Medicines adherence: Involving patients in decisions about prescribed medicines and supporting adherence

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Nunes, V. ; Neilson, J. ; O'Flynn, N. ; Calvert, N. ; Kuntze, S. ; Smithson, H. ; Benson, J. ; Blair, J. ; Bowser, A. ; Clyne, W. ; Crome, P. ; Haddad, P. ; Hemingway, S. ; Horne, R. ; Johnson, S. ; Kelly, S. ; Packam, B. ; Patel, Mahendra ; Steel, J. ; National Collaborating Centre for Primary Care (2009)
  • Publisher: NICE: National Institute for Health and Clinical Excellence,
  • Subject: R1 | RS

It is thought that between a third and a half of all medicines1\ud There are many causes of non-adherence but they fall into two overlapping categories: intentional and unintentional. Unintentional non-adherence occurs when the patient wants to follow the agreed treatment but is prevented from doing so by barriers that are beyond their control. Examples include poor recall or difficulties in understanding the instructions, problems with using the treatment, inability to pay for the treatment, or simply forgetting to take it. prescribed for long-term conditions are not taken as recommended. If the prescription is appropriate, then this may represent a loss to patients, the healthcare system and society. The costs are both personal and economic. Adherence presumes an agreement between prescriber and patient about the prescriber’s recommendations. Adherence to medicines is defined as the extent to which the patient’s action matches the agreed recommendations. Non-adherence may limit the benefits of medicines, resulting in lack of improvement, or deterioration, in health. The economic costs are not limited to wasted medicines but also include the knock-on costs arising from increased demands for healthcare if health deteriorates. Non-adherence should not be seen as the patient’s problem. It represents a fundamental limitation in the delivery of healthcare, often because of a failure to fully agree the prescription in the first place or to identify and provide the support that patients need later on. Addressing non-adherence is not about getting patients to take more medicines per se. Rather, it starts with an exploration of patients’ perspectives of medicines and the reasons why they may not want or are unable to use them. Healthcare professionals have a duty to help patients make informed decisions about treatment and use appropriately prescribed medicines to best effect
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