' and 20 different search terms for 'drug reminder packaging', limited to the English and German languages. Additional references were identified through cross-referencing. All prospective controlled trials with an intervention using drug reminder packaging for patients taking at least one medication without the assistance of a health-care professional were included in the evidence mapping of the effect of drug reminder packaging on adherence and outcomes according to the Economic, Clinical and Humanistic Outcomes (ECHO) model.

Results: A total of 30 studies met the inclusion criteria: 10 randomized controlled trials, 19 controlled clinical trials and 1 cohort study. Drug reminder packaging had a significant effect on at least one adherence parameter in 17 studies (57%). The methodological quality was strong in five studies. Two studies provided complete information. Clear research gaps emerged.

Conclusions: Overall, the studies showed a positive effect of drug reminder packaging on adherence and clinical outcomes. However, poor reporting and important gaps like missing humanistic and economic outcomes and neglected safety issues limit the drawing of firm conclusions. Suggestions are made for future research.

Figure 1

Distribution of the eight criteria defined for the completeness of information (n = 30 studies).

Figure 2

Consolidation of results of outcomes, methodological quality and completeness of information. Each box represents one study numbered as in Table 2, plotted in a segment of reported outcome(s) and at a height based on its methodological quality. Completeness of information is indicated by the size of the box, with values between 0 (e.g., study no. 21) and 1 (e.g., study no. 12). Bold frames are for the additionally included studies compared to previously published reviews [18-20]. No filling indicates at least one outcome was statistically significant and shading indicates none of the outcomes were statistically significant. A, adherence; C, clinical outcome; E, economic outcome; H, humanistic outcome.