Medication non-adherence is a serious public health issue costing lives and money. Research shows that many patients don’t take or use their prescribed medicines as recommended, whether that’s because they lead a busy lifestyle or are following complex medication regimes. In England alone, between a third and half of all medicines prescribed for long-term conditions are not taken as recommended.
Behind these startling facts lie thousands of family tragedies and yet in the main, the general public are largely unaware of the critical risks around medication non-adherence. The longstanding problem of how to improve adherence isn’t something one organisation can solve on its own.
For this reason, Omnicell UK & Ireland launched the ‘Let’s Take Care of It’ campaign to raise the profile of non-adherence, change perceptions, improve understanding and encourage conversations.
In 2015, as part of the campaign we saw the first National Medication Adherence Week – a week of action aimed at getting healthcare professionals talking about how to tackle the issue, saving lives and money in the process.
Research shows that medication adherence is best supported through intensive individualised patient support delivered repeatedly by pharmacists. Community pharmacists have the unique benefit of seeing a patient face to face each time they renew their prescription and with that comes the ideal opportunity to deliver this type of adherence support; they therefore have the potential to play a huge role in improving the care of patients, as Paul describes:
“Given the increasing pressures on the NHS, pharmacists need to move further away from just a dispensing role and establish new clinical roles in collaboration with family GP’s. Of course, there are several barriers to this such as workload but pharmacy needs to adapt to overcome these.”
“Medication adherence is particularly pertinent in my area of specialism, heart failure. Heart failure is a condition associated with a high mortality and morbidity; non-adherence to medication is known to significantly increase this risk yet many patients fail to adhere to their prescriptions. The barriers are both complex and multi-faceted but include logistical (e.g. ordering medications, reading, swallowing), educational (e.g. poor understanding), social (e.g. lifestyle and level of family/carer support), emotional (e.g. patient beliefs, depression) and cognitive (e.g. dementia) factors amongst others.”
“Put simply, without adherence support, some heart failure patients are going to remain at an unnecessarily elevated risk of hospitalisation and death. Pharmacists need to have systematic ways of identifying all patients that are non-adherent to medication – it is no longer acceptable to simply let them slip through the cracks. We must work collaboratively towards patient-centric care with health and social partners to reverse this decline.”
Dave Williams, 62, from Manchester has been caring for his partner Martin Bird, 59, since he was diagnosed as HIV positive in 1988. Here, he tells how that task would be impossible without a patient pack system for all Martin’s drugs.
“Martin and I have been together for 32 years and I have been his carer for many
of those. With HIV, compliance is absolutely critical because the virus can replicate and become resistant to treatment.”
“But that’s just part of the problem these days. Martin now also has memory loss, hepatitis B, epilepsy, diabetes, peripheral neuropathy and an underactive thyroid
– as a result of which he currently has to take a total of between 56 and 58 tablets every day.”
“I used to try to arrange his daily medication in a plastic box myself. Every fortnight I would sit down for at least two hours at a time to organise his upcoming treatment. But the trouble was if you dropped the box you’d have to start all over again.”
“Now I use pre-packed blister packs from Boots which are picked up once a month, apart from his HIV medicines which are provided separately. I’ve been using these blister packs for the majority of the pills for about six months now and we’ve had no problems at all.”
“It would be a virtually impossible task for many carers without them.”
Lisa Williams, 29, suffers with epilepsy as a result of a road traffic accident. Taking the right dose of medication at the right time is essential. Lisa, from Manchester, tells how patient adherence packs provided by her pharmacist ensure she keeps her condition under control.
“In 2006, I was involved in a car accident as a back seat passenger. I was in a coma for two weeks and in hospital for a total of 17 weeks. I suffered a head injury which rapidly led to epilepsy and left me quite forgetful. Almost immediately, I started suffering fits and seizures. It was really scary.”
“Doctors prescribed me the anti-epileptic drug Levetiracetam, which I have to take two of in the morning and two in the evening. I also take folic acid at the moment because I am trying to get pregnant.”
“I get my patient medication adherence pack from the pharmacist every week. It gets dropped off on a Monday morning. I used to find it really difficult managing my medication. I could never remember if I had taken my drugs or not – on one occasion, I took too many and overdosed and had to go to hospital.”
“I’ve been using the packs now for about three years and have had no problems in that time. My epilepsy is well controlled now and the last seizure I suffered was over a year ago.”
As a pharmacist, Irfan Ali has been supporting patients with their medication for the past 25 years. He is now a member of the Omnicell team.
Throughout his career he has witnessed first-hand the issues surrounding adherence. He comments that while there have been many improvements over the years, the problem still remains that too many patients fail, forget or struggle to take their medication correctly.
“Given the number of aides that are available to support patients, it’s a real concern that adherence is still such a huge problem here in the UK and further afield,” he says.
He believes the solution lies in the further development of adherence aides and in working in closer partnership with other healthcare professionals: “In the future I think we will see greater use of technology, for example mobile phone apps and intelligent packaging which monitors, prompts and records when a patient’s medication is due and has been taken. This will be invaluable to the patient, their family and all the health professionals associated with their care.”
“It’s not the introduction of technology that’s an issue, the real challenge is getting everyone to work together to break the cycle of medication non-adherence. How can we not do this when it’s the most obvious way to improve the lives of patients with long-term conditions?”
The report throws the spotlight on the ‘missing millions’ in the NHS and the staggering cost to the nation of medication non-adherence.
Adherence to Long Term Therapies, Evidence for Action