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Medicines adherence overview

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These are the paths in the Medicines adherence pathway:

Medicines adherence HAI

About

What is covered

This pathway covers how healthcare professionals can involve adult patients in decisions about prescribed medicines and support adherence. The clinical guideline scope does not cover children and young people, however, the recommendations may be considered for a child or young person who is deemed competent to express a view on their prescription.
Between a third and a half of medicines that are prescribed for long-term conditions are not used as recommended. This represents a health loss for patients and an economic loss for society.
Non-adherence should not be considered the patient's problem. Rather, it usually results from a failure to fully agree the prescription with the patient in the first place and to support the patient once the medicine has been dispensed.
Non-adherence falls into two overlapping categories: intentional (the patient decides not to follow the treatment recommendations) and unintentional (the patient wants to follow the treatment recommendations but has practical problems).
To understand non-adherence we need to consider perceptual factors (beliefs and preferences) that influence motivation to start and continue treatment as well as practical factors.
This requires:
  • an open, no-blame approach that encourages patients to discuss any doubts or concerns about treatment
  • a patient-centred approach that encourages informed adherence
  • identification of perceptual and practical barriers to adherence at the time of prescribing and during regular review.
In this pathway 'medicines' is used as a general term to refer to prescribed medicines that are self-administered and includes tablets, syrups, ointments, creams, eyedrops and suppositories.

Updates

Information for the public

NICE produces information for the public that summarises, in plain English, the recommendations that NICE makes to healthcare and other professionals.
NICE has written information for the public explaining its guidance on each of the following topic.

Patient-centred care

Patients and healthcare professionals have rights and responsibilities as set out in the NHS Constitution for England – all NICE guidance is written to reflect these. Treatment and care should take into account individual needs and preferences. People should have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals. If the person is under 16, their family or carers should also be given information and support to help the child or young person to make decisions about their treatment. Healthcare professionals should follow the Department of Health's advice on consent. If someone does not have capacity to make decisions, healthcare professionals should follow the code of practice that accompanies the Mental Capacity Act and the supplementary code of practice on deprivation of liberty safeguards.
For young people moving between paediatric and adult services, care should be planned and managed according to the best practice guidance described in the Department of Health’s Transition: getting it right for young people.
Adult and paediatric healthcare teams should work jointly to provide assessment and services to young people. Diagnosis and management should be reviewed throughout the transition process, and there should be clarity about who is the lead clinician to ensure continuity of care.

Updates to this pathway

17 December 2013 Minor maintenance update.
17 May 2013 Minor maintenance updates.

Short Text

Involving patients in decisions about prescribed medicines and supporting adherence

What is covered

This pathway covers how healthcare professionals can involve adult patients in decisions about prescribed medicines and support adherence. The clinical guideline scope does not cover children and young people, however, the recommendations may be considered for a child or young person who is deemed competent to express a view on their prescription.
Between a third and a half of medicines that are prescribed for long-term conditions are not used as recommended. This represents a health loss for patients and an economic loss for society.
Non-adherence should not be considered the patient's problem. Rather, it usually results from a failure to fully agree the prescription with the patient in the first place and to support the patient once the medicine has been dispensed.
Non-adherence falls into two overlapping categories: intentional (the patient decides not to follow the treatment recommendations) and unintentional (the patient wants to follow the treatment recommendations but has practical problems).
To understand non-adherence we need to consider perceptual factors (beliefs and preferences) that influence motivation to start and continue treatment as well as practical factors.
This requires:
  • an open, no-blame approach that encourages patients to discuss any doubts or concerns about treatment
  • a patient-centred approach that encourages informed adherence
  • identification of perceptual and practical barriers to adherence at the time of prescribing and during regular review.
In this pathway 'medicines' is used as a general term to refer to prescribed medicines that are self-administered and includes tablets, syrups, ointments, creams, eyedrops and suppositories.

Sources

The NICE guidance that was used to create the pathway.
Medicines adherence. NICE clinical guideline 76 (2009)

Quality standards

Quality statements

Effective interventions library

Effective interventions library

Successful effective interventions library details

Implementation

Commissioning

These resources include support for commissioners to plan for costs and savings of guidance implementation and meeting quality standards where they apply.
These resources will help to inform discussions with providers about the development of services and may include measurement and action planning tools.

Education and learning

NICE produces resources for individual practitioners, teams and those with a role in education to help improve and assess users' knowledge of relevant NICE guidance and its application in practice.

Service improvement and audit

These resources provide help with planning ahead for NICE guidance, understanding where you are now, and conducting improvement initiatives.

Pathway information

Information for the public

NICE produces information for the public that summarises, in plain English, the recommendations that NICE makes to healthcare and other professionals.
NICE has written information for the public explaining its guidance on each of the following topic.

Patient-centred care

Patients and healthcare professionals have rights and responsibilities as set out in the NHS Constitution for England – all NICE guidance is written to reflect these. Treatment and care should take into account individual needs and preferences. People should have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals. If the person is under 16, their family or carers should also be given information and support to help the child or young person to make decisions about their treatment. Healthcare professionals should follow the Department of Health's advice on consent. If someone does not have capacity to make decisions, healthcare professionals should follow the code of practice that accompanies the Mental Capacity Act and the supplementary code of practice on deprivation of liberty safeguards.
For young people moving between paediatric and adult services, care should be planned and managed according to the best practice guidance described in the Department of Health’s Transition: getting it right for young people.
Adult and paediatric healthcare teams should work jointly to provide assessment and services to young people. Diagnosis and management should be reviewed throughout the transition process, and there should be clarity about who is the lead clinician to ensure continuity of care.

Updates to this pathway

17 December 2013 Minor maintenance update.
17 May 2013 Minor maintenance updates.

Supporting information

Glossary

Paths in this pathway

Pathway created: September 2012 Last updated: December 2013

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