This blog by Graham Prestwich was previously put on the National Pharmacy Association’s website as part of Ask your Pharmacist Week which ran from 5th- 12th November 2018.
A GP told me a couple of weeks ago that, in his view, not achieving safe and proper use of medicines is the biggest risk to effective care and the future of the NHS. Why? Something that is so common and so widely used, the most common approach to improving health and wellbeing, is not being used as intended or expected.
It is generally accepted that up to 50% of prescription medicines may not be used properly, even though many medicines are intended to prevent harmful and often fatal events such as a stroke or heart attack. There are 1.3 million items prescribed every day across the NHS and the NHS relies on people to use and take their medicines as intended. If patients are not using medicines as intended problems with effectiveness, safety and waste of treatment are the result. These are all good reasons to seek out new and effective ways to further improve patient outcomes.
Patients are important members of the health and wellbeing team, not least because when it comes to medicines, people can choose what to do and what not to do, and when. We asked people from different communities across the city about the way they use medicines and interestingly they revealed very similar issues. Most people openly shared their experiences and stated that they often have unresolved issues relating to the choice or use of medicines, and because their issue is largely unresolved a range of unhelpful actions take place. Often this means simply not taking the medicines. The more medicines someone is prescribed the more likely there will be an issue to resolve.
People give many different reasons for not sharing the full story about how they take their medicines with their doctor, the most common being concern about the reaction when it is discovered that they are not following the directions, either accidentally or intentionally, so the situation gradually gets worse. This means that doctors and their patients are not working as effectively together as they could be to reach the best possible outcome of care. Patients are leaving a consultation with their doctor or leaving a brief conversation with the pharmacist or pharmacy technician without sharing their issue that needs to be resolved to become confident in their medicines. Leaving the consultation with the issue still in your pocket means nothing is sorted and the issues get more and more complicated, and more difficult to resolve
So, whilst doctors, nurses and pharmacists are clinical experts, patients (and their carers) are the expert when it comes to their own life and all the opportunities and challenges day to day living throws at us. As patients we take control for most of the time, taking medicines every day and organising our own routine and depending on the people around us to help establish a reliable approach to our medicines. To be in charge we need to understand enough to do medicines taking responsibility, properly. This means that if we have an issue or concern we need to get it sorted and to access the right professional help to get it sorted.
For patients, community pharmacy teams are a fantastic resource, an opportunity to be helped and supported to overcome barriers to safe and effective use of medicines, and the starting point is asking for some insight to deal with an unresolved issue. The local pharmacist is a great person to ask because they are usually easily accessible during daytime hours, they know a great deal about medicines, and if they cannot help they will be able to explain who the best person to speak to is. Patients have the job of taking the first step and sharing with someone in the know what the problem is, in other words what exactly needs to be sorted. Once the problem is known and shared it is much easier to find and agree on a solution.
Me and My Medicines is a campaign to support and encourage patients to ask and clinicians to listen so that through working together a shared decision and solution to the problem can be found that works for everyone involved. Sharing the responsibility and agreeing the way forward, together. To support and enable this approach there is the Medicines Communication Charter which patients have developed to encourage more effective ways of supporting people to get the most benefit from their medicines.