Does the Formulation of Oral Solid Dosage Forms Affect Acceptance and Adherence in Older Patients?: A Mixed Methods Systematic Review

Zakia B Shariff; Dania T Dahmash; Daniel J Kirby; Shahrzad Missaghi; Ali Rajabi-Siahboomi; Ian D Maidment

doi:10.1016/j.jamda.2020.01.108

Does the Formulation of Oral Solid Dosage Forms Affect Acceptance and Adherence in Older Patients? A Mixed Methods Systematic Review

Zakia B Shariff^*, Dania T Dahmash, Daniel J Kirby, Shahrzad Missaghi, Ali Rajabi-Siahboomi, Ian D Maidment

^*Corresponding author for this work

Research output: Contribution to journal › Review article › peer-review

Abstract

OBJECTIVES: Age-related changes mean that the older population can encounter barriers toward taking medication orally. Further work is needed to identify the characteristics of oral solid dosage forms that will improve patient acceptance and adherence. The aim of this systematic review was to identify if and how formulation aspects of oral solid dosage forms affect acceptance and adherence in older people.

DESIGN: Mixed methods systematic review using a data-based convergent synthesis design.

SETTING AND PARTICIPANTS: Articles were selected if they included participants aged 60 years and older, or included health care professionals, social care professionals, and informal carers of patients aged 60 years and older.

METHODS: A systematic search of the following databases was undertaken: Web of Science, MEDLINE, Scopus, and The Cochrane Databases. The search of databases was supplemented by a search of gray literature, and reference lists of included papers were manually searched.

RESULTS: A total of 16 studies were included in the final synthesis. Three themes were generated from the thematic analysis: (1) dimensions, (2) palatability, and (3) appearance. The dimensions and palatability are often modified to improve swallowability by breaking tablets in half or taste masking with food. Polypharmacy can lead to patients using the appearance to identify tablets; however, this can lead to confusion when products appear similar. No study was identified that explored formulation characteristics across all 3 categories directly in the older population.

CONCLUSION AND IMPLICATIONS: Manufacturers should take into account practical problems older people may encounter when considering the dimensions, palatability, and appearance of the final drug product. These characteristics should be optimized to aid visual identification and swallowability. Medical providers and pharmacists have an important role in ensuring that these patient-centric drug products are prescribed and dispensed appropriately so that patients receive the most suitable formulation.

Original language	English
Pages (from-to)	1015-1023.e8
Journal	Journal of the American Medical Directors Association
Volume	21
Issue number	8
Early online date	26 Mar 2020
DOIs	https://doi.org/10.1016/j.jamda.2020.01.108
Publication status	Published - Aug 2020

Bibliographical note

© 2020 AMDA The Society for Post-Acute and Long-Term Care Medicine. This is an open access article
under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Keywords

Oral solid formulation
acceptance
adherence
older people
systematic review

Access to Document

10.1016/j.jamda.2020.01.108Licence: CC BY-NC-ND 3.0

Does the Formulation of Oral Solid Dosage Forms Affect Acceptance
© 2020 AMDA The Society for Post-Acute and Long-Term Care Medicine. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)
Final published version, 690 KBLicence: CC BY-NC-ND 3.0

Cite this

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title = "Does the Formulation of Oral Solid Dosage Forms Affect Acceptance and Adherence in Older Patients?: A Mixed Methods Systematic Review",

abstract = "OBJECTIVES: Age-related changes mean that the older population can encounter barriers toward taking medication orally. Further work is needed to identify the characteristics of oral solid dosage forms that will improve patient acceptance and adherence. The aim of this systematic review was to identify if and how formulation aspects of oral solid dosage forms affect acceptance and adherence in older people.DESIGN: Mixed methods systematic review using a data-based convergent synthesis design.SETTING AND PARTICIPANTS: Articles were selected if they included participants aged 60 years and older, or included health care professionals, social care professionals, and informal carers of patients aged 60 years and older.METHODS: A systematic search of the following databases was undertaken: Web of Science, MEDLINE, Scopus, and The Cochrane Databases. The search of databases was supplemented by a search of gray literature, and reference lists of included papers were manually searched.RESULTS: A total of 16 studies were included in the final synthesis. Three themes were generated from the thematic analysis: (1) dimensions, (2) palatability, and (3) appearance. The dimensions and palatability are often modified to improve swallowability by breaking tablets in half or taste masking with food. Polypharmacy can lead to patients using the appearance to identify tablets; however, this can lead to confusion when products appear similar. No study was identified that explored formulation characteristics across all 3 categories directly in the older population.CONCLUSION AND IMPLICATIONS: Manufacturers should take into account practical problems older people may encounter when considering the dimensions, palatability, and appearance of the final drug product. These characteristics should be optimized to aid visual identification and swallowability. Medical providers and pharmacists have an important role in ensuring that these patient-centric drug products are prescribed and dispensed appropriately so that patients receive the most suitable formulation.",

keywords = "Oral solid formulation, acceptance, adherence, older people, systematic review",

author = "Shariff, {Zakia B} and Dahmash, {Dania T} and Kirby, {Daniel J} and Shahrzad Missaghi and Ali Rajabi-Siahboomi and Maidment, {Ian D}",

note = "{\textcopyright} 2020 AMDA The Society for Post-Acute and Long-Term Care Medicine. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)",

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language = "English",

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Does the Formulation of Oral Solid Dosage Forms Affect Acceptance and Adherence in Older Patients? A Mixed Methods Systematic Review. / Shariff, Zakia B; Dahmash, Dania T; Kirby, Daniel J et al.
In: Journal of the American Medical Directors Association, Vol. 21, No. 8, 08.2020, p. 1015-1023.e8.

