The Pharmaceutical Journal
Vol 269 No 7219 p539
12 October 2002

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British Pharmaceutical Conference 2002 summary

Primary and secondary care

Adapting to change

Professor Rob Horne, University of Brighton, emphasised the relevance of psychology to medicines management. He pointed out that prescribing is the most common intervention in health care and that pharmacists will be involved as long as the profession is in existence. However, they, along with other health care professionals, often give patients low priority and keep them in the background. Professor Horne thinks that this is a mistake as the National Health Service depends on patients being able to manage medicines effectively, for example, by good concordance.

He went on to talk about the problem of non-adherence. "It is estimated that more than 30 per cent of medicines are not taken as directed. If the prescription is appropriate, this represents a loss for patients, for the NHS and for the pharmaceutical industry. However, effective interventions to facilitate adherence are elusive and we do not get far if we try to improve adherence." He believes the reasons for non-adherence to drug therapy are both unintentional and intentional. Unintentional non-adherence depends on the skills and ability of the patient, whereas intentional non-adherence is influenced by motivation and beliefs. Patients who intentionally do not adhere to their drug therapy might have doubts about the necessity to take it and concerns about, for example, side effects, long-term effects, dependence and disruption to their social life.

He explained the satisfaction with information with medicine scale (SIMS) which was used to assess patient needs regarding information about practical aspects of medicines use and alleviate concerns about the negative effects of medicines. "Patients' information needs vary and we need to ask them and find out what their needs are. SIMS has shown that people want more information."

"The implication for medicines management is that we have to help patients make decisions informed by an accurate understanding. Care should be individualised and the patient motivated. We need better ways of facilitating self-management and informed choice. Patients, the NHS and the industry share a common interest and pharmacists are in the best position to broker partnerships."

Richard Seal, National Prescribing Centre, talked about lessons from the pilots looking at medicines management in practice. He explained that the collaborative has brought people together from different backgrounds, including patients, for better medicines management. Since being inaugurated in 2000, the pilots have involved over 700 GP practices and have looked at measures such as the average number of items prescribed for over 65-year olds, who are taking more than four regular medicines. Since the start of the programme, the average number of items prescribed has decreased, which is an improvement. Another measure mentioned by Mr Seal looked at the percentage of prescriptions without specific dosage instructions. There has been a dramatic reduction since the start of the pilot and this has implications for patient safety, according to Mr Seal.

Mark Galloway, Coventry Primary Care Trust, described his local prescription review and intervention scheme with education. Pharmacists are asked to review and intervene when prescriptions are presented to them. This has involved 65 local pharmacists who have been trained under a local accreditation scheme. The premises are also accredited if they have a professional appearance and a consultation room or area. The sort of interventions that the pharmacists are making are in the areas of dose/pack optimisation, drug detail problems and repeat prescribing issues. Interventions are recorded on a report form giving brief details and with an intervention code. The pharmacist and GP sign the report which has two more duplicates, one of which goes to the PCT each week. The scheme has been in operation since the beginning of February, running initially for six to 12 months. Results to date show that patients have been found to be ordering too much and hoarding too many medicines. Significant savings have also been identified and patient care enhanced. There is a possibility that the scheme will be developed for a further 12 months.

The last speaker, Dr Dennis Morrison, Northern Health and Social Services Board, Northern Ireland, talked about medicines management in practice. He said that medicines management is a medication review service. In Northern Ireland, the health board has developed a service protocol to implement the scheme and has recruited one in five community pharmacists in the area. Feedback has shown that they have found the scheme rewarding and interesting, and they enjoyed working with GPs.
— Contributed by Diane Langleben, editor, Hospital Pharmacist.