Medicines partnership
pharmafile | October 20, 2003 | Feature | |Â Â compliance, medicines partnership, patientÂ
Medicines Partnership was set up by the Department of Health in January 2002 to encourage people to take their medicines and thereby improve health and reduce drug wastage. It believes compliance occurs through partnerships between industry, patient, prescriber and pharmacist, a process called concordance.
The Government is pursuing this rigorously and has invited the pharmaceutical industry, the healthcare professions and patient groups to join it in a national strategy for integrating partnership in medicines taking into all levels of the NHS. The Task Force on Medicines Partnership has been allocated £1.3 million funding out of the £30 million provided for medicines management services as laid out in the NHS Plan's 'Pharmacy in the Future' document.
Medicines Partnership presents pharma companies with a unique opportunity to become involved in patient care and influence one of the most crucial stages of the pharmaceutical industry: the point when the patient makes the decision on whether or not to take the medicine.
Need for partnerships
The key theme of the NHS Plan is empowering patients to take more control of their health. It recognises that patients are not passive recipients of prescribing decisions but need to be involved earlier on in the decision-making process if they are to comply with medicine taking.
In fact, compliance is now superseded by the term concordance. Concordance is a way of defining the process of successful prescribing and medicine taking, based on partnership.
Reasons for non-compliance
People often do not take their medicines as prescribed. This non-compliance has serious and wide reaching outcomes to the pharma industry and NHS of wasted medicines and additional treatment. There is also a cost to patients of avoidable illness and, in serious cases, death.
The reasons for non-compliance are not just about forgetting instructions. In many cases, people do not follow treatment because they have made a definite choice not to. This is based on their own beliefs about the medicines, how they work and how they are best used. Research shows that patients are more likely to be motivated to take their medicines as prescribed when they:
- understand and accept the diagnosis
- agree with the treatment proposed
- have had their concerns about the medicines specifically and seriously addressed.
Aims of Medicines Partnership
The Medicines Partnership programme has two overall aims. These are to achieve greater health benefits for patients and improve patient satisfaction with delivery of healthcare. The benefits associated with this strategy are:
- a reduction in avoidable ill health and premature death
- fewer hospital admissions
- less waste of medicines.
The strategy will ensure that partnership in medicine taking is built into key policy initiatives, like the implementation of national service frameworks for the key clinical priorities and the training in communication skills of all NHS professional staff.
A role for pharma companies
The Government is looking to pharma companies to take an active role in Medicines Partnership. There are many opportunities for pharma companies to get involved, including patient empowerment through educational support material and through education of doctors and new prescribers, such as pharmacists and nurses.
There are also opportunities for setting up pilots with the NHS and primary care trusts investigating practical routes to concordance. Pharma companies are well placed to use their expertise in medicines and disease areas to collaborate with PCTs, GPs, nurses and pharmacists to demonstrate how medicines partnership can work in practice by:
- identifying existing projects and supporting them
- facilitating new projects in high priority areas, where there is greatest potential for learning
- sharing project results with practitioners, managers and policy makers.
Medicines Partnership is good for business
A link to Medicines Partnership is a channel for communicating your project to influential decision-makers. Medicines Partnership informs ministers, and at the end of its two-year programme, the Task Force will be reporting progress and making recommendations for the broader implementation of medicines partnership. This report will be based on what has been learned from the Medicines Partnership projects and will be a vehicle for projects to communicate their achievements to the broadest possible audience of policy makers, senior managers and other key players in UK healthcare.
The Task Force encourages submissions of projects in the conception or planning stage. Where these look promising, the Task Force will be happy to consider how advice and/or support could be provided to enable them to go ahead.
Medicines Partnership is now supporting five projects that aim to demonstrate concordance in action:
- concordance assessment tool project
- pharmacist-led antiretroviral clinic
- pharmacist-led anticoagulation clinic
- Terrence Higgins Trust Living Well programme
- type 2 diabetes concordance project.
Medicines Partnership Case study: type 2 diabetes concordance project
This project meets the needs of patients diagnosed with type 2 diabetes. Many of these patients have co-morbidities, notably cardiovascular disease and common complications of diabetes including renal, retinal and peripheral vascular problems. They are frequently prescribed a complex regimen of drug therapy.
This project is funded in two ways:
- PCT pharmacy team and other staff in its design and delivery, in their normal working hours
- financial assistance from GlaxoSmithKline of £25,000
The project involved several phases:
- The PCT undertook a baseline audit of its primary care diabetes service. This involved establishing the nature of the service provided and the availability, qualifications and ultimately the training needs of the medical, nursing and other staff delivering the service.
- Project leads established the state of patients' knowledge of their medication and underlying medical condition. This was done by talking with individuals and groups of patients through questionnaires and structured interviews.
- Project leads investigated the extent of patients' concordance with their treatment plan in terms of lifestyle issues needing to be considered. They also assessed the level of compliance with treatment using computer records in surgeries and pharmacies and by patients' self-reporting.
- An educational programme was developed and then delivered to patients via written material and also group sessions, supported by suitably trained personnel.
- An ongoing programme of staff development tailored to the requirements of the service and with input from secondary care and service users. In particular, the Medicines Partnership Task Force provided developmental support around practitioners' consultation styles. This was intended to ensure that patients own views were taken into account in a way that enabled them to set their own goals when agreeing treatment plans with clinical staff.
The PCT will run a local concordance professional development event in October/November 2003, with input from the Medicines Partnership and industry to coincide with the launch of the education programme.
The main thrust of this project is, in partnership with patients and patient representatives, to create opportunities for patients to come to a greater understanding of their medication and medical conditions. This will empower patients, in discussion with clinicians, to make an informed decision about their own treatment plan.
Most diabetes education programmes currently take place within a secondary care setting. This programme will be different in that it will take place in primary care, and will be underpinned by a development programme for staff to enable them to consult in a more concordant way.
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