Patients pleased?

Debra is late getting up for work again. In her heart of hearts, she’s not really enjoying her job as a teaching assistant in the local primary school. There’s a lot of stress, but it’s a job.

She was in such a rush this morning that she forgot to take her tablets, again. But if she is really honest with herself, she often doesn’t take them. What good are they actually doing anyway? And as her mum used to say, ‘all tablets are poisons’.

An all too familiar story.

Why doesn’t good intent translate into adherence?

Getting the most out of medicines means engaging with the idea of taking a medicine, then making a conscious or subconscious decision about whether to follow the doctor’s recommendation. In other words, taking a new medicine and sticking with it, is a behaviour change.

Patients thinking around medicines is nuanced; “How important is it for me, right now, to start, and continue taking this medicine?” and “What are the downsides?”

“What are my concerns about taking this particular medicine?” and “Are there practical barriers to my starting and continuing?”

It turns out that patients tend to have a number of often misplaced beliefs about medicines, e.g., “I don’t need this medicine when I feel well”, “If I take it for years will it build up in my body and cause nasty side effects?”

These beliefs have a profound and proven impact on patient engagement with medicines. They influence how they judge their personal need for the treatment against their concerns about it.

Not following the treatment recommendations can seem to the patient, to be the common-sense option. Even if they do start taking it, they will often take less than recommended or drop out of treatment early.

The problem is that although these beliefs seem logical to the patient, they are often misplaced. But unless we know about these beliefs, we can’t begin to change how clinicians engage with patients and how manufacturers of medicines can do more to effectively support that engagement agenda.

Behaviourally informed patient engagement

Our studies tell us that many people have objections to taking medicines, either because they have low necessity beliefs and/or high concerns about that medicine.

By uncovering these objections, we can help clinicians to have a ‘no blame’ conversation that provides patients with alternative ways of thinking about the medicine and their need for it.

We can also apply these principles to create more effective patient support and communication delivered outside the consultation. The result: engagement, adherence and persistence improve significantly (by as much as 50%) benefitting patients, maximising the value of the medicine and reducing healthcare costs.

Practically, how can the improvements we see repeatedly in our studies and these behavioural approaches which inform NICE best practice guidelines, be replicated in the real world?

Pharmaceutical companies can improve their understanding of the potential causes of non-adherence for their medicine. This will help them design clinician and patient support materials and improve patient engagement.

We have built a comprehensive profiling tool that identifies a patient’s risk of non-engagement / non-adherence, providing a powerful means of segmentation to tailor and personalise support to those who need it most and thereby improving the efficacy of patient support programmes.

Healthcare professionals understanding an individual patient’s perspectives on their medicines can help tailor support to meet their needs, helping them to make informed choices to get the best from their treatments.

The benefit of this approach to supporting patient engagement is clearly recognised in the NICE guidance on decision making and adherence (NICE guideline CG76 ref 1) (reviewed 2019) which makes recommendations about how clinicians could best support patients to make decisions about medicines and to adhere to medicines regimes.

These recommendations were informed by a ‘Necessity, Concerns and Practicalities’ approach and tools such as the Beliefs about Medicines Questionnaire, developed by Professor Rob Horne and colleagues.

We have recently developed a digital application of the NICE guidance, which significantly reduces patients’ treatment doubts, concerns and practical difficulties and improves engagement, adherence and persistence, providing clinicians with a proven means to improve patient outcomes.

Conclusion

Ultimately our extensive body of research is about helping patients, like Debra, to get the most from their medicines, and whilst our scientific endeavour remains at the forefront of that agenda, supporting the manufacturers of medicines and the clinicians who use them, is the practical means of achieving a purpose that is positive for all stakeholders.

For more information about our extensive body of work in Behavioural Medicine and how we support pharmaceutical companies across the functional and drug development phases please contact Rob Gray CEO Personia Health.

rob.gray@sosadherence.co.uk

Professor Rob Horne bio:

Rob Horne is Professor of Behavioural Medicine at University College London. He trained in pharmacy and health psychology.

A key theme in his research is the understanding of patient and public perspectives of illness and treatment and how this can be applied to help get the best from essential treatments for the benefit of individuals and society.

His work has resulted in internationally applied tools and guidelines for supporting adherence to treatment and improving patient care.

He has over 300 peer-reviewed publications supported by grants of over £30 million in the last decade. He is a Founding Fellow of the Royal Pharmaceutical Society and Fellow of the Royal College of Physicians, Faculty of Pharmaceutical Medicine.

He is the founding Director of Spoonful of Sugar Ltd (Personia Health), a UCL Business company, a consultancy focused on implementing his research into practice.

Professor Alf Collins bio:

From 2016-2023, Alf was NHS England’s National Clinical Director for personalised care. Shared decision making, care planning, self-management support, social prescribing and health literacy sat within his policy portfolio, and he led on implementation of ‘Universal Personalised Care’.

He is an internationally respected authority on person-centred care and has published widely on shared decision making, measurement in person-centred care, self-management support, high value care and ‘Rethinking Medicine’.

Alf has honorary fellowships from the Royal College of Physicians and the Royal College of General Practitioners and a Visiting Professorship in Healthcare Policy at Coventry University. He is a Trustee of Picker Europe and the Patients Association.

Reference 1:

Medicines adherence: involving patients in decisions about prescribed medicines and supporting adherence

Clinical guideline [CG76]Published: 28 January 2009. Reviewed 2019.