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Medication: Take It, Leave it or Sometimes Forget
The doctor says ‘take two in the morning and take two at midday and two in the evening’ plus the other tablets… so it makes you feel horrible; that’s why I cut down.”
[Focus group attendee (Aston Medication Adherence Study (AMAS) explaining their medication 1 issues]
Patients on medication for long-term conditions can often face difficulties with taking their medication as directed by their doctor. In addition to the potentially detrimental effect on their health, the cost to the NHS of people not taking their medicines properly is estimated at more than £500 million per year.
A pioneering study, believed to be the first large-scale research project on medication adherence of its kind in the UK, has recently been completed by a research team led by pharmacists 2 from Aston Pharmacy School. There is a paucity of research examining medication adherence in large populations in the UK and the Aston Medication Adherence Study (AMAS) was designed to help fill this knowledge gap.
The study employed a mixed methodology 3 to examine the extent of non-adherence and the factors associated with lower levels of adherence within three specific patient groups (patients diagnosed with dyslipidaemia, type 2 diabetes or hypothyroidism 4 ) living in the Heart of Birmingham 5 .
Results from the analysis of the prescribing data 6 showed that overall, around one-quarter to one-third of patients were non-adherent to their medication. Further analysis of the factors associated with non-adherence, enabled profiling of patients most likely to benefit from targeted support to help them take their medications as prescribed; these included patients:
· younger than 60 years of age
· of Islamic faith
· of Asian, Caribbean, African or ‘Other Black’ origin
· whose primary language is Urdu or Bengali
· living in the most socioeconomically deprived areas
Results 7 from the exploratory focus groups revealed an array of issues and barriers faced by patients on long-term medication. For example, patients expressed their fears about side effects of medication and the need for better communication and information about medicines. The presence or absence of symptoms played a role in patients’ medication taking behaviour and constant changes in generic forms of a medication decreased the levels of trust that patients had in pharmacists.
Professor Chris Langley, Principal Investigator for the AMAS said; “What is important about the AMAS is that it identifies adherence patterns within an ethnically diverse inner city area with high levels of deprivation; this is currently unchartered territory. The development of an innovative software tool 8 was pivotal to the study and facilitated analysis of a vast volume of prescribing data. The results from this study have provided an intriguing insight into adherence behaviour within an inner-city population, whilst the focus group data provided context and understanding of the barriers to adherence from the patients’ perspective.”
Dr Joe Bush, Investigator for the AMAS added; “We identified numerous groups in which adherence levels were lower than in the general population, but it is not possible at this time to identify why adherence is lower in these groups. Whilst the focus groups suggested possible reasons for non-adherence, we hope to explore these issues further and identify the primary reasons for non-adherence in these patient groups in future research.”
This study makes a number of recommendations including the targeting of any interventions designed to support adherence at those patient groups who are most likely to experience difficulties with taking medicines.
For more information, please visit the webpages
Funding for the study was provided by Heart of Birmingham teaching Primary Care Trust, which also collaborated on the project.
For all media enquiries, please contact Professor Chris Langley at Aston University, on 07703 716 510or email [email protected]
Notes to Editors
Chris Langley is Professor of Pharmacy Law & Practice and Deputy Head of Aston Pharmacy School at Aston University. Chris’ research interests include examining the role of the pharmacist in both primary and secondary care, alongside research work within the area of pharmacy education and policy. He has published numerous academic papers and professional reports, and he is also the co‐ author of four academic textbooks.
Biography: Dr Joe Bush
Joe Bush is Lecturer in Pharmacy Practice at Aston Pharmacy School. Joe’s research interests are focussed on the role of the pharmacist in improving the health of the public, medication adherence and pharmaceutical education. He has authored a number of research reports and academic papers.
3 Over 1 million anonymised individual prescription issues were analysed; just over 7,000 patient questionnaires were administered (in two mailings); seven focus groups were conducted; and a full review of the literature regarding adherence was undertaken.
Abnormal levels of lipids (e.g. cholesterol or fat) in the blood.
Type 2 diabetes
A condition which develops in adulthood where the body does not produce enough insulin or the body is unable to use the insulin which is produced efficiently.
Abnormally low activity of the thyroid gland, a gland which is found in the neck. This gland produces hormones that are released into the bloodstream to control the body's growth and metabolism.
5 Heart of Birmingham teaching Primary Care Trust (HoBtPCT) serves the health needs of more than 300,000 people living in the HoBtPCT patch, which covers some of the city’s poorest neighbourhoods as well as the wealthier shopping and business districts in the centre of Birmingham. The areas covered include Oscott, Perry Barr, Handsworth Wood, Lozells, Soho, Aston, Nechells, Ladywood, Sparkbrook and Springfield, and 70% of the demographics are ethnic minority. Together HoBtPCT, Birmingham East and North PCT, South Birmingham PCT and Solihull PCT comprise the Birmingham and Solihull NHS Cluster, which co-ordinates the delivery of primary care services for the population of Birmingham and Solihull.
6 The results from the analysis of the prescribing data were triangulated with data collated from a self-reported measure of adherence via a patient questionnaire (Modified Morisky Scale©MMAS-8) and with a clinical marker (cholesterol levels) from the prescribing data.
8 The software programme calculated individual patient Medication Possession Ratios (MPRs). MPRs were calculated for all medication runs of interest (a “run” is the time between the first prescription and last prescription for a medicine). Although not a definitive indicator of adherence to a medication regimen (as the data does not indicate whether the prescribed medication was dispensed and/or subsequently taken by the patient), a low MPR value is a reliable indicator of non-adherence.