Getting to the heart of the non-adherence epidemic
In these austere times when the NHS is charged with delivering efficiency challenges of £120 bn, tackling non-adherence to medicines could be the single greatest innovation in reducing wastage and improving health outcomes for all. Non-adherence is a complex behaviour, driven by the beliefs that patients have about their condition and their treatment. The good news is that because beliefs are modifiable, it is possible to develop strategies that positively influence this behaviour, resulting in improved health outcomes.
The World Health Organisation estimates that around 50 per cent of patients around the globe, with long-term illnesses, do not take their medications as prescribed.1 The NHS is facing unprecedented resourcing pressures, and by 2050, 40 million people in England are expected to suffer from non-curable long-term conditions that require management through medication.2
Intervening, to ensure that patients take their medications properly can dramatically reduce downstream health costs. Experts in the pioneering field of health psychology have discovered proven ways to create behaviour change resulting in increasing adherence to medications and lifestyle changes.
Joint working arrangements, aimed at medicines optimisation, is everybody’s business. Providers specialising in evidence-based adherence solutions, the pharmaceutical industry and the NHS should be working together to improve patient outcomes, efficacy of treatments, and reducing healthcare expenditure on managing long-term conditions.
The National Institute of Health and Clinical Excellence (NICE), estimate that in the UK, around £4 bn of medicines supplied on prescription through the NHS are not used correctly. Overall in Europe, non-adherence costs £125 bn annually, and is estimated to cause nearly 200,000 deaths each year.3
Non-adherence is more than forgetfulness
Although around 30% of non-adherence can be attributed to unintentional behaviour, such as forgetting, a staggering 70% of non-adherence is actually intentional, according to Professor John Weinman, HOD of Health Psychology at Kings College, London.
“…tackling non-adherence to medicines could be the single greatest innovation in reducing wastage and improving health outcomes for all.”
“When you consider that each patient is living an individual life, and has personal attitudes to their condition and treatment that determine why they choose not to take their medication, it becomes clear that traditional adherence programmes based on ‘reminders’ or the provision of information alone are not tackling the root of the problem,” says Professor Weinman. “A reminder is not going to change someone’s mind about their treatment if they have decided– not to take it. And it’s clear that however effective a drug has been proven to be, it won’t work unless a patient takes it properly.”
Non-adherence to medication is a product of multifactorial elements, health literacy, symptom experience, coping skills and other social and cultural factors. For example, deciding not to take a medication because their high cholesterol is asymptomatic and they don’t ‘feel’ ill, or concerns about side-effects or wanting to ‘give their body a break’. Adherence solutions need to focus on addressing the underlying beliefs that drive an individual’s decision to opt out of using treatment as prescribed.
“A reminder is not going to change someone’s mind about their treatment if they have decided not to take it.”
Delivering personalised patient support
An innovative example where personalised patient support is delivered is shown through the OneHeart programme initiated and funded by– AstraZeneca, this is for patients with Acute Coronary Syndromes (ACS – an umbrella term used for patients who have suffered from a heart attack or episode of unstable angina). The programme utilises a partnership approach with Acute and Primary Care Trusts to enrol patients on the programme aimed at improving adherence to medication and health outcomes.
Nick Jones, National Collaboration Manager for AstraZeneca (UK) explains, “The OneHeart programme takes a collaborative approach to enrolling patients, we have put joint working arrangements in place with Acute Trusts and work closely with healthcare professionals on the ward – allowing more patients access to the support provided on this programme once discharged from hospital.”
“Patients on this programme receive a number of personalised interventions, designed to help them make the necessary lifestyle changes to recover from ACS while taking their prescribed medication correctly. This includes a series of health magazines with content designed to target their key non-adherent beliefs that may cause them to miss-take their meds, access to a personalised web experience to guide them through the information most relevant to them, and access to a clinical contact centre if they would like to speak with a nurse” says Nick Jones.
“…a staggering 70% of non-adherence is actually intentional…”
Spokesperson from the Association of the British Pharmaceutical Industry (ABPI) – Carol Blount says that it’s great to see examples of such collaboration, “Joint working between the pharmaceutical industry and the NHS is an effective way to collaborate by pooling resources and expertise to deliver new and innovative projects for the benefit of patients.”
Focusing on quality outcomes for patients
Evidence-based support programmes designed to increase adherence complement the vision set out by government in the white paper, “Equity and Excellence: liberating the NHS” (2010). The report states that for the UK to successfully reach world-class health outcomes, the NHS must shift focus from costs and targets to generating quality outcomes for patients. This initiative, otherwise known as Value-Based Pricing (VBP), will officially commence in the NHS from 2014 and marks a fundamental shift in UK healthcare, where medications will be assessed on the value they offer patients.4
“To achieve a better quality of life for patients, pharmaceutical companies, pharmacists and other NHS providers must be incentivised to move from the mere supply of medicines to making medicine-taking a positive experience,” says Mark Duman, Chair of the Patient Information Forum – a UK based social enterprise supporting consumer health information professionals. “Such a service would be underpinned by a true understanding of the individual patient, the delivery of personalised education, and the establishment of support mechanisms to elicit behaviour change.”
There’s a real opportunity for the exciting discipline of health psychology to shape patient-focused interventions that empower people to better self-manage their conditions – thereby reducing the burden on the NHS. This evidence-based approach must form the basis of any patient support programme if we want to make large-scale, measurable progress in addressing the non-adherence epidemic.
1. World Health Organisation. (2003).
2. J. Oldham. (2011). Long Term Conditions. Retrieved from http://www.insidegovernment.co.uk/health/long-term-conditions/
3. Cap Gemini (2011). Patient Adherence, the next frontier in patient care.
4. ABPI. (2011). Demonstrating value with real world data: A practical guide.
Disclosure of interest
• AstraZeneca work in collaboration with Atlantis Healthcare on the ACS patient support programme OneHeart in the UK.
• Professor John Weinman consults to Atlantis Healthcare as the lead in the European Health Psychology team.
• Mark Duman advises Atlantis Healthcare on public healthcare commercial matters.
About the author:
Kate has worked in the healthcare industry for over 16 years at both clinical and industry levels. Her role at Atlantis Healthcare employs her extensive knowledge of strategic planning to help create innovative evidence-based patient support programmes. She has previous experience working on patient support programme launches, DAC campaigns, CRM programmes, and public affairs and government liaison. Recently, she held Strategic Planning and Business Director roles at DDB Health Advertising, working on top pharmaceutical brands.
What can be done to address the non-adherence epidemic?