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NMS improