Q Exchange

Helping patients to make better choices about their medicines

Investigating the potential for the application of behavioural science approaches that “nudge” people towards adherence to prescribed medicines whilst maintaining their freedom of choice.

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Idea
2018

Meet the team: #mymedicinesmychoice

Also:

Dr Tim Chadborn, Head of Behavioural Insights and Evaluation Lead, Public Health England
Dr Abigail Dunn, Behavioural Insights Team, Public Health England
Professor John Weinman, Professor of Psychology as applied to Medicines, Kings College London
Dr Christina Jackson, Programme Manager, Centre for Adherence Research and Education (CARE)
Members of the Health Innovation Network’s Medicines Optimisation Community of Practice

What is the challenge we are focusing on?

Prescribing medicines to improve outcomes for patients is the most frequent clinical intervention we make. It might be assumed that patients always take their medicines as they should, however a surprising number do not – in fact, studies suggest that only about half of the medicines prescribed are taken as they should be. Adherence to prescribed medicines is a problem in many developed countries not just in the UK and again studies suggest that there has been little improvement over the past 50 years.

The overall costs of wasted medicines to the NHS in England each year is estimated to be around £300 million

When people don’t take their medicines as prescribed, not only is this a waste of resources – the NHS spends more on medicines than on anything else other than staff costs – but it also means poorer outcomes for patients, leading to more visits to the doctor, more hospital admissions and sometimes the addition of even more medication as clinicians believe that the medicines they have already prescribed are not working.

People don’t take their medicines as prescribed for lots of different reasons. Professor John Weinman from Kings College London has identified 26 different factors that influence adherence – 70 % of which are intentional – so people don’t just always “forget” to take their medicines as we often assume but make a conscious decision not to take the medicine.

Failing to recognise intentional non-adherence and figuring out how to positively influence that is a huge challenge for healthcare systems worldwide – A few years ago a Cochrane systematic review on interventions for enhancing medicines adherence to be mostly complex and not very effective, adding that we must continue to search for effective and practical interventions to promote medicines adherence.

Is there anything we can do about this?

We are members of the Health Innovation Network’s Medicines Optimisation Community of Practice – a social learning network of peers who come together across professional and organisational boundaries and with patients focussing on how to support people to get the most out of their medicines.

Recently we have been working with Professor John Weinman and his colleagues who have set up a Centre for Adherence Research and Education (CARE). Together with our community CARE is co-creating materials that can be used during consultations to support adherence.

If we are successful with this bid we would like to build on this work with Dr Tim Chadborn and the Behavioural Insights Team at Public Health England, to investigate the potential for the application of behavioural science techniques – using “nudge” approaches to steer people towards improved decisions about their medicines whilst maintaining their freedom of choice. These techniques would then be evaluated by CARE and if found to improve adherence could be spread through our community supported by the Health Innovation Network.

This work is extremely exciting for us. It would bring together Clinical Psychology and Behavioural Psychology, link research with clinical practice and is likely to be of considerable value for both individual patients and the healthcare system alike.

What are the benefits we expect for the Q community?

Many members of Q will be supporting patients with medicines as part of their care. The learning from this project and details of any nudge approaches we develop will of course be shared with the Q. We therefore hope that what we are trying to achieve would benefit your patients too.

How you can contribute

Are there any members of the Q community who have undertaken Behavioural Insights work in other areas who can share their learning with us?
It would be great to hear from members who have tried other approaches to support “intentional” non-adherence so we can learn from your experience
Would anyone from the Q community like to help us test the “nudge” approaches we develop?

Comments

Sunil Sampath 19 Oct 2020

Hi Cleo and Team

This is clearly a very important area for optimal care of the patient and cost savings. I work in paediatrics and non-adherence to prescribed therapies is a big problem in this group too, especially in the adolescents. Do you plan to include this (adolescents) age group ?

All the best
Matthew Mezey 19 Jun 2018

If you’re interested in NHS Communities of Practice (CoPs), please join Q’s CoPs special interest group’s Zoom call on 13 July (1pm) to hear about the evaluation of the Health Innovation Network’s CoPs – their challenges and their journey (Cleo - part of the core team on this medicines project - will share her experiences).
** More info/to register: https://q.health.org.uk/event/the-sustainability-and-impact-of-nhs-communities-of-practice-lessons-from-a-rand-europe-evaluation/ **
The call will be an opportunity to glean advice and insights to help this project too.
1. Cleo Butterworth 19 Jun 2018
  
  Thanks for highlighting this Matthew. Yes, this work has grown out of our Medicines Optimisation Community of Practice - a story I look forward to sharing on the call.
Paul Gimson 15 Jun 2018

This is a great idea. We have been using BI to help people in primary care design interventions and been looking with interest at the evidence around this AMR prescribing.

Good luck and will follow this with interest!
1. Cleo Butterworth 15 Jun 2018
  
  Thanks Paul - would be really interested to hear more about your primary care design journey when you have time!
Michael Wilcock 14 Jun 2018

Hi Cleo, a very interesting topic - should we be nudging intentional or non intentional adherence towards improved medicine taking? It does indeed bring in the SDM concept at the start of the patient's pathway with medicines used to treat long term conditions. Also what nudges can we use (for patients and health professionals) to ensure that time limited treatment courses cease and do not end up being on repeat prescription? Keen to help if at all possible.
1. Cleo Butterworth 15 Jun 2018
  
  Hi Michael. Although I originally framed the idea as a way to support "intentional" non-adherence, clearly interventions could be used to support both types of non-adherence and similarly nudges can be used to support both clinicians and patients. I think if we are successful with this bid it will be a very interesting journey - thanks for the offer of help. I will definitely take you up on that going forward!
Wasim Baqir 3 Jun 2018

Hi Cleo et al

Will you be linking this to the shared decision making work? Co-prescribing a medicines (patient and professional) generally increases the chances that the medicines will be taken. Equally, if polypharmacy is the issue then co-deprescribing medicines (using nudge techniques) could be powerful. Happy to help and support.

Good luck.
1. Cleo Butterworth 4 Jun 2018
  
  Hi Waz - Yes, we cannot leave behind shared decision making and finding ways to have better conversations with patients about their treatment. Behavioural insight techniques will need to be developed for both clinicians and patients I think.
  
  Thanks very much for your support and for your offer of help - much appreciated!
Ewan Maule 31 May 2018

Hi, I've always had an interest in behavioural insights and have thought about how they could be better used to influence many aspects of medicines optimisation. I've given talks on 'nudges' in patient safety - more around the prescribing element rather than the adherence though.

I'm a Pharmacist by background and am soon to be moving in to a new role as Head of Medicines Optimisation at a CCG in the North East and I would be keen to see how I could be involved?
1. Cleo Butterworth 31 May 2018
  
  Hi Ewan - I agree that the potential to use behavioural insights to support with medicines optimisation is probably huge and under-utilised. In my CCG days I used some “nudges” to support prescribing decisions though I didn’t realise I was using behioural science techniques at the time.
  
  I am excited about the possibility of using to support adherence with this project because I feel we really need to focus on this more and more particularly with the rise of polypharmacy being attributable in part to non-adherence.
  
  i am delighted you would like to be involved as we progress - we will always need comments, trials and evaluation of any proposed nudges so I’ll be sure to stay in touch!
Nicola Thomas 21 May 2018

Think this is a great idea but think you need people who are prescribed lots of medicines to work with you on this
1. Cleo Butterworth 21 May 2018
  
  Hi Nicola
  
  I totally agree - we have patients as members of the community of practice and would always welcome more because as you say this needs proper co-production or indeed to be patient led!