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Involving patients in decisions about prescribed medicines and supporting
adherence: The NICE response
Dr Wendy ClyneDr Wendy ClyneAssistant Director:
Medicines Partnership ProgrammeNPC Plus
The NICE medicines adherence guideline
• Why?
• How?
• What?
• What now?
Why?: lessons from the Picker Institute
Picker Institute (April, 2006) Engaging patients in their Healthcare: How is the UK doing relative to other countries
Why? Most people want involvement in treatment deci sions
32%
32%
When you see a doctor, which, if any, of the follow ing do you prefer?% of respondents
The doctor to decide what treatment is best for me
24%
40%
24%
39%
2003
2004
Source: MORI – research commissioned for the Medicines Partnership Programme
The doctor and I to decide together the best treatment for me
Doctor explains treatment choices - I decide which I prefer
Draft NHS constitution reflects importance of partn ership
NHS services must reflect the needs and preferences of patients, their families and their carers. Patients, with their families and carers, where appropriate, will be involved in and consulted on all decisions about their care and treatment.
You have the right to be given information about your proposed treatment in advance, including any significant risks and any treatment in advance, including any significant risks and any alternative treatments which may be available, and the risks involved in doing nothing.
You have the right to be involved in discussions and decisions about your healthcare, and to be given information to enable you to do this.
You should follow the course of treatment which you have agreed with your clinician.
Why produce the NICE medicines adherence guideline?
Concordance modelCompliance modelCompliance model Adherence model
One consequence of the traditional model
Source: Fairview Pharmacy, London, 2004 - medicines picked up from an elderly lady’s home
What NICE doesGuidance in three areas of health:
• Public health–guidance on promotion of good health and the
prevention of ill health for those working in the NHS, local
authorities and wider public and voluntary sector.
• Health technologies–guidance on the use of new and
existing medicines, treatments and procedures within
the NHS.
• Clinical practice–guidance on the appropriate
treatment and care of people with specific diseases and
conditions within the NHS.
How NICE does itDH assign topics to NICE
1.Scope(3 mths)
2.Development 17-18 mths
3.Validation/QA 6-7 mths
4.Pre-publication check4.Pre-publication check
5.Publication
6.Update (2-4 years)
Stage 2-5 takes 2 to 2½ yrs.
35 guidelines in progress at once.
The NICE medicines adherence guideline
Visit www.nice.org.uk/CG076 for:
• the guideline
• the quick reference guide
• ‘Understanding NICE guidance’
• costing statement
• audit support
• guide to resources
• patient information resource
Involve patients in decisionsabout medicines
Improve communication
Increase patient involvement in decision-making
They don’t want to
(intentional non–adherence)
They have practical problems
(unintentional non–adherence)
Why don’t some patients take their medicines as prescribed?
What can be done about this?
about medicines
Support adherence
decision-making
Increase understanding of patient’s perspective
Provide information on medicines
Assess adherence
Review medicines
Improve communication between healthcare professionals Consider interventions to increase
adherence
NICE medicines adherence recommendation 1.2.5
‘Be aware that although adherence can be improved, no specific intervention can be recommended for all patients. Tailor any for all patients. Tailor any intervention to increase adherence to the specific difficulties with adherence the patient is experiencing.’
What does NICE say about adherence interventions?
NICE adherence guideline: the importance of good co nsulting
• “A frank and open discussion
• A patient-centred approach
• Identification of specific perceptual and practical barriers for each individual
• asking open-ended questions because these are more likely to uncover concerns
• encouraging patients to ask questions
• clearly explaining the condition and the pros and cons of treatment
• clarifying what the patient hopes the treatment will achieve
• talking and listening to the patient and noting any non-verbal cues rather than making
• assumptions about patients’ preferences about treatment
• helping patients to make decisions based on likely benefits and risks rather than misconceptions”
What the NICE medicines adherence guideline doesn’t do
� Supporting adherence as a cost-
effective intervention
� Process/ healthcare systems factors
that impact on adherence
� Implementation of the guideline
(but note the caveats)
Medicines Partnership Programme – supporting impleme ntation
�Web-based resources – NPCi adherence to medicines floor
�Workshops for HCPs – consultation skills for supporting adherence, incorporate role -plays with supporting adherence, incorporate role -plays with simulated patients
� Service development projects – medication review service design
� Adherence support programmes – Motivation for Medicines (M4M)
NPCi.org.uk
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