The Pharmaceutical Journal
Vol 268 No 7199 p717-719
25 May 2002

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  Dispensing
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Letters to the Editor

Concordance

Patients aware of resource constraints

From Dr S. Peacock, BM, Dr K. Pollock, PhD, and Professor A. Blenkinsopp, FRPharmS

The Wanless report recommends that patients should be informed of the cost of some treatments to the National Health Service.¹ Your leading article (PJ, 27 April, p556) proposed that this should include the cost of medicines, with the hope that it will lead to a more thoughtful and grateful use of medicines by patients. This suggests that patients do not think or care about the NHS resources consumed by medicines. No evidence was put forward to support this view, but there is evidence to the contrary.

First, research has shown that some medicines are prescribed when not required because of the doctor incorrectly perceiving a pressure to prescribe.^2,3 Thus, patients sometimes are prescribed medicines they do not want and are unlikely to use.

Secondly, in a recent qualitative study carried out by Dr Peacock involving in depth interviews with 20 patients, we have shown that patients already have a careful approach to the use of NHS resources, and many are aware of the resource constraints that affect medicines use. We investigated the possible effects of telling patients the cost of their medicines and found that there are negative as well as the unproven positive effects. The negatives include: embarrassment at needing expensive treatment; guilt at using a resource someone else might need; reluctance to complete a course of medication once health is improving; and feeling that the burden and blame for managing the health care budget is being shifted from the doctor to the sick patient. We do not claim that all patients hold these views but argue that our research findings contradict the stereotype that portrays patients as careless consumers of NHS resources.

Our research shows that some patients are willing to include cost among other factors in their decision as to whether to use a medicine or not, particularly where the health benefit is small, but this needs careful managing to avoid the negative consequences. Rather than implementing a wholesale plan to tell all patients the cost of their prescribed medicines, we suggest that concordance would be enhanced if health professionals elicited patients' views and engaged in more open discussion.

Stephen Peacock
General Practitioner,
Wolverhampton

Kristian Pollock
Concordance Research Fellow,
Department of Medicines Management,
Keele University

Alison Blenkinsopp
Professor of the Practice of Pharmacy,
Department of Medicines Management,
Keele University

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