Involving patients in decisions about long-term medication
Up to half of medicines for treating long-term conditions are not taken as prescribed. Sometimes the patient never agreed to take the medication in the first place. In other cases, practical problems - such as not being able to open the packaging - could be to blame.
NICE aims to overcome many of these difficulties in ‘Medicines adherence: involving patients in decisions about prescribed medicines and supporting adherence'.
The guidance, which was published at the end of January, encourages healthcare professionals to have a discussion with patients about any medication they are prescribing on a long-term basis.
This involves explaining clearly how the medicine could help their disease and condition, as well as listening to any concerns they might have. For example, the patient may be worried about possible side-effects, may not believe the medicine is necessary - or may feel it will be difficult to take at set times.
In addition, whenever they are dispensing or reviewing such a prescription, healthcare professionals are advised to assess whether or not patients are taking the medication - albeit in a non-judgemental manner.
Most importantly, healthcare professionals should accept that patients have the right to refuse medication, as long as they are capable of making an informed decision. In such cases, they should be offered support and a follow-up review at agreed intervals to see if they have changed their mind.
The key is to establish the most effective way of communicating. If necessary, NICE says, consider using pictures, symbols or an interpreter.
“Many patients feel that if they approach their healthcare professional about failure to take their medicines, they will be told off,” says Alison Bowser, service user representative on NICE's guideline development group. “The reason why they can't take a particular medicine may be because they can't open the packaging. Or their hectic lifestyle may make it difficult to take medicines at the same time each day.
“The good thing about this guidance is that it opens a path to renegotiate how the patient and healthcare professional communicate about medicine. For example, if after receiving information a patient decides not to take medication, their healthcare professional will discuss with them alternative methods to minimise any risk. In the case of a patient with a heart problem, their healthcare professional may concentrate on trying a diet and exercise programme or give them help to stop smoking.”
The guidance is available at www.nice.org.uk/Guidance/CG76
Issued: 16 February 2009
This page was last updated: 11 May 2010