How do patients perceive the change in appearance of chronically used medications and to what extent does it lead to non-adherence to therapy?

Non-adherence and changes in medication appearance

Non-adherence to treatment is a major problem across medical fields. About 50% of patients with chronic diseases such as hypertension, hypercholesterolemia, or type 2 diabetes are considered non-adherent. Non-adherence is associated with poorer clinical outcomes and higher expenses for hospitalizations or treatment of disease progression.

Non-adherence can have various causes, such as side effects of therapy, cognitive decline of the patient, or high co-payments for medications. However, we must not overlook factors such as changes in medication appearance, which some previous research has already focused on. According to one study, 29% of patients who started therapy with one of the 4 classes of cardiovascular (CV) drugs after a myocardial infarction encountered a change in the color or shape of the pill during the first year of therapy. Other studies have noted an increased likelihood that patients would cease or delay using essential CV drugs and antiepileptics when they notice a change in medication appearance.

Survey among patients and pharmacists

A team of experts from Harvard and Colorado University and the U.S. Food and Drug Administration (FDA) conducted an independent nationwide survey among patients and pharmacists to better understand their preferences, experiences, and reactions related to changes in pill appearance (i.e., size, shape, color, and labeling). 1000 patients (response rate of 30%) over 50 years old who took medications for depression, diabetes, epilepsy, HIV, hyperlipidemia, or hypertension, and 710 pharmacists (response rate of 33%) were contacted.

Findings

Most patients surveyed “definitely” or “probably” preferred their medications to have the same color (63%), size (68%), shape (63%), and labeling (55%).

Approximately half of the patients (51%) reported that the appearance of their chronically used medication had changed in the last year, and about half of them (53%) experienced this change 2 or more times. Patients further indicated that the most frequently changing characteristic of the medication was color (68%), followed by shape (46%), size (42%), and labeling (20%). 82% of patients would prefer to be informed about changes in advance. Among patients whose medication appearance changed in the past year, 36% were verbally notified by a pharmacist and 45% through a label on the package.

Nearly one third of patients (29%) whose medication appearance changed assumed it was the wrong pill. Approximately 1 in 8 patients (12%) then changed the way they took the medication—either by taking it less frequently (8%) or stopping it altogether (4%). 

Responses from pharmacists revealed that many of them often encounter changes in medication appearance in the pharmacy. 47% indicated that such changes occurred 6 or more times per month, and more than three-quarters often informed patients about them (88% verbally, 77% via label).

Discussion and conclusion

According to the survey results, most patients prefer their medications to remain the same in appearance. Still, the majority of them have encountered some change. Such an occurrence can be very confusing, especially for older patients taking multiple medications for chronic conditions. Patient responses indicate that notification by a pharmacist about changes is not always standard. Some even stopped taking their medication or started taking it less frequently due to appearance changes.

For patients, an easily recognizable pill, such as Concor, which is heart-shaped, is ideal. Even doctors immediately know which pill the patient is referring to. The survey findings point out areas for improvement in informing patients about changes in medication appearance by both doctors and pharmacists to prevent potential misunderstandings and non-adherence to treatment.

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Source: Barenie R. E., Kesselheim A. S., Gagne J. J. et al. Preferences for and experiences with pill appearance changes: national surveys of patients and pharmacists. Am J Manag Care 2020; 26 (8): 340−347, doi: 10.37765/ajmc.2020.44070.