Improving patient adherence to medicines through the New Medicines Service
16 December 2014
Research at the UCL School of Pharmacy underpinned the design and implementation of the New Medicines Service, in which pharmacists help patients who are starting certain new medicines. The NMS significantly increases patients' medicine taking, provides better patient outcomes at reduced costs, and was well received by patients.
Many patients who start taking new medicines for chronic conditions experience problems in the first few weeks, and these frequently lead to patients discontinuing treatment.
Work led by Professor Nick Barber (UCL School of Pharmacy) highlighted difficulties in doctor-patient communications that may result in patients not taking prescribed medicines as advised. Following on from this work, he developed a telephone-based pharmacy advice service to increase adherence. A subsequent proof-of-concept randomised controlled trial involving 40 pharmacies across England found that the proportion of non-adherent patients was significantly reduced in the intervention group. A health economic study of the service estimated a saving to the NHS of £95.40 per patient, with an estimated net benefit of £1.5bn (discounted) over a 10-year period.
This work was then expanded to create a new national service based in community pharmacies - the New Medicines Service - which was launched in England in October 2011, targeted at patients starting what was for them a new medicine for high blood pressure, asthma, chronic obstructive pulmonary disease (COPD) type 2 diabetes, or blood thinning. These are medicines associated with avoidable hospital admissions (typically due to poor adherence).
When the patient presents their prescription, the pharmacist arranges a follow-up appointment two weeks later. At this, the pharmacist asks a series of open questions to elicit the patient's experiences with the medicine, their adherence and any problems or questions. The pharmacist can then explore possible ways to deal with any issues raised. After another two weeks, the pharmacist contacts the patient again to see if the issues have been resolved, to check adherence and to find out whether any further advice is needed.
Over 90% of community pharmacies in England have delivered the service and by the end of May 2013 over a million patients had received the service. It has improved patient safety through better identification and reporting of adverse effects. An evaluation of over 500 patients at 46 pharmacies, funded by the Department of Health, found that adherence to medication increased from 60-71% and saved £21 per patient in the short term, and in the long term both increases quality of life and saves the NHS money. If it were a new drug the NHS would fund it. Both pharmacists and patients liked the service.
I am delighted that this service, based on work I developed with my colleagues, is making a difference to patients' lives and saves the NHS money. It is based on a very simple idea - we cannot be sure how a patient will get on with a new medicine, so we should ask them, and then use our knowledge to make their life better. It is pleasing to know that kindness works in the world of evidence as well as the world of the patient. - Professor Nick Barber