Packaging saves lives

When sick we may turn to med­i­cines to get bet­ter. How­ev­er, swal­low­ing pills and down­ing bit­ter liq­uids to over­come ill­ness can be cum­ber­some, even at the best of times, let alone remem­ber­ing guide­lines on when to take the next dose. But skip­ping dos­es, dou­bling up or not com­plet­ing pre­scrip­tions is com­mon­place. This non-adher­ence to guide­lines can lead to unde­sir­able out­comes, such as recur­ring infec­tions or side effects.

In the UK, three peo­ple die every day from asth­ma. The Roy­al Col­lege of Physi­cians states that poor adher­ence to rec­om­mend­ed asth­mas med­ica­tion or action plans is part of the cause. This non-adher­ence to pre­scribed med­i­cine sees the NHS waste £500 mil­lion a year. The fig­ure is com­pound­ed by 50 per cent of patients who do not take their med­ica­tion cor­rect­ly. In the EU, 200,000 deaths occur each year because of missed dos­es of med­ica­tion.

“£500 mil­lion is con­ser­v­a­tive,” says James Mur­ray, sales and mar­ket­ing direc­tor at MTS Med­ica­tion Tech­nolo­gies, on the cost of non-adher­ence in the UK. “It does not include the mea­sure­ment of wast­ed drugs, peo­ple who don’t take them, addi­tion­al costs such as peo­ple stay­ing in hos­pi­tals and med­ica­tion that is out of date.”

In the Unit­ed States, this cost is esti­mat­ed at a stag­ger­ing $100 bil­lion to $300 bil­lion a year, which stands at three times NHS England’s entire bud­get. This includes costs from avoid­able hos­pi­tal­i­sa­tions, nurs­ing home admis­sions and pre­ma­ture deaths.

Accord­ing to MTS Med­ica­tion Tech­nolo­gies, one in twen­ty patients in the UK take more than ten types of med­i­cines each day. “The more types of med­i­cine a patient needs to take, over­all the less com­pli­ant they can become with respect to their dosage tim­ings,” says Mr Mur­ray, on the over­whelm­ing choice of med­i­cines avail­able, each with a dif­fer­ent dosage cycle.

“Patients are at their most vul­ner­a­ble when they are about to take their med­i­cine for the first time,” he says. But with so many dif­fer­ent types of pack­ag­ing and the excess amount of infor­ma­tion on such a small sur­face, it is no won­der patients are left com­plete­ly bewil­dered.

ICONS POINT TO FUTURE

Simon Wight, man­ag­ing direc­tor of Green­wich Design, says iconog­ra­phy – dis­sem­i­nat­ing con­tent using images – can alle­vi­ate the con­fu­sion. “In the EU, many health com­pa­nies are try­ing to ensure that their pack­ag­ing works across mul­ti­ple lan­guages,” he explains. “The main bar­ri­er is lan­guage, where­as num­bers and visu­als are uni­ver­sal.” Green­wich Design recent­ly redesigned the entire range of pack­ag­ing for Mil­ton Health­care.

How­ev­er, Mr Wight cau­tions against the overuse of iconog­ra­phy. “These are only worth hav­ing if they’re uni­ver­sal­ly under­stood,” he says, stress­ing the need for more mar­ket research on usage.

The chang­ing colour of a syringe can warn patients when the nee­dle is unsafe

Advice to refer to a web­site is anoth­er fac­tor that con­tributes to non-adher­ence. “Being redi­rect­ed to a web­site requires tak­ing an extra step, which is unnec­es­sary,” he says. “Cus­tomers will choose to believe what’s on the pack first. The short-cut here is that it gives the patient the infor­ma­tion on dosage quick­ly. The bat­tle of psy­chol­o­gy is done in mil­lisec­onds.”

Solv­ing the issue of non-adher­ence is not easy. The amount of space allo­cat­ed for on-pack com­mu­ni­ca­tions can be split into three cat­e­gories: 50 to 60 per cent for the nec­es­sary legalese, 25 to 30 per cent for a company’s own mes­sag­ing, leav­ing only 10 per cent to the design­er.

EU REGULATION

In addi­tion, any med­i­cines list­ed as cer­tain types of “food” will have to com­ply with new EU laws after Decem­ber 13 this year. This new reg­u­la­tion will see, for exam­ple, the “best before” date print­ed on one area of the label in large leg­i­ble print. The new labels must also high­light aller­gens, such as milk and nuts, list­ed in an appen­dix to the reg­u­la­tion.

It is not just med­i­cine that is sub­ject to non-adher­ence issues. The World Health Orga­ni­za­tion esti­mates up to 40 per cent of the 40 bil­lion injec­tions admin­is­tered each year are deliv­ered with syringes reused with­out ster­il­i­sa­tion, allow­ing dis­eases such as Hepati­tis B and C as well as HIV to be trans­mit­ted and result­ing in 1.3 mil­lion in deaths.

This glob­al health­care prob­lem has led to a redesign in syringe pack­ag­ing by the Uni­ver­si­ty of Hud­der­s­field where the chang­ing colour of a syringe can warn patients when the nee­dle is unsafe. Like an opened car­ton of milk, the syringe’s expo­sure to air, specif­i­cal­ly car­bon diox­ide, acti­vates an ink after a minute, turn­ing the label to red. This alerts patients to the fact that the syringe has been used once and is no longer ster­ile.

The design, devel­oped by Dr David Swann, received the 2014 World Design Impact Prize, which is award­ed every two years by the Inter­na­tion­al Coun­cil of Soci­eties of Indus­tri­al Design.

Pack­ag­ing alone is not the solu­tion. It may be that both graph­ics and struc­ture play a role. “Around 200,000 patients in the UK require fur­ther sup­port to take their med­ica­tion cor­rect­ly – above and beyond exist­ing adher­ence sys­tems,” says Mr Mur­ray of MTS Med­ica­tion Tech­nolo­gies.

Con­sid­er­a­tion of the use of bio­met­rics, such as with the new Apple Watch, can focus on basic para­me­ters, includ­ing exer­cise, diet, stress and med­ica­tion sched­ul­ing. Then there are “clever card” tech­nolo­gies which prompt and record med­ica­tion adher­ence. As soon as a blis­ter is opened a mes­sage is sent to a cloud-based sys­tem let­ting car­ers and phar­ma­cists know the med­ica­tion has been accessed.

ICONS POINT TO FUTURE

EU REGULATION