Medication review: impact on medicines taking, adherence and concordance Wendy Clyne Assistant Director: Medicines Pa

1. Medication review: impact on medicines taking, adherence and concordance Wendy Clyne Assistant Director: Medicines Partnership Programme NPC Plus

2. Content Extent of compliance/adherence with medicines Patterns of adherence Determinants of adherence Medication review as an adherence intervention What does a medication review to improve adherence look like?

3. Non-compliance affects virtually all disease areas Source: Whitney HAK, Jr. et al. (Editors). Medication compliance: a healthcare problem. Annals of Pharmacotherapy 1993; 27 (9. Suppl). This slide shows levels of non-compliance across a number of disease areas, and you can see that non-compliance is lower for people with arthritis at 35% moving up through epilepsy, hypertension, and diabetes to a massive 80% level of non-compliance for asthma. Non-compliance can mean not taking any medicine at all, not taking it at a sufficient dose for it to have a therapeutic benefit, or taking medicines some days and not others. Source: Whitney HAK, Jr. et al. (Editors). Medication compliance: a healthcare problem. Annals of Pharmacotherapy 1993; 27 (9. Suppl). This slide shows levels of non-compliance across a number of disease areas, and you can see that non-compliance is lower for people with arthritis at 35% moving up through epilepsy, hypertension, and diabetes to a massive 80% level of non-compliance for asthma. Non-compliance can mean not taking any medicine at all, not taking it at a sufficient dose for it to have a therapeutic benefit, or taking medicines some days and not others.

4. Individual patterns of medicine taking - statins

5. Persistence with medicine taking decreases over time

6. Persistence with medicine taking decreases over time

7. Adherence to medication “increasing the effectiveness of adherence interventions might have a far greater impact on the health of a population than any improvement in specific medical treatments” WHO (2003) Adherence to long-term therapies: Evidence for action

8. Adherence and medication review Medication review = adherence intervention after prescription

10. Content

11. Levels of review

12. Characteristics of medication review

13. Medication Review, QOF, and patient involvement 2006 guidance for the Quality and Outcomes Framework (QOF) ‘it is expected that as least a level 2 medication review will occur as described in room for review’[i] in relation to medicines indicators 11 and 12. A review with the patient’s notes but not necessarily with the patient is the minimum standard expected of medication reviews for the General Medical Services (GMS) Contract. [i]http://www.bma.org.uk/ap.nsf/AttachmentsByTitle/PDFQOF2006/$FILE/Quality+and+outcomes+framework+guidance+-+Feb+2006.pdf

14. MUR: numbers Between January and March 2008 average of 99,482 MURs each month cost: an average of £2,686,031 per month Since April 2005 – 950,887 MURs http://www.psnc.org.uk/index.php?type=page&pid=72&k=3

15. Medication review and mental health trusts Only 18% of medication reviews in inpatient settings involved the patient Healthcare Commission (2007) Talking about medicines: The management of medicines in trusts providing mental health services

16. What does a medication review to improve adherence look like?

17. What is the work of a medication review?

18. NICE medicines concordance guideline due January 2009

19. Achieving concordance – a guide to good practice

20. Thankyou Dr Wendy Clyne w.clyne@mema.keele.ac.uk www.npcplus.co.uk

21. Patients’ experience of medication review 1 Patients’ perceptions before the review: + it would be helpful to have a chance to talk things through - feeling it was expected of them to attend - believing the review was principally to check up on whether the patient was taking their medicines - was primarily about cutting costs

22. Patients’ experience of medication review 2 Participating in a medication review: + the review was valuable when it wasn’t rushed - concern about hidden agendas. Some patients participating in brief reviews felt that the review had really been about trying to save money +/- patients were less concerned about the profession of the practitioner than that good communication should occur

23. Patients’ experience of medication review 3 Perceptions of actions following review + appreciated reassurance about their medicine-taking - when changes were made to their medicines, patients were not always happy or clear why the change was being made few patients reported being given written information after the review From Room for Review evaluation report, available from Medicines Partnership Programme