The facts
Around 50% of patients with long-term conditions are non-adherent to their medications (WHO, 2003). The odds of good health outcomes are 3x lower for patients who do not take their medication as prescribed (DiMatteo, 2002). The OECD estimates that poor adherence costs Europe a staggering 125 billion euros and leads to up to 200,000 premature deaths annually as a result (2018). More than any technical advancement, improving adherence interventions is predicted the best tool to improve global health outcomes (WHO, 2003).
The idea
In 2011, Professors Graham Davies, Anne Greenough and Peter Hylands, initiated the idea of a Centre for Effective Medicine Use. The main aim was to bring together the four world leading organisations that make up King’s Health Partners (KHP) to provide an effective and safe medicine service for the local community. One of its key components: medicine adherence. Professor Davies says: “We wanted to put adherence, which was being overlooked, on the agenda - underpinning education and research - not a box ticking exercise, but because it’s the right thing to do.” When Professor John Weinman joined the Institute of Pharmaceutical Sciences, he quickly became enthused with the idea of a centre focusing on adherence, eventually forming CARE with the support of KHP. A steering group was formed made up of senior clinicians and researchers from across the Trust – ensuring both clinical and academic input.
The how
In conversation with patients and clinicians, it soon became clear both parties experience barriers in discussing adherence issues. This means that problems with medication very often go unnoticed and unresolved. Although healthcare professionals are well placed to target adherence issues during routine consultations, what is lacking is the confidence and ability to identify and challenge these issues. To tackle this, CARE created a simple, user-friendly screener questionnaire, which allows patients to indicate if they are experiencing any adherence issues and provides a conversation starter for their clinician (Weinman et al, 2019). A training based on a set of adherence support strategies using behavioural science was developed alongside to ensure the tools to effectively deal with many of the issues identified.
More than 300 healthcare professionals have been trained so far, showing a significant increase in confidence and ability.
The future
An immediate task is to run trials to evaluate the efficacy of our training on improving patients’ adherence and clinical outcomes. Future research includes developing more sophisticated and personalised adherence support interventions alongside further digital development.
CARE is working to expand its current training suite with more specialist training into specific conditions (e.g., diabetes; mental health problems) and certain groups (e.g., parents of children with medical conditions; adolescents).
Non-adherence is normal human behaviour, let’s start the conversation.