Medicine taking

Question 1

What is the most common patient level intervention in the NHS?

Answer 1

Prescribing (covers all sectors of care- primary, hospital, public and community health)
- a means of legitimising symptoms

Question 2

What is the second highest area of spending in the NHS?

Answer 2

Prescribing - it is second to staffing costs

Question 3

Who is to blame for overprescribing?

Answer 3

It is often blamed on patients, but actually it is GPs
- Wide variations in prescribing practice between GPs even though there are protocols in place, decisions and perceptions and experience of doctors contributes to this variation

Question 4

What are the current trends on NHS expenditure of medicines?

Answer 4

They are always increasing

- in 2015/16 it increased by 8% since 2014/15 and it increased by 29.1% since 2010/11

Question 5

What other costs in the NHS are also increasing?

Answer 5

hospital use
-45.2% of total cost in 2015/16, up from 43% in 2014/15 and 32.1% in 2010/11

Cost of medicines
- increased by 8% overall and 13.6% in hospitals from 2014/15 to 2015/16

Question 6

What is said to be greatest predictor of the decision to prescribe?

Answer 6

doctor’s perceptions of the patients expectations

Question 7

In developed countries what is the percentage of prescriptions that are actually used?

Answer 7

only 50% of drugs are taken by patients with chronic conditions
- poor adherence in developing countries is assumed to be higher due to the paucity fo health resources and challenges with access

Question 8

Define: concordance

Answer 8

development of a therapeutic alliance between doctors and patients in which beliefs and information about medicines are shared
- term to describe what’s going on

Question 9

Define: compliance (full/partial)

Answer 9

the extent to which the patient follows mutually agreeable instructions/extent to which actual drug taking behaviour matches the prescribed regime
- follow instructions

Question 10

Define: medication persistence

Answer 10

refers to the act of continuing the treatment for the prescribed duration. It may be defined as the duration of time from initiation to discontinuation of the therapy
- active continuing of treatment for defined period of prescription

Question 11

Define: non-adherence

Answer 11

patient makes a conscious decision not to take the prescribed medicine

Question 12

Define: unintentional

Answer 12

situations in which the patient intends to take the medicine but does not do so e.g. by forgetting or not understanding how to take it, loses the medication, can’t pick it up, prompt of symptoms is no longer there

Question 13

What sorts of questions can you ask a patient to assess adherence?

Answer 13

It is vital to use a patient centred approach to ensure you are not making them feel guilty

• Asking Q’s in a way that does not apportion blame
• Explaining why you are asking the Q’s
• Mentioning a specific time period such as “in the past week”
• Asking about medicine taking behaviour such as reducing the dose, stopping and starting medicines

By being sensitive you are more likely to find out the truth about their adherence

Question 14

What are the two broad sources of information about medicine used by patients?

Answer 14

FORMAL HEALTHCARE
- healthcare professionals - if patients are getting differing answers from them this can jeopardise the patients adherence

LAY/NON-EXPERT

• Media - probably the biggest influence
• Self-help groups
• Non-expert people- friends family

Question 15

What are the key things patients want to know about their medication?

Answer 15

• side effects
• what it does and what it’s for
• do’s and dont’s
• how to take it

Difficult to get through all of this in a 10 min consultation

Question 16

What circumstances might alter a patient’s need for information?

Answer 16

People have a broad range of info preferences that may differ at different times and for different reasons

• pregnancy, breast feeding, menopause, taking part in competitive sport, job (driving, working with heavy machinery)

Question 17

What are all the questions that need to be addressed in a 10 min consultation?

Answer 17

Satisfaction with information about medicine scales (SIMS)

1) what your medicine is called
2) what your medicine is for
3) what it does
4) how it works
5) how long it will take to act
6) how you can tell if it is working
7) how long you will need to be on the medicine
8) how to use your medicine
9) how to get more
10) whether the medicine has any side effects
11) what the risks are of getting the side effects
12) what you should do if you experience unwanted effect
13) whether you can drink alcohol or not - often this is a key reason why people don’t take their medication if they can’t drink alcohol
14) whether the medicine interferes with other medications
15) whether the medicine will make you feel drowsy
16) whether the medication will affect your sex life - side effect of some BP tablets in men
17) what you should do if you forget to take a dose

Question 18

What other factors can affect medicine taking behaviour?

Answer 18

Feel that their diagnosis was at a time of stress and now they are better they no longer need to take the medicine (e.g.blood pressure tablets

Difficult to take medication when you are feeling fine

Fear of becoming addicted

Feeling as if they are not working properly e.g. blood pressure fluctuating

Question 19

Does colour of medication have an effect on adherence?

Answer 19

red, yellow and orange = stimulant effect
blue, green = tranquillising effect

Colour of drug affects perceived action

• white = general drugs, weak
• red, scarlet = cardiovascular, blood, lymphatic system
• tan, beige, burnt orange = skin
• red, black = strong

Question 20

What are the preferred and most disliked colour of drugs?

Answer 20

Preferred: white

Most disliked: purple, brown capsules

Question 21

What factors correlate with compliance of a treatment?

Answer 21

Dosing regime - more likely to comply if it is easy
Patient lifestyle routines- more likely to comply if it fits into their regime
Use of other medications - can be taken at same time
Side effects - less side effects, means greater compliance

Question 22

What factors don’t correlate with compliance of a treatment?

Answer 22

sex- although women tend to be more in the know about health, it appears that men and women are the same 
educational level 
socio-economic status
disease state 
disease severity