Do Fixed-Dose Pills or Unit-of-Use Packaging Improve Adherence? A Systematic Review

摘要: Objective: To quantify the advantages of fixed-dose combination pills and unit-of-use packaging compared with medications in their usual presentation, in terms of adherence to treatment and improved outcomes.Design: Systematic review of randomized and quasi-randomized controlled trials.Setting and Population: Trials were included if they involved adults taking more than one oral self-administered medication, an intervention consisting of a combination pill or unit-of-use packaging system compared with separate pills in usual containers, and at least one outcome measure relating to adherence, the pharmacological goal of medication, or the cost of therapy.Outcome Measures: 1. Adherence to the regimens under study; by pill counting, self-report, or biological markers. 2. Clinical or intermediate end-point relevant to condition being treated; blood pressure, HbA1c, HIV viral load, CD4+, TB sputum conversion.Results: Fourteen trials met the inclusion criteria, three using fixed-dose combination pills, and 11 with unit-of-use packaging. The trials involved treatments for communicable diseases (n= 5), combinations of blood pressure–lowering medications (n= 3), diabetic patients with multiple medications (n= 1), and management of multiple medications by the elderly (n= 5). There were trends to improved adherence and/or clinical outcomes in all but two of the trials, which reached statistical significance in 4 of 7 trials reporting a clinically relevant or intermediate endpoint, and 7 of 12 studies reporting medication adherence. However, outcome measures and settings were heterogeneous. Methodological issues, particularly trial size and length and …