patient and provide education and counselling and answer questions related to medicines . What is interesting here , however , is the subtle shift from a previous definition which included reference to the patient being able to make ‘ appropriate ’ health decisions to now being able to make an ‘ informed ’ decision . This reflects the growing acknowledgement of personal autonomy despite evidencebased information . This is likely a challenge for pharmacists ( among others ) as we are trained to understand and question the science and , having robustly tested it , we are likely to accept the conclusions . An example of this is the current pandemic in which we see people termed ‘ vaccine hesitant ’; this can evoke a lot of disbelief and frustration on the part of those pro-vaccination . It is , however , a huge opportunity for pharmacists to discuss these sincerely held beliefs with the patient and to engage in a dialogue whereby mis- / disinformation can be challenged . When we consider someone taking medicine , we must also consider this in the context of their individual beliefs , culture , faith , and many other factors . Some important work was carried out by Robert Horne and colleagues as far back as 1999 , and resulted in the development of the Beliefs About Medicines Questionnaire . 10 The theory underpinning this is that each person will have a set of beliefs relating to medicines in general , and specific medicines . The degree of positivity to which people respond to the individual statements gives an indication of their likelihood to take these medicines and can be a starting point for a conversation between the pharmacist and the patient .
Opportunity With regards to opportunity , the first word that comes to mind is ‘ access ’ and access to medicines and medicines information is not equitable in Europe today . The greater the capability and opportunity the more likely a behaviour is likely to occur . Pharmacists who are working in hospitals encounter people with differing ages , incomes , native languages , levels of education , faiths , ethnicities , and political backgrounds . Awareness that health information , access to services , and specifically access to medicines , is not equitable is of huge importance to the help that pharmacists can provide . In your setting there may be one thing that you can do to try and balance this inequity . Important work has been done by many organisations and one of these is the National Adult Literacy Agency , based in Ireland . 11 This is a useful resource to give information on how we as healthcare professionals can communicate more clearly with our patients and contains insightful videos from the perspective of the patient . Similarly , organisations in the UK , including the British Heart Foundation , have recognised that having the patient at the centre of what we do leads to better outcomes . They have produced a guide on 16 ways we can improve communication with patients . 12
Motivation This is the key driver for many patients who do not adhere , either fully or at all , with the prescribed course of treatment . In my experience , many patients are not always sure of the ‘ why ’ of treatment . What is the want or the need for me to engage in this behaviour ? For the hospital pharmacist , specifically , a patient being discharged back to the community setting is an ideal chance to engage with the patient regarding changes to their medication . An Israeli study in 2005 that examined the knowledge of medicines of 341 patients upon discharge demonstrated that although 73 % knew the indication for their medicine , they still lacked knowledge regarding side effects , necessary lifestyle changes , and correct dosing frequencies . This study concluded that the only factor that positively affected levels of correct knowledge was whether the patient had received medication counselling during their hospital stay . 13 While the resource implications of counselling each patient and ensuring an accurate discharge prescription can be considerable , this should be weighed against the substantial costs associated with unplanned readmissions . 14
Conclusion In conclusion , hospital pharmacists are uniquely placed to have a positive impact upon medication adherence in their patients . The combination of their specialised skillset and in-depth knowledge of medicines means that they can tailor the information and guidance to the needs of the individual patient .
KEY POINTS
• Patients may be intentionally or unintentionally non-adherent and the strategies to optimise adherence are similarly diverse .
• Communicate clearly and simply , avoiding medical jargon and using relatable comparisons when describing diseases and treatment options .
• Pharmacists tend to have positive beliefs about medicines , but patients may or may not share these positive beliefs , so asking open questions will elicit more information regarding potential barriers .
• Increasing patient knowledge about their medicines has been shown to improve adherence .
• We are all learning to be better communicators ; investigate and use the tools and guides available to support you in your practice setting .
References 1 Vrijens B et al . A new taxonomy for describing and defining adherence to medications . Br J Clin Pharmacol 2012 ; 73 ( 5 ): 691 – 705 . 2 Brown R et al . Associations of statin adherence and lipid targets with adverse outcomes in myocardial infarction survivors : a retrospective cohort study . BMJ Open 2021 ; 11 ( 9 ): e054893 . 3 van Boven JFM et al . Urging Europe to put non-adherence to inhaled respiratory medication higher on the policy agenda : a report from the First European Congress on Adherence to Therapy . Eur Respir J 2017 ; 49 ( 5 ): 1700076 . 4 Action on medicine wastage and improving medicine use [ Internet ]. GOV . UK . www . gov . uk / government / news / |
action-on-medicine-wastage-andimproving-medicine-use ( accessed January 2022 ). 5 Oral Dosage Forms That Should Not Be Crushed [ Internet ]. Institute For Safe Medication Practices . www . ismp . org / recommendations / do-not-crush ( accessed January 2022 ). 6 Michie S , van Stralen MM , West R . The behaviour change wheel : A new method for characterising and designing behaviour change interventions . Implement Sci 2011 ; 6 ( 1 ): 42 . 7 Sabaté E . Adherence to longterm therapies : evidence . https :// scholar . google . com / scholar _ lookup ? title = Adherence + to + Long-Ter m + Therapies :+ Evidence + for + Action & author = E .+ Sabat % C3 % A9 & publicati |
on _ year = 2003 & ( accessed January 2022 ). 8 Fernandez-Lazaro CI et al . Adherence to treatment and related factors among patients with chronic conditions in primary care : a cross-sectional study . BMC Fam Pract 2019 ; 20 ( 1 ): 132 . 9 Centers for Disease Control and Prevention . What is health literacy ? Take action . Find out . [ Internet ]. 2021 www . cdc . gov / healthliteracy / learn / index . html ( accessed January 2022 ). 10 Horne R , Weinman J , Hankins M . The beliefs about medicines questionnaire : The development and evaluation of a new method for assessing the cognitive representation of medication . Psychol Health 1999 ; 14 ( 1 ): 1 – 24 . 11 National Adult Literacy Agency . Health literacy [ Internet ]. www . nala . ie / healthliteracy |
/ ( accessed January 2022 ). 12 British Heart Foundation . 16 ways to improve your communication skills with patients [ Internet ]. www . bhf . org . uk / for-professionals / healthcareprofessionals / blog / 16-ways-to-improveyour-communication-skills-with-patients ( accessed January 2022 ). 13 Kerzman H , Baron-Epel O , Toren O . What do discharged patients know about their medication ? Patient Educ Couns 2005 ; 56 ( 3 ): 276 – 82 . 14 Uitvlugt EB et al . Medication- Related Hospital Readmissions Within 30Days of Discharge : Prevalence , Preventability , Type of Medication Errors and Risk Factors . Front Pharmacol 2021 ; 12:567424 . |
28 | Issue 100 | hospitalpharmacyeurope . com