The Pharmaceutical Journal
Vol 268 No 7182 p87
26 January 2002

This article
Reprint
Photocopy

Partnerships in medicine taking: the next step

A Medicines Partnership programme has been implemented by the Department of Health to help improve the use of medicines in the National Health Service. Zoë Gross describes the aims of the programme and how they will be tackled

In the past, a need to understand the importance of involving patients in prescribing decisions may not have been fully recognised by the National Health Service. As a result, many patients have not been taking their medicines as prescribed, causing otherwise avoidable ill health, premature death, unnecessary hospital admissions and additional costs to the NHS.

Addressing this issue and developing the partnership between patients and health care professionals, including pharmacists, will help to provide more patient-focused health services and help patients to receive maximum benefit from their medicines. This is exactly what the Medicines Partnership programme, a new two-year initiative funded by the Department of Health, aims to achieve.

To get the programme off the ground, a national joint task force of representative health care professionals, patient groups and the pharmaceutical industry has been set up to focus on how to develop concordance in medicine-taking, as the activity is more formally called.

A project team, working under the direction of the task force and based at the Royal Pharmaceutical Society's headquarters, has also been set up.

The programme is expected to improve the taking of medicines by patients and improve the delivery of medicines by health care professionals, by involving patients in the precribing decision. Joanne Shaw, director of the Medicines Partnership programme, says that drug mismanagement accounts for 20 per cent of all adverse clinical incidents and costs the NHS £500m a year through longer stays in hospital. Other research suggests that as much as 50 per cent of medicines are not taken as prescribed.

Ms Shaw says that prescribers need to recognise patients' personal beliefs about the medicines they take — such as how they work and how they should be taken — and should listen to patients when making prescribing decisions. Concordance is a new approach to prescribing and taking medicines. It allows health care professionals to recognise that "patients are not just passive recipients of prescribing decisions". "It is time that the NHS recognised that patients need to be part of the prescribing decision," she says.

Improving communication

The programme will also "improve the communication between patients and the professionals who support them, giving patients greater say in their treatment and greater control over their health. This is also very much in tune with the NHS's own goals," she says.

The intention is for the programme to run alongside national service frameworks and other initiatives, such as the Expert Patient programme. It will focus on specific conditions where problems with compliance have already been identified, such as cardiovascular disease and diabetes, as well as particular patient groups, such as older people.

Over the next two years, the task force will seek to demonstrate, through the use of pilot studies, the practicality of applying the concepts of concordance in practice and the benefits of developing the partnership between patients and health care professionals. Positive outcomes found in these pilot studies are expected to be implemented within the NHS in two years' time.

Both the primary and secondary health care sectors will be involved in the programme. "But most prescriptions are written in the primary care setting and long-term illnesses are managed through primary care, so the relationship between the GP, the community pharmacist and the patient is going to be an absolutely key one," says Ms Shaw.

She suggests that, in order to help patients make the best use of their medicines, they should be given ongoing support throughout their treatment, rather than just being given support at the time a prescription is written or dispensed. This is where "there is a tremendously important role for pharmacists". Pharmacists are in a good position to provide patients with ongoing support as they have a good knowledge about particular patients. "This is something that will develop through the programme," she says.

The programme will also provide other opportunities for pharmacists to improve the use of medicines and help patients overcome barriers that may be stopping them from taking their medicines.

Members of the Medicines Partnership task force met for the first time earlier this week. A detailed work programme will be developed over the next three months. The task force is looking to identify specific areas where a real difference in medicine-taking can be made and get pilot studies up and running as soon as possible. "Now is the time to take concordance from a realm of ideas into the real world — and that is our job," Ms Shaw said.