Research output: Contribution to journal › Review article › peer-review

TY - JOUR

T1 - Does the Formulation of Oral Solid Dosage Forms Affect Acceptance and Adherence in Older Patients?

T2 - A Mixed Methods Systematic Review

AU - Shariff, Zakia B

AU - Dahmash, Dania T

AU - Kirby, Daniel J

AU - Missaghi, Shahrzad

AU - Rajabi-Siahboomi, Ali

AU - Maidment, Ian D

PY - 2020/8

Y1 - 2020/8

N2 - OBJECTIVES: Age-related changes mean that the older population can encounter barriers toward taking medication orally. Further work is needed to identify the characteristics of oral solid dosage forms that will improve patient acceptance and adherence. The aim of this systematic review was to identify if and how formulation aspects of oral solid dosage forms affect acceptance and adherence in older people.DESIGN: Mixed methods systematic review using a data-based convergent synthesis design.SETTING AND PARTICIPANTS: Articles were selected if they included participants aged 60 years and older, or included health care professionals, social care professionals, and informal carers of patients aged 60 years and older.METHODS: A systematic search of the following databases was undertaken: Web of Science, MEDLINE, Scopus, and The Cochrane Databases. The search of databases was supplemented by a search of gray literature, and reference lists of included papers were manually searched.RESULTS: A total of 16 studies were included in the final synthesis. Three themes were generated from the thematic analysis: (1) dimensions, (2) palatability, and (3) appearance. The dimensions and palatability are often modified to improve swallowability by breaking tablets in half or taste masking with food. Polypharmacy can lead to patients using the appearance to identify tablets; however, this can lead to confusion when products appear similar. No study was identified that explored formulation characteristics across all 3 categories directly in the older population.CONCLUSION AND IMPLICATIONS: Manufacturers should take into account practical problems older people may encounter when considering the dimensions, palatability, and appearance of the final drug product. These characteristics should be optimized to aid visual identification and swallowability. Medical providers and pharmacists have an important role in ensuring that these patient-centric drug products are prescribed and dispensed appropriately so that patients receive the most suitable formulation.

AB - OBJECTIVES: Age-related changes mean that the older population can encounter barriers toward taking medication orally. Further work is needed to identify the characteristics of oral solid dosage forms that will improve patient acceptance and adherence. The aim of this systematic review was to identify if and how formulation aspects of oral solid dosage forms affect acceptance and adherence in older people.DESIGN: Mixed methods systematic review using a data-based convergent synthesis design.SETTING AND PARTICIPANTS: Articles were selected if they included participants aged 60 years and older, or included health care professionals, social care professionals, and informal carers of patients aged 60 years and older.METHODS: A systematic search of the following databases was undertaken: Web of Science, MEDLINE, Scopus, and The Cochrane Databases. The search of databases was supplemented by a search of gray literature, and reference lists of included papers were manually searched.RESULTS: A total of 16 studies were included in the final synthesis. Three themes were generated from the thematic analysis: (1) dimensions, (2) palatability, and (3) appearance. The dimensions and palatability are often modified to improve swallowability by breaking tablets in half or taste masking with food. Polypharmacy can lead to patients using the appearance to identify tablets; however, this can lead to confusion when products appear similar. No study was identified that explored formulation characteristics across all 3 categories directly in the older population.CONCLUSION AND IMPLICATIONS: Manufacturers should take into account practical problems older people may encounter when considering the dimensions, palatability, and appearance of the final drug product. These characteristics should be optimized to aid visual identification and swallowability. Medical providers and pharmacists have an important role in ensuring that these patient-centric drug products are prescribed and dispensed appropriately so that patients receive the most suitable formulation.

KW - Oral solid formulation

KW - acceptance

KW - adherence

KW - older people

KW - systematic review

UR - https://www.jamda.com/article/S1525-8610(20)30146-8/fulltext

UR - http://www.scopus.com/inward/record.url?scp=85082421317&partnerID=8YFLogxK

U2 - 10.1016/j.jamda.2020.01.108

DO - 10.1016/j.jamda.2020.01.108

M3 - Review article

C2 - 32224260

SN - 1525-8610

VL - 21

SP - 1015-1023.e8

JO - Journal of the American Medical Directors Association

JF - Journal of the American Medical Directors Association

IS - 8

ER -

Does the Formulation of Oral Solid Dosage Forms Affect Acceptance and Adherence in Older Patients? A Mixed Methods Systematic Review

Abstract

Bibliographical note

Keywords

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Patient Centric Medicine Design: An Investigation into Understanding and Enhancing Older People’s Adherence to and Acceptance of Oral Solid Dosage Forms

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Does the Formulation of Oral Solid Dosage Forms Affect Acceptance and Adherence in Older Patients? A Mixed Methods Systematic Review

Abstract

Bibliographical note

Keywords

Access to Document

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Student theses

Patient Centric Medicine Design: An Investigation into Understanding and Enhancing Older People’s Adherence to and Acceptance of Oral Solid Dosage Forms

Cite this