18 December 2013
Patient / Carer Revision
Human Medicines Research and Development Support Division
Geriatric Needs Survey to the Quality Working Party
(QWP) on appropriate packaging and formulations for
older people.
This questionnaire is intended to be sent to older patients and their carers to help the European
Medicines Agency (EMA) clarify the clinical needs and practical suggestions on packaging and
formulations for older people. This will help us to understand if the medicines you are taking could
be improved.
Please email the completed questionnaire to Geriatrics@ema.europa.eu by February 3rd 2014.
Note, for questionnaires completed in paper format, please scan and email to the provided email
address.
Patient
Carer
(Please answer according to your experience)
Gender
Male
Female
What age are you?
65-69
70-74
80-85
85+
75-79
How many medications are you taking?
0-3
4-6
6+
Country __________
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E-mail info@ema.europa.eu Website www.ema.europa.eu
An agency of the European Union
© European Medicines Agency, 2016. Reproduction is authorised provided the source is acknowledged.
List of questions
1. Patient Needs
1.1. Have you experienced difficulty in opening medicine packages?
(E.g. opening child resistant containers, peel back or push though foil
packages) YES
NO
If YES, please explain:
1.2. Have you experienced difficulties in swallowing medicines?
YES
NO
1.3. If so, which types of medicines do you have the most difficulties
with? (E.g. tablet with unpleasant taste / smell, large capsule)
1.4. Which types of medicines do you find the easiest to use? (E.g.
capsules, granules to mix into food, liquids, medicated patches)
1.5. Have you experienced confusion when taking your medicines? E.g.
the colour, shape, size of the tablets look similar
YES
NO
1.6. If so, have you any ideas on how to help avoid confusion?
1.7. When taking your medication, do you need to crush or split tablets?
YES
NO
1.8. Do you check if you are allowed to do so by:
Reading the patient information leaflet
Asking your doctor / pharmacist
I do not check
1.9. Do you think that combination medicines (e.g. two medicines
combined into one tablet) would be helpful?
YES
NO
If YES, please explain:
Geriatric Needs Survey to the Quality Working Party (QWP) on appropriate
packaging and formulations for older people.
EMA/CHMP/SAWP/794669/2013
Page 2/4
2. Packaging and design
2.1. Do you have any suggestions on how to improve packaging design
(E.g. adaptations to caps for creams, eye drops, syringe plungers etc)
Please provide suggestions:
2.2. Do you have any specific comments about child resistant caps?
2.3. Do you or your pharmacist often repackage medicines? (E.g.
remove from the original package and store in a weekly pill box)
YES
NO
If YES, please explain:
2.4. Weekkly pill boxes / blister medication packs are used by many
older people. Have you experienced any problems in using these? For
example the appearance of tablets in the box changes over time
2.5. Have you experienced difficulties in reading the instruction label?
YES
NO
If YES, please explain:
2.6. Any other comments or suggestions?
3. Compliance and adherence
3.1. Do you think that imprinting symbols on medicines, such as a heart
symbol for heart medicines makes it easier to know what the tablet is
for?
YES
NO
If YES, please explain:
3.2. Any other comments or suggestions?
Geriatric Needs Survey to the Quality Working Party (QWP) on appropriate
packaging and formulations for older people.
EMA/CHMP/SAWP/794669/2013
Page 3/4
4. Information about your medicine(s)
4.1. Every medicine pack includes a Patient Information Leaflet (PIL),
which provides the patient with information on how to use their
medicine safely. Did you know that you can ask for a large print
information leaflet from your pharmacist and / or the manufacturer?
YES
NO
4.2. Do you think that the Patient Information Leaflet (PIL) includes
adequate information on:
How to take the medicine
What the medicine looks like
When not to use the medicine
What to do if a dose is missed
What happens if you are taking other medicines
4.3. Is there any other information that you would like to see included
in the Patient Information Leaflet?
4.4. Do you think that more visual images would be helpful? (E.g.
images of how to apply a medicated patch etc.)
YES
NO
4.5. Do you have any suggestions on improving and adapting the PIL to
the needs of the older population? (e.g. information regarding missed
dose, interactions with other medicines)
YES
NO
If YES, please provide suggestions:
4.6. Any other comments or suggestions?
5. Conclusion
5.1. Besides packaging and formulation, what do you think are the
major needs of older patients?
Geriatric Needs Survey to the Quality Working Party (QWP) on appropriate
packaging and formulations for older people.
EMA/CHMP/SAWP/794669/2013
Page 4/4