title: Real-world impact of reminder packaging on antihypertensive treatment adherence and persistence.
abstract: BACKGROUND
  Patient medication adherence is multidimensional and poses significant concerns to health care professionals. One aspect of adherence is a patient forgetting to take their prescribed medication, which may be improved with reminder packaging (RP). The objective of this analysis was to assess the impact of RP on patient adherence to antihypertensive therapy.
  
  
  METHODS
  This retrospective, propensity score-matched study evaluated patients switching to a single-pill combination of valsartan-hydrochlorothiazide in RP compared with patients remaining on the combination without reminder packaging (non-RP). Patients receiving combination therapy between April 1, 2009 and July 31, 2010 were eligible for inclusion. Patients were propensity score-matched on baseline adherence and background demographic variables, including comorbidities. Medication possession ratio, proportion of days covered, time to refill, and time to discontinuation were evaluated as primary measures of subsequent adherence and persistence.
  
  
  RESULTS
  In a total of 9266 matched patients (4633 participants in both cohorts), adherence was significantly higher in the RP cohort compared with patients in the non-RP cohort (medication possession ratio, RP 80% versus non-RP 73%; proportion of days covered, RP 76% versus non-RP 63%; both P < 0.001). Refill timing was 10 days for RP patients versus 16 days for non-RP patients (P < 0.001). Similar trends were observed with respect to time to discontinuation (RP 196 days, non-RP 174 days; P < 0.001). A higher proportion of RP patients remained on therapy compared with non-RP patients, with patients in the RP group being 17% less likely to discontinue therapy compared with patients in the non-RP group (hazards ratio 0.833; 95% confidence interval 0.793-0.875).
  
  
  CONCLUSIONS
  This real-world assessment of differences in adherence and persistence rates demonstrated that patients receiving RP were more adherent and persistent with their treatment regimens.
authors.affiliation: Novartis Pharmaceuticals, East Hanover, NJ.
authors.forename: Leon
authors.initials: L
authors.lastname: Dupclay
authors.forename: Michael
authors.initials: M
authors.lastname: Eaddy
authors.forename: James
authors.initials: J
authors.lastname: Jackson
authors.forename: Aditya
authors.initials: A
authors.lastname: Raju
authors.forename: Andrew
authors.initials: A
authors.lastname: Shim