Follow our blogs feed 
Hello guest, welcome to PJ online
gateway to the world of pharmacy and medicines
Citation
- Online only
The one thing that strikes me... (Rachel Hall)
By Clinical Pharmacist Columnist
The one thing that strikes me as a pharmacist prescriber is the number of people who don’t take their medicines either correctly or at all. Over the past three years, since I have worked full time at the GP surgery, there have been many occasions where patients have admitted their poor adherence.
Rachel Hall
Having access to their medical records makes it easy to identify the ones who are not requesting their repeat prescriptions regularly; but the system cannot, of course, reveal those who collect their prescriptions and do not get them dispensed — or do, but leave them in a drawer along with the other dozen-or-so boxes.
I find that the most common medicines not to be taken are antihypertensives, statins, inhaled corticosteroids and calcium, which I would say amounts to a large proportion of the medicines we prescribe.
Patients volunteer all kinds of reasons for this, among them:
- “I just forget to take them”
- “I didn’t realise I needed to carry on taking them”
- “I don’t like the taste”
- “they make me feel tired all the time”
- or, simply, “I ran out”
One chap I saw the other day told me he was “fed up of taking tablets” so figured he would “stop the lot”!
Once I have established why a patient is not taking his or her prescribed medicines, I can then look at ways to help.
The first question I ask myself is: are the patient’s medicines still appropriate? Next, I look at the reason for non-adherence; maybe all that is needed is reinforcement of why a particular medicine was prescribed in the first place and what benefits it offers.
It may be necessary to agree a change in the timing of doses, discuss ways to remind the patient to take his or her medicines, switch formulations (eg, to a modified-release product) or even rationalise the regimen to one less complicated. This is where being an independent prescriber is particularly useful.
If the reason for non-adherence is a side effect, my action will depend what the symptoms are and how long the patient has been taking the medicine. But a word of caution: from my experience if you keep changing patients’ medicines at the slightest stomach upset or muscle ache, some individuals will start presenting more regularly with symptoms that they attribute to the new drugs.
In my early days as a prescriber, there were a few such patients for whom I started running out of treatment options! I now have the confidence to encourage my patients to continue a bit longer on their new medicines before we agree to make a switch.
Rachel Hall is clinical pharmacist at The Old School Surgery, Bristol
Hello. The one thing
Hello.
The one thing that strikes me (probably harder) as a pharmacist and human being is the number of pharmacists who don't take their medicines correctly.
Despite admitting my poor adherence -endless times!- to myself and to the mirror, this did not change anything much. What's more, the mirror and I are not on speaking terms anymore.
But why, you will frown, do you assume that other people also make the same errors as you? I could give an elaborate answer, but instead I won't. Let's say I have a strong hunch. I'm sure there are other guilty pharmacists out there, too.
I am fed up with taking my Arsenicum Album, Nerve Calming and Hysteria Potion but I do, as my homeopath is very learned and appears to know exactly what he's doing: I'd love to challenge him, but I wouldn't have a toe to stand on. I've been playing along for ages. Still, sometimes I chuck some left over pills to the cat. She likes them, they taste sweet. I've got an overconfident cat.
I mix homeopathic and orthodox medicine, as I tend to belive more in the latter, but still, I know SSRIs are powerfull stuff so, to give myself courage, I reach for the bottle of gin before I take my dose.
The only medicines I adhere to are my fat burners and starch magnets. Everybody should be on these! You can eat your bodyweight in peanuts and not put on any weight.
Anyway, enough chatter! More to the point, I'd like to know how many pharmacists are pristinely compliant with their medication.
Thank you.
Lia
http://www.justgiving.com/Lia-Curran/
Compliance - The one new thing?
Rachel
What did you do before became an independant prescriber? I believe all of us in community pharmacy practice new that compliance was an issue and were aware of the sort of reasons you cite from about 5 minutes after we qualified.
David
Clarification
Rachel Hall is a regular columnist for the series "Reflections of an independent prescriber" in Clinical Pharmacist. These published columnists are uploaded to the blog section of PJ Online each month; perhaps their online publication in a different context has led to some confusion.
In reflecting on the various reasons for non-adherence Rachel is setting the scene for her viewpoint, which I understand is this: as an independent prescriber, her time with patients and access to GP notes allows her to identify those most poorly adherent and — here's the point — as a prescriber she can modify their treatment regimens to help tackle issues with adherence (in a way that busy community pharmacists — who are certainly aware of the reasons for poor adherence — might not be in a position to).
I would encourage all pharmacists to reflect on the possible reasons for their patients' non-adherence to prescribed medicines and what they might do to help — and, once having done so, consider recording this reflection as a CPD entry at www.uptodate.org.uk.
Matthew Wright
Editor, Clinical Pharmacist