The problem of people not understanding basic health information has been in the news this week, with the publication in the BMJ of a study looking at health literacy, which found that of the UK adults included in the study almost half of those aged over 80, and a quarter aged 60 or under, were unable to answer correctly all four questions based on instructions similar to those found in a packet of aspirin.
Failing to take medication correctly, through lack of understanding or difficulty in remembering to take it, clearly has serious implications for health. There are many reminder systems designed to help people take their medication correctly, including simple things such as blister ‘calendar’ packs for pills, but do they work?
A Cochrane review on medication ‘reminder packaging’ to improve adherence was recently updated and now provides evidence from 12 randomised controlled trials with 2196 participants, who were self-administering medication for at least one month. Here’s what they found:
- Reminder packaging increased the percentage of pills taken (mean difference (MD) 11% (95% confidence interval (CI) 6% to 17%))
- The review included a trial with a population in which the majority had low-literacy, evaluating the usefulness of a pill card with pictures showing what to take, when to take it and what each pill was for. No data was provided on adherence, but of 173 patients who used the pill card,132 patients (76.3 %) reported it as being very helpful in reminding them to take their medication. Patient feedback included suggestions such as a wallet-sized card to serve as a more portable reminder, larger font size, and including the strength of each medication on the card
- There was some evidence that reminder packaging may be beneficial in improving clinical outcomes such as blood pressure
- There were problems with the conduct of most of the trials included in thie review, with ten judged as having a high risk of bias, including the trial with the low-literacy participants
- The authors noted a lack of evidence on the use of reminder packaging in elderly populations
The authors’ conclusions are appropriately cautious:
“Reminder packing may represent a simple method for improving adherence for patients with selected conditions.”
Mahtani KR, Heneghan CJ, Glasziou PP, Perera R. Reminder packaging for improving adherence to self-administered long-term medications. Cochrane Database of Systematic Reviews 2011, Issue 9. Art. No.: CD005025. DOI: 10.1002/14651858.CD005025.pub3.
A Cochrane summary and a podcast of this review are available
BBC News Poor literacy increases early death risk for elderly. 16th March 2012.