Boosting patient compliance through pharma packaging innovation
Medicine non-adherence is one of the largest challenges facing the healthcare industry, costing the global economy an estimated $637bn a year. The problem is particularly large in the US, where 75% of adults prescribed medication aren’t complying with recommended adherence advice.
Non-adherence can take many forms, like forgetting to take a dose, taking more or less than recommended, or not requesting a repeat prescription. Whatever the circumstance, it’s affecting pharmaceutical manufacturers, healthcare professionals and patients alike.
Packaging innovation is a key area of focus as part of wider strategies to boost patient compliance, making medicines easier to use, ‘intelligent’ and preventing contamination.
Rich Quelch, Global Head of Marketing at Origin reviews the latest industry developments and how the pharma packaging sector can play its role in increasing patient compliance and health outcomes.
Research suggests the biggest contributing factor to medical non-compliance is affordability in countries where healthcare isn’t free at the point of use. Although the pharma packaging industry can’t be held accountable for the cost of products to the end user, it can certainly play its part in driving efficiencies across the supply chain.
At an operational level, pharma manufacturers can relieve some of the pressure to deliver safe and effective drugs at lower costs by being sensible when it comes to capital equipment purchases.
Markets can change quickly, meaning many 'new' equipment purchases are redundant or unnecessary after a short period. By sourcing compliant machinery and equipment from reputable sellers, manufacturers can make use of the surplus of inventory available at a cheaper cost than buying new.
Packaging design engineers are also now using 3D visualisation tools in the product design stage - making virtual tweaks to products, rather than producing physical prototypes for every stage of the process. This saves significantly on time and resources, allowing designers to modify size, shape and detailing before the product goes into manufacturing.
3D printing is also an important technological innovation which is helping manufacturers break existing performance trade-offs in two essential ways. Firstly, it decreases the capital involved in achieving economies of scale. Secondly, it enhances flexibility and diminishes the capital needed to attain scope.
The flexibility of 3D printing will facilitate the growth in the assortment of products a unit of capital can generate, lowering the costs normally associated with customisation and production changeovers, which incorporates the overall quantities of necessary capital.
Accurate and timely doses
Even if a patient finishes a full course of medicine, it doesn’t guarantee they’ve adhered to the recommended dosage advice. Common compliance errors can also include taking too much or too little of a medication, or missing doses.
Many contextual factors can contribute to missed doses, with research suggesting the more frequent doses are, the more likely they’ll be missed.
If the problem is simply forgetfulness, there are tools available to help patients monitor their doses. “Smart” blister packs are becoming increasingly popular, featuring an incorporated microchip which captures use-related data to monitor when a medicine is being taken and remind patients when the next dose is due.
There’s strong evidence compliance increases when medication comes in adherence packaging, for example a single-dose blister pack. Patients can easily access a dose without needing to measure or weigh components, making it much easier to fit around their lifestyle.
- Roche remains the most sustainable healthcare company in the Dow Jones Sustainability Indices
- How will Brexit impact the UK's access to medicines?
- Opternative introduces voice-activated digital eye exams for smartphones
Another good example of innovation in this area is smart wireless pill bottles which incorporate a wireless cellular chip and sensors to collect real-time adherence data such as when the bottle is opened and reclosed. In the case of a missed dose, the system sends an automated alert via text to the patient, caregiver or pharmacist.
Not all medication is the same and each has its challenges for patient compliance. For example, while pills are fairly simple to consume, this benefit also means patients easily forget if they’ve taken a dose.
Reconstituted medicines require extra preparation from patients, needing a dilute and solute mixed together to make a liquid. Dry and powdered medicine can be stored for longer, so when they’re ready to be consumed they need to be prepared by the patient.
The trouble with these medications though, is that the components tend to be mixed in specific measurements to ensure each serving has the right concentration of solute. Problems often arise in measuring and mixing, with patients required to use a syringe or measure servings of dilute to add to the powdered medication.
This is where pharma packaging can help - not only saving money for patients by reducing the risk of mistakes in the reconstituting process, but also boosting patient compliance by making it an easier and safer process.
Specialised bottles store a powdered solution in the lid, while an accurate measurement of solute is kept separate in the bottle itself. When the medicine’s ready to be prepared, the lid can be pressed down to release the powder and the components can be safely reconstituted.
