June 17, 2013, by Cerina

Adherence VS. Pharmacy – A Never Ending Feud?

As the second year of my pharmacy degree draws to a close, I am beginning to realise how all the skills and knowledge I have learnt can actually be used in practice.

During my second semester, I studied a professional skills module in which I was exposed to the idea of ‘adherence’. I have had some exposure to this before but this time I became thoroughly aware of this issue and the problems pharmacists face with regards to a patient’s medicines taking behaviour.
It appears to me that there are some people that have some sort of stigma against drugs and medication and as a result become less adherent or likely to take their medication. It has become more apparent to me that this is particularly an issue in the older population of patients – whom are more likely to consider ‘old remedies’ or even ‘medical myths’. Here is a specific quote that highlights this from a man who was not taking his prescribed pain killers:

“It’s not worrying me that much that I think I ought to take medication because I tend not to like taking medication if I can avoid it…Yes I think nature has its own way of mending things in many cases…I’m always slightly wary of drugs of any sort really, I mean other than paracetamol…If I don’t need them I won’t take them.” (1)

It is not only stigma that holds people back, but several other reasons and circumstances related to their patient status that seem to be out of a pharmacist’s control. It seems to me that we cannot predict whether a patient will take their medication properly or not- thus is the ability to treat a patient just in fact left to chance?

A recent article published by a pharmaceutical journal called ‘Pharmacy Magazine’ had also written about this and only reinforced the importance of this to me. The article was titled ‘Improving Adherence – a missed opportunity?’ It considers the role of pharmaceutical industries in improving medicine adherence in patients. According to Numark Pharmacies, industries do not do enough to engage with pharmacy and its patients; – who appear to be their route to market their brands. Having also carried out two studies with regards to this issue, the extent of this problem was further highlighted to me and appears to continue to stain the future of pharmacy. Sadly, I feel as though adherence seems to be a deep rooted problem that does not lie only in the pharmacy itself.

On a lighter note, problems with adherence have led me to appreciate the importance of a patient focused practice in the community and communication with manufacturers and other partners to ensure that they all contribute towards their role for the safe and effective use of medicines. The introduction of schemes like ‘new medicines services’ or NMS and ‘medicines use reviews’or MUR (2) directs pharmacy practice to a better route with a particular focus on the ‘during’ and ‘post’ provision of treatment or medication by pharmacists. I do believe that it is these two stages in the management of conditions that we take for granted, but are in fact the most important stages in managing a patient’s condition. Without a patient being comfortable enough to take their medication and have a complete understanding of the management of their condition, pharmacy almost remains at a dead end.
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I am hoping that in the future, pharmacy will defeat problems of adherence particularly with the introduction of schemes like these mentioned above. However, what do our future pharmacists or even our public with an interest in pharmacy think of this issue? Will adherence always remain a problem in pharmacy? What else could we do as healthcare professionals in order to improve a patient’s behaviour towards taking their medication?

Until next time!

P.S. I have listed some useful websites below that describe the NMS and MUR services aswell as the website from the quote above detailing people’s experiences of different health-related conditions.

(1) Healthtalkonline (2008) Healthtalkonline.org [online] available at: http://www.healthtalkonline.org/
(2) Pharmaceutical Services and Negotiating Committee (2013) Advanced Services within the pharmacy contract [online] available at: http://www.psnc.org.uk/pages/advanced_services.html

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