Pill Identification Affects Patient Compliance—How Compounding Pharmacists Can Help
Consider this scenario: a long-time patient has become confused about what medications she was supposed to take when. She’s been visiting her pharmacy for years for the same drugs—an anti-seizure medication and a particular statin that was safe for her to take given her epilepsy. She bases her daily regimen on pill identification–the shape, size, and color of her medications–to know what to take when. It’s a common trick for patients who take multiple drugs, but when those identifiers change, patients get off-track. Luckily this patient sought out her pharmacist’s help right away when she noticed that her levetiracetam pill looked like her depression meds. After a discussion with her pharmacist, she got back on her schedule easily.
Unfortunately, not all other patients are as perceptive. And non-compliance of crucial medications can lead to serious health problems, including fatalities.
The FDA has recently taken a close look at how pill identification affects patient compliance and health.1 In a guidance document issued in 2013, the Agency urged generic drug companies to consider how the appearance of compounded prescriptions could (and probably should) stay consistent with branded drugs for patient safety, specifically with respect to film coatings, taste-enhancers, smell, weight, surface area, and pill shape.
A more recent study conducted by Brigham and Women’s Hospital, showed that over 50% of patients who receive generic drugs that change in appearance just stop taking the drug be.2Cardiovascular patients, in particular, respond poorly to changes in how their medications look.3 In a study of patients who had a myocardial infarction and then started treatment with a generic beta-blocker, an angiotensin-converting enzyme inhibitor, an angiotensin II-receptor blocker, or a statin, 34% of patients who had a change in pill color and 66% of those with a change in pill shape stopped taking their pills relative to placebo cases.
How Can Pharmacists Help Patients Keep On Top of Pill Identification?
The obvious solution is for pharmacists to keep their patients informed about what changes are being made to their medications. But oftentimes, patients simply don’t remember, have too many medications to keep track of, or don’t have a clear understanding of what’s being said. The FDA is conducting a follow-up survey to investigate how specific properties in terms of pill identification affect patient compliance further4 and has indicated that it will inquire as to how often pharmacies change suppliers for their generic drugs, how they educate patients in transitioning through changes in the appearance of compounded prescriptions and generic drugs, and how patients respond to the changes.
The survey will ask pharmacists to share information about strategies they have used to alert patients to changes in pill identification, for example, alert stickers on pill bottles, and about how patients have responded to those strategies. The FDA also plans to focus on what types of change in pill appearance, such as shape, size, and color, confuses patients the most. Asking these questions of patients ahead of time not only opens up a dialogue about changes to a patient’s medication, but also prepares the pharmacist to answer the survey with greater details.
Technology portals, pill identification apps, and websites that track medications by size and color are other tools that can help patients keep updated about changes in how their medications look. Handouts outlining popular apps and websites can encourage patients to use these newer tools to help jog their memories about what this pink tablet or that oval pill is for.
We can also make use of our ability to tailor the appearance of compounded medications to fit each patient’s needs. It might be best, in certain cases, to design unique pill identification properties to help individual patients take the right pill on schedule. Manufacturers of generic drugs are not required to follow the same color, size, and shape as their trademarked counterparts. However, pharmacists can compound medications with specific dyes, delivery methods (tablet versus gel cap, for example), and even offer color-coordinated prescription bottles to help their patients stay compliant with their medications.5
Shifting patient expectations as to how to remember what medications to take when is an essential part of ensuring patient compliance. Even colored prescription labels have the potential to inform patients of what medications to take, whether or not the appearance of the compounded prescription inside changes. Disposable color-coordinated pamphlets of individual patient regimen given at each medication refill may also help keep patients updated as to what to take when. Pharmacists are trained well to ensure that patients receive safe, effective medications in the right dosages. As far as making sure patients take their pills despite changes in how their pills look…well, it’s time we start thinking outside the bottle.
Patients often rely on pill identification to keep patients on track to take their pills on schedule. At Pharmaceutica North America, we are committed to helping you give the best treatment you can to your patients. That means we care about giving you the high quality, safe medications they need, and giving you the research you need to ensure patient compliance. Contact us to learn more about how we can help you.
- “The FDA Has Taken A Real Interest in How Compounded Prescriptions Look,” May 14, 2015, http://www.raps.org/Regulatory-Focus/News/2015/05/14/22176/FDA-to-Study-Effect-of-Generic-Drug-Appearance-on-Patient-Adherence/ ↩
- “Color of Generic Drugs Impacts Medication Compliance,” February 24, 2016, http://psychcentral.com/news/2013/01/02/color-of-generic-drugs-impacts-medication-compliance/49908.html ↩
- “Burden of changes in pill appearance for patients receiving generic cardiovascular medications after myocardial infarction: cohort and nested case-control studies,” July 15, 2014, http://www.ncbi.nlm.nih.gov/pubmed/25023248 ↩
- “Agency Information Collection Activities: Proposed Collection; Comment Request; Survey of Pharmacists and Patients; Variations in the Physical Characteristics of Generic Drug Pills and Patients’ Perceptions,” October 15, 2014, https://www.federalregister.gov/articles/2014/10/15/2014-24365/agency-information-collection-activities-proposed-collection-comment-request-survey-of-pharmacists#table_of_contents ↩
- “Why is that tablet blue?” May 1, 2012, http://www.pharmacist.com/why-tablet-blue ↩