Published in January 2009 by the National Institute for Health and Clinical Excellence (NICE) the clinical guidance Medicines adherence – Involving patients in decisions about prescribed medicines and supporting adherence (NICE clinical guideline 76) gives guidance to health professionals on how to involve patients in decisions about prescribed medicines and how to support adherence.
What is the background to this?
Adherence to medicines is defined as the extent to which the patient’s action matches the agreed recommendations.1 Extensive reviews of the literature reveal that in developed countries adherence to therapies averages 50%.2
In 2007, Medicines Partnership at NPC Plus published “A competency framework for shared decision-making with patients: achieving concordance for taking medicines”. This document set out good practice for health and social care professionals in their consultations with patients about their healthcare and treatment. It described the skills and behaviours that practitioners need to ensure that they listen effectively to patients.
This guidance offers best practice advice on how to involve patients in decisions about prescribed medicines and how to support adherence. It also recommends that the initial decision to prescribe medicines, the patient’s experience of using the medicines and the patient’s needs for adherence support should be reviewed regularly. Healthcare professionals involved in prescribing, dispensing or reviewing medicines should ensure that there are robust processes for communicating effectively with other healthcare professionals involved in a patient’s care.
To complement this new guidance the NPC has launched a new NPC section on ‘adherence to medicines’. This is the first in a series of five floors focussing on adherence to medicines that will be rolled out over the next 12 months. These floors will give access to a number of different learning resources to improve your understanding and knowledge around adherence to medicines as well as tools and documents you may find useful in practice.
The General Medical Council has also recognised the importance of involving patients and issued guidance in which it states “You must work in partnership with your patients. You should discuss with them their condition and treatment options in a way they can understand, and respect their right to make decisions about their care”.
What does this mean to medicines management?
This guidance has the potential to impact many key areas of medicines management such as prescribing, dispensing, patient understanding of their medication, medicines waste and patient safety. Improving and encouraging a partnership approach to medicines taking will help to improve these areas and others, resulting in a medication regimen that is more likely to be adhered to by the patient.
Extended prescribing roles for nurses pharmacists mean that optimal medicines management is increasingly a team responsibility, and to ensure that all health professionals work as a team communication networks need to be optimised. Healthcare professionals who prescribe or dispense medicines, or who have a role in making decisions about medicines with patients, should read and make use of this guidance to help improve patients’ medicines management.
1 Cushing, A, and Metcalfe, R. (2007). Optimising Medicines Management: From Compliance to Concordance.
2 World Health Organisation (2003). Cited in: Cushing, A, and Metcalfe, R. (2007). Optimising Medicines Management: From Compliance to Concordance.