The vast number of patients who take prescribed medicines incorrectly is one of the biggest challenges facing the UK healthcare system. With COVID-19 particularly affecting people with underlying health conditions – and considering the difficulties in accessing frontline services right now – it’s never been more essential for people to take their medication and follow the advice of experts.
The problem of poor medication adherence is estimated to cost the NHS £300m a year[i] and there is a view, by the World Health Organisation (WHO) among others, that increasing the effectiveness of adherence interventions may have more of an impact on the health of a population than any improvement in specific medical treatments[ii].
With up to 50% of medicines prescribed for long-term conditions taken incorrectly[iii], it’s clear that not only is this a potentially damaging issue for the patient themselves, but also for the wider healthcare system. In the US, up to 69% of medication-related hospital admissions are due to poor adherence[iv].
Counting the cost
While it’s understood that the ramifications of poor medication adherence are serious and widespread, it’s difficult to understand the full extent of the problem. Take high blood pressure as an example; in the UK it’s reported that one in three patients don’t take their blood pressure medication as prescribed[v]. Because high blood pressure is often a symptom-free condition, many people assume they don’t need treatment. However, it’s a silent killer and implicated in tens of thousands of heart attacks and strokes that hit suddenly and without warning. The British Heart Foundation estimates that the total annual cost of treating heart and circulatory diseases in the UK is £9bn[vi].
Major depressive disorder, otherwise known as clinical depression, is also a major burden on the UK healthcare system and one that is likely to get exponentially worse over the next decade. According to WHO, major depressive disorder will become a leading cause of disability globally by 2030[vii]. In the UK, prescribed antidepressants are used to treat the condition and have been proven to effectively reduce depressive symptoms, however, poor adherence to antidepressants remains a widespread problem and is recognised as one of the reasons for treatment failure. Studies reveal that up to 50% of primary care patients will prematurely stop taking their medication for a range of reasons, including concerns about side effects, lack of sufficient patient education and poor follow-up with their clinician[viii].
Poor adherence impacts patients, healthcare services and the wider economy. Unnecessary hospital admissions put an extra burden on the NHS and lead to additional healthcare costs, while patients suffering from ongoing ill-health are often unable to work, increasing their reliance on social care and the welfare state.
However, most poor adherence in the UK is unintentional and due to patients not understanding why and how the medication they’ve been prescribed manages their symptoms. It’s no wonder patients are confused when the average length of time for a GP consultation is only 9.2 minutes – too short according to the Royal College of General Practitioners. In addition, 2019’s NHS England Patient Satisfaction Survey revealed that more than one in five patients with long-term conditions say they don’t receive enough support to manage their condition, an increase on the year before. The reality is that at present the UK’s healthcare system is under unsustainable pressure and has too many moving parts to ensure consistent medication adherence.
So, what’s the solution? Technology is playing a part in helping remind people when to take their medication and educating them about their use. Various apps and wearables are now available that do this, and NHS England has developed an apps library to help patients choose those that are safe and have value. An example of an app in the library is myCOPD, which enables people living with chronic obstructive pulmonary disease to take greater control of their condition by monitoring their symptoms, tracking their medicine use and getting training on correct inhaler technique.
While it’s clear that technology can be used to empower patients to look after their health, human interaction and better forms of communication are key to improving adherence. At Medical Solutions, we have seen a growing number of patients wanting advice from our GPs regarding their long-term condition(s), including how to manage their symptoms and queries about medication. We understand that pharmacists have a major role to play in meeting the challenges of poor medication adherence and providing support for patients with complex needs. This is why we launched Medi-SMART, a dedicated support helpline that provides access to experienced clinical pharmacists who are experts in medication management.
Overcoming barriers to medication adherence often entail a healthcare professional talking to the patient and providing the individual support they need. By enhancing the patient experience, the best possible outcomes can be achieved both for the patient and for the wider healthcare system.
Dr Chris Morris is Chief Medical Officer of Medical Solutions
[iii] NICE Medicines Optimisation