Introduction to medicines concordance and adherence to treatment Key Slides

1
Introduction to medicines concordance and
adherence to treatment Key Slides
2
The extent of medicine taking

• At any one time 70 of the UK population is
  taking medicines to treat or prevent ill-health
  or to enhance well-being
• 3 out of 4 people over 75 are taking prescribed
  medicines
• 36 of older people take 4 or more different
  medicines on a regular basis
• Department of Health. Medicines and older people
  implementing medicines-related aspects of the NSF
  for older people. March 2001. www.dh.gov.uk

3
Prescriptions and the Drugs Bill in 2007

• 796 million prescriptions were dispensed in 2007
  at a cost of 8,372.7 million
• The number increased by 5.9 per cent on 2006 and
  is 59.2 per cent higher than in 1997
• The average net ingredient cost per prescription
  item was 10.51. The net ingredient cost per item
  in 1997 was 8.73
• On average 15.6 prescription items were dispensed
  per head of population compared to 10.3 in 1997
• The elderly received 42.4 items per head in 2007
  compared to 22.3 in 1997
• NHS Information Centre. Prescriptions dispensed
  in the community 19972007 NS. July 2008.
  Available from www.ic.nhs.uk

4
Definitions

• Compliance the extent to which the patients
• behaviour matches the prescribers
• recommendations1
• Adherence the extent to which the patients
• behaviour matches agreed recommendations from
• the prescriber2
• 1Haynes R, et al Compliance in Health Care. 1st
  ed. Baltimore John Hopkins
• University Press 1979

5
Poor adherence to treatment of chronic
diseases is a worldwide problem of striking
magnitude. Adherence to long-term therapy for
chronic illnesses in developed countries
averages 50. (WHO 2003)
6
The burden of non-adherence

• Avoidable ill-health
• Extra costs for NHS
• Impact on person, family, economy

7

• Increasing the effectiveness of adherence
• interventions may have a far greater impact on
  the
• health of the population than any improvement in
• specific medical treatments1
• The extent of non-adherence is substantial
• More effective use could be made of the resources
  spent on medicines
• Need to think conceptually about what causes
  non-adherence and target interventions
  accordingly
• 1Haynes RB. Cochrane Database of Systematic
  Reviews 2001, 1

8
Concerns about taking prescribed medicines
Beliefs about the necessity of
prescribed medicines
Beliefs about necessity of prescribed medication
Source Horne R, Weinman J. Psychosomatic Res
1999 47 555567
9
When you see a doctor, which, if any, of the
following do you prefer?

of respondents
The doctor to decide what treatment is best for me
The doctor and I to decide together the best
treatment for me
Doctor explains treatment choices - I decide
which I prefer
Source MORI research commissioned for the
Medicines Partnership Programme
10
NHS Patient Surveys 2004-6
11
Non-adherence should not be seen as the
patients problem. Rather, it represents a
fundamental limitation in the delivery of
healthcare, often because of a failure to fully
agree the prescription in the first place or to
identify and provide the support that patients
need later on. (NICE Guideline 2009)
12
Why dont some patients take their medicines as
prescribed?
They dont want to (intentional nonadherence)
They have practical problems (unintentional
nonadherence)
What can be done about this?
Improve communication
Increase patient involvement in decision-making
Involve patients in decisions about medicines
Increase understanding of patients perspective
Provide information on medicines
Support adherence
Review medicines
Assess adherence
Improve communication between healthcare
professionals
Consider interventions to increase adherence