An important part of patient compliance is limiting access to medicine for only the individual who has been prescribed it.
One of the most common misuses of medication is accidental consumption by children. It’s estimated around 86% of emergency department visits for medicine poisoning are due to the child ingesting medicine belonging to a parent or grandparent.
Although the responsibility ultimately lies with parents keeping medicine out of reach in a safe location, pharma packaging can play an important role in preventing accidental ingestion through innovation in child-resistant packaging (CRP) design.
A classic example of CRP is liquid beakers with bottle-caps that young children can’t unscrew. However, not all medication comes in a bottle and new innovations need to be developed to cover all types of packaging.
At Origin, we are currently working on a new CR Smart technology, which comprises a ‘twin child-resistant design’ to create an even stronger preventative barrier. The design is at a concept stage and has been purposely left to allow interested parties to take the design and adapt it to their given application.
Several packaging firms have also developed innovative CRP options beyond traditional bottles. These include ‘press-to-engage’ resealable sliders that are difficult for young children but easy for adults of all ages.
Blister packs are also being reimagined to incorporate new child-resistant functionalities such as a tear band which must be permanently removed to release the child resistant slider mechanism and reveal the apertures through which the user gains access to the product.
Whenever the child-resistant mechanism is opened a visible tab is exposed reminding the user to re-close the pack. And for those who don’t remember, returning the pack to the upright position will automatically close the child resistant matrix, hiding the blister apertures once more.
Google and NIST Address Supply Chain Cybersecurity
As high-level supply chain attacks hit the news, Google and the U.S. National Institute of Standards and Technology (NIST) have both developed proposals for how to address software supply chain security. This isn’t a new field, unfortunately. Since supply chains are a critical part of business resilience, criminals have no qualms about targeting its software. That’s why identifying, assessing, and mitigating cyber supply chain risks (C-SCRM) is at the top of Google and NIST’s respective agendas.
High-Profile Supply Chain Attacks
According to Google, no comprehensive end-to-end framework exists to mitigate threats across the software supply chain. [Yet] ‘there is an urgent need for a solution in the face of the eye-opening, multi-billion-dollar attacks in recent months...some of which could have been prevented or made more difficult’.
Here are several of the largest cybersecurity failures in recent months:
- SolarWinds. Alleged Russian hackers slipped malicious code into a routine software update, which they then used as a Trojan horse for a massive cyberattack.
- Codecov. Attackers used automation to collect credentials and raid ‘additional resources’, such as data from other software development vendors.
- Malicious attacks on open-source repositories. Out of 1,000 GitHub accounts, more than one in five contained at least one dependency confusion-related misconfiguration.
As a result of these attacks and Biden’s recent cybersecurity mandate, NIST and Google took action. NIST held a 1,400-person workshop and published 150 papers worth of recommendations from Microsoft, Synopsys, The Linux Foundation, and other software experts; Google will work with popular source, build, and packaging platforms to help companies implement and excel at their SLSA framework.
What Are Their Recommendations?
Here’s a quick recap: NIST has grouped together recommendations to create federal standards; Google has developed an end-to-end framework called Supply Chain Levels for Software Artifacts (SLSA)—pronounced “Salsa”. Both address software procurement and security.
Now, here’s the slightly more in-depth version:
- NIST. The organisation wants more ‘rigorous and predictable’ ways to secure critical software. They suggest that firms use vulnerability disclosure programmes (VDP) and software bills of materials (SBOM), consider simplifying their software and give at least one developer per project security training.
- Google. The company thinks that SLSA will encompass the source-build-publish software workflow. Essentially, the four-level framework helps businesses make informed choices about the security of the software they use, with SLSA 4 representing an ideal end state.
If this all sounds very abstract, consider the recent SolarWinds attack. The attacker compromised the build platform, installed an implant, and injected malicious behaviour during each build. According to Google, higher SLSA levels would have required stronger security controls for the build platform, making it more difficult for the attacker to succeed.
How Do The Proposals Differ?
As Brian Fox, the co-founder and CTO at Sonatype, sees it, NIST and Google have created proposals that complement each other. ‘The NIST [version] is focused on defining minimum requirements for software sold to the government’, he explained, while Google ‘goes [further] and proposes a specific model for scoring the supply chain. NIST is currently focused on the “what”. Google, along with other industry leaders, is grappling with the “how”’.