Results from a patient support programme developed by Celesio UK and manufacturer MSD have shown that pharmacist interventions can improve adherence to diabetes medication by up to 61 per cent.
Laura Southall, service design manager for medicines adherence and patient support Celesio, said: “We know that poor adherence in diabetes has a strong association with an increased risk of mortality and medical complications (such as severe cardiovascular disease) as well as poor quality of life. Not only does this impact the patient and their family, it creates an extra burden on our health service.
“We wanted to provide targeted support that was tailored to the individual needs of patients and we therefore segmented them according to their risk of non-adherence (High, Medium and Low) as well as their type of non-adherence (intentional versus unintentional).”
Beliefs about a drug and the convenience of treatment or its complexity are important predictors of non-adherence. ‘Concern’ beliefs are about the adverse consequences of taking a drug, whereas ‘necessity’ beliefs are about the positive effects of a drug on someone’s health.
Previous research has found that for intentional non-adherers, ‘concerns’ play a more important role than ‘beliefs’ about the necessity of the drug for glucose lowering medications so the Celesio/MSD programme was specifically designed to address patients’ individual concerns about their diabetes medication.
Support was delivered to patients who had given their explicit consent and who had been assessed for suitability against the inclusion criteria. The LloydsPharmacy pharmacist-led Clinical Contact Centre contacted patients through telephone and SMS text messages over a six month period. The Contact Centre team, who are experts in diabetes, were trained in behavioural change including motivational interviewing and helped to empower patients to take control of their disease and get the most out of their medication.
Laura says: “The aim was to improve patients’ knowledge of how and when to take their medication , explain why the medication is beneficial and dispel any myths, address any of their concerns and to improve overall adherence and persistence to their prescribed regime as intended by their GP.”
- A total of 225 patients were recruited on the programme who received support over a six month period. There was only an 8% discontinuation rate.
- Overall, patients whose adherence was the most challenging when enrolled showed the greatest success. There were 74 patients in this group and their average adherence increased across six months from 57.2% to 80.9%.
- Patients enrolled as low adherent patients ended the pilot with the highest overall adherence; an improvement of +61.4% with a movement from 33.6% to 95.1%.
- After 6 months, the 38 patients in the ‘Medium’ risk of non- adherence group moved to ‘High’ with an improvement of +27.7% (from 69.2% to 96.9%)
Laura said: “Our patient support programme has proven how effective a tailored and personalised pharmacist-led intervention can be in addressing reasons for non-adherence and driving positive outcomes. This has wide-reaching implications for patients, their families and the NHS, providing further support for the enhanced role of pharmacists in supporting and advising patients with their medicines.”
Samuel Pygall pharmacy strategy lead for MSD, said: “MSD is committed to developing patient services, solutions and resources to support pharmacists in their critical role of managing diabetes in primary care. Pharmacists are in an excellent position within the patient journey to make impactful interventions. We are delighted to partner with Celesio on this initiative and hope that it is the beginning of collaboration that provides tailored projects that can really deliver change to healthcare provision in the community”.
¹Classified by PDC (proportion of days covered)
Celesio: Claire Salmons/Joe Scholes 024 7662 5530 email@example.com
MSD: Switchboard: 01992 467272 Email: firstname.lastname@example.org
Notes to editors
Classification of patients according to risk of non-adherence
- Individualised PDC (Proportion of days covered) scores were calculated from LloydsPharmacy retail dispensing data to generate a baseline adherence level
- Calculation is based on the dates of dispensing and the amount of days that drug is supplied to cover within each prescription
- The metric identifies the percentage of patients taking medications in a particular drug class that have high adherence (PDC > 80% for the individual).
- From a patient’s baseline PDC score they can be segmented into level of risk to non-adherence based on their individualised score
- Categorised into High, Medium or Low need depending on baseline
- High Risk patients receive more support than low risk patients
- High risk of non-adherence PDC below 50%
- Medium risk of non-adherence PDC between 50-79%
- Low risk of non-adherence PDC above 80%
Baseline Analysis of Adherence using PDC
- Metrics reported include:
- The percentage of patients taking medications that have high adherence (PDC > 80% for the individual) as a proportion of all patients included within the analysis period for the target class of drugs
- The average PDC value for that cohort (%) which indicates the proportion of time analysed where drug was available on hand to the patient
- Baseline adherence data was calculated for patients from dispensing records available across 1,545 pharmacies
- Period of baseline analysis was from 1st April to 30th September 2014 and included 22,890 patients.
- 69% of patients were classified as adherent i.e. had a PDC score greater than 80%
- 31% of patients were classified as non-adherent i.e. had a PDC score below 80%
- The overall average PDC score was 76.2%
About Celesio UK
Celesio UK is a leading provider of integrated healthcare services to the NHS specialising in medicines, pharmaceutical care and primary care patient services. With almost 25,000 employees, more than 1,750 community pharmacies, a UK-wide logistics network and dispensing in excess of 150 million items a year, Celesio UK works in partnership with the NHS, community pharmacies and medicines manufacturers to help UK citizens live longer, healthier and more positive lives. Celesio UK provides customers, the NHS and patients with high levels of service, value, efficiency and innovation.Celesio UK comprises LloydsPharmacy, AAH Pharmaceuticals, John Bell & Croyden, LloydsPharmacy Clinical Homecare, MASTA, Online Doctor and Betterlife.
MSD operates in more than 140 countries and through our prescription medicines, vaccines, biologic therapies, and animal health products we work with customers to bring innovative healthcare solutions to those who need them the most. We also demonstrate our commitment to increasing access to healthcare through far-reaching policies, programmes and partnerships. For more information visit www.msd-uk.com. The company is known as Merck in the United States and Canada. Everywhere else, we are known as MSD.