Can’t take, won’t take: why patients do not take their medicines, with Nick Barber

We’re now a few weeks into this term’s batch of Lunch Hour Lectures and the bill is as strong as ever. Thursday 25 October saw Professor Nick Barber, from the UCL School of Pharmacy, presenting his research.

While you may recognise him from the BBC2 documentary Victorian Pharmacy, Professor Barber came to shed some light on why some patients are unable, or willing, to take their medicines as they’re prescribed.

He started with the first surprising fact of the talk; of all the patients on medication for chronic health conditions, 30 to 50 percent do not take their prescriptions as they are supposed to. This is not a trivial matter, leading to a huge amount of suffering and premature death worldwide.

This led on to another startling consideration; if we, as a society, were able to make more patients take their medications properly, this would be a bigger therapeutic advance than the development of a new drug.

Barber, along with other colleagues at the School of Pharmacy – notably, Professor Rob Horne – has spent a great deal of time and effort investigating exactly why some people are less likely to stick to their prescriptions, and how we might prevent it.

Apparently, this group of people divides roughly in two, where half of the “non-adherence” is intentional, while the other half is unintentional (with a little overlap). In one casestudy, they studied cancer patients newly prescribed the anti-leukaemia drug Imatinib.

This trial saw a range of different strategies that people used to rationalise not taking their meds correctly, ranging from some quite understandable reasons to some perhaps more surprising.

Some were quite mundane. Pills are easily dropped, or timings to take them forgotten – or even forgetting that you have already taken it, and so taking another.

Others are to be expected, particularly when considering many drugs have undesirable side-effects. Nausea is a common reaction, which might make people want to cut off or cut back on their drugs.

Combining drugs with alcohol, or not taking them with food, can often make symptoms worse, which means sometimes people might prioritise their social lives over their medical schedule.

The most shocking of the tales was one of sabotage, where an individual reported taking her current prescriptions incorrectly (sometimes too few, other times too many, sometimes not at all) in order to deliberately make her medical scores fluctuate.

This particular individual had gone online and researched the inclusion criteria for this trial: by manipulating her medicine intake they had ensured they were an eligible candidate. In this case, for better or worse, it worked, and they got on the trial and got to take their desired drug.

The overwhelming output of their studies showed that patients often feel unhappy after seeing their doctors, believing they’ve not been listened to or properly catered for. Instead of a person, they’re a patient with symptoms to be solved.

Having discovered this problem, Barber and co. proposed a solution; not a drug, but a novel medical aid.

The New Medicines Service (NMS) came into effect in October 2011 and has a very simple remit; to target patients on medication for chronic illnesses, who have just been prescribed new medicines, and try to minimise the risk that they won’t take their medicines as intended.

It operates very simply. Two weeks after getting a prescription for a new medication, a patient gets a phone call from a trained pharmacist and they have a friendly, informal chat about their new therapy. They explain the rationale behind that choice, ask whether the medicine is going well and discuss its pros and cons.

It’s a patient-oriented, theory-based, priority targeted approach – and it works. Early users report higher adherence and increased positivity towards their new drugs, in a highly cost-effective manner.

Medical funding is a finite resource, so we need to ensure that we spend it wisely. Ideas like those that Professor Barber talked about in this lecture are exactly the kind that we need to be working on.