Are you taking your medicine? Nearly half the time, the answer is “no.”

This blog is by Ayobola Chike-Michael, Patient Safety Project Manager at the Health Innovation Network

The real life cost of non-adherence

Medicines are made to be taken. Right? Well, medicines are being manufactured, prescribed and dispensed, but up to 30–50 per cent of prescribed medicines may not be taken as directed. This is a big issue for John Weinman, distinguished Professor of Psychology as Applied to Medicines at King’s College London, who recently gave a presentation to representatives from all 15 Academic Health Science Networks (AHSN) on this topic. It’s also a prevalent issue for doctors, pharmacists, patients, carers and relatives. If this is not an issue in your world, it should be.

“Non-adherence” to prescribed medication is when a person does not take the medications as directed. This is surprisingly very common. As a result of this, many kitchen drawers overflow with medicines that eventually get thrown away, or worse, cause harm to an unintended consumer.

A look at some of the contributing factors
It’s not only patients who feel the negative impact of non-adherence; evidence shows that there are poorer clinical outcomes and increased healthcare costs associated with it too. This 2018 OECD report states that poor adherence contributes to 200,000 premature deaths in Europe per year and costs 125 billion euros through avoidable hospitalisations, emergency care and outpatient visits. Good-quality health as defined by the OECD is three times lower in those who do not adhere to their medication. It is a huge drain on public reserves and a massive health challenge to overcome. Most significantly, it does not have to be this way.

So why would someone who is unwell and needs medication not take it? The reasons why transcend the smell or size of the tablets they are given. Some people do not believe that medication is important for them. Some worry about side effects or lose motivation and so refuse to take them or do not take them as prescribed. Research literature identifies almost 200 reasons for non-adherence. Some are obvious, others are less so. But when there are so many factors involved, how do we know where to begin supporting patients?

Understanding the why

King’s Health Partners established a centre that addresses these questions and many others relating to matters of adherence. The Centre for Adherence Research & Education (CARE) provides a hub for understanding and addressing the reasons for non-adherence. The team of experts at CARE aim to improve patients’, caregivers’ and health and social care staff’s awareness of non-adherence and provide approaches to support patients.

CARE has carefully grouped the many reasons for non-adherence into three manageable areas: Capability, Opportunity and Motivation.

Capability. Some people do not know how to properly take their medication, or may have problems with their understanding, memory or physical ability to do so.

Opportunity. Some people are limited by situations outside of their control. These are external challenges such as financial constraints, access and lifestyle opportunities.

Motivation. Some have developed a negative perception about their medication through social pressures and stigma, or as a result of their perspectives and experiences (those of side effects or low moods, for example) can become convinced that the medications are not necessary or beneficial to them.

Improving adherence

It is important that healthcare professionals and carers understand, and support their patients’ understanding of, the impact of non-adherence. But equally important is that we promote and celebrate the benefits of adherence. With adherence, patients experience an improved quality of life because their symptoms can be reduced and they can benefit from increased physical function and improved health outcomes. This is a win-win for patients and healthcare professionals.

Some healthcare professionals feel limited in supporting their patients to improve adherence because of the tremendous time pressure they’re under, or because they don’t know how to go about it. The CARE approach enables collaborative working with the patient to find solutions. They train clinicians to understand the issues and provide them with user-friendly tools and support strategies designed for routine care. These are available on the King’s Health Partners Learning Hub.

To join our conversation around how to support patients in getting the most out of their medicines, contact a member of our patient safety team at hin.southlondon@nhs.net. Let us all in our individual capacities do what we can to make the world of medicines a better place.