Martin Davies (CTUHB), Emma Williams (CTUHB) and Anne Hinchliffe (PHW)
Cwm Taf University Health Board and Public Health Wales NHS Trust
‘Increasing the effectiveness of adherence interventions may have a far greater impact on the health of the population than any improvement in specific medical treatments’.
In 2005, as part of a new contractual framework for community pharmacy, the Medicines Use Review (MUR) service was introduced. The service involves an accredited pharmacist undertaking a structured adherence-centred review with a patient and each pharmacy can offer up to 400 MURs per year. Usually the community pharmacist initiates a MUR by asking a patient if they would like one; research suggests that the majority of patients believe having a MUR is more for the benefit of the pharmacist then themselves.
In developing this project we considered that if a patient requested the MUR him/herself (s)he would be more likely to benefit from it. Theoretically, patients can self-refer for a MUR but in practice very few MURs are initiated by patients. Applying behavioural insights to the design of the interventions, we propose to test three approaches which encourage patients to self-refer for a MUR (poster, leaflet, and personal invitation).
The interventions will be trialed in pharmacies in Rhondda Cynon Taf between September and November 2016 and the impact of the three interventions analysed. The project has been submitted to a Public Health Wales Research and Development Group. Ethical approval is not required.
This Project Supports Prudent Healthcare:
Prescribing a medicine is one of most common interventions in NHS Wales with around £600 million per annum being spent on prescribed medicines in primary care. However, an estimated 30-50 per cent of medicines for long-term conditions are not taken as prescribed. Poor adherence with medicines results not only in medicines waste but also a potential loss of health benefits. Reducing non-adherence would lead to more effective use of healthcare resources as well as benefiting patients.
Non-adherence with medication can be intentional or non-intentional. Some patients can’t take their medicines e.g. unable to read instructions, failure to use an inhaler effectively; others don’t want to take their medicines, often because they have concerns about them or don’t fully appreciate their need for the medication. To identify and address non-adherence clinicians must involve their patients effectively in consultations, adopting the principle of co-production.
We anticipate patient satisfaction with MURs will be increased as pharmacists and patients work together to identify and overcome those medicines related problems that lead to the patient not taking their medicines. Other potential outcomes include reduced medicines waste by minimising medicines that are not taken and greater health benefits by maximising the effect of the medication prescribed, although the project is not designed to measure these outcomes.
The project will result in posters and leaflets being designed and published. If shown to be effective these will be shared with other Health Boards in Wales, avoiding duplication of effort. The learning from the project will be disseminated to colleagues within NHS Wales and form the basis for future developments.
Furthermore, a network of pharmacists and academics interested in health psychology and medicines use is developing in Wales, which will progress further activity in this area. The leads for this project are well connected with that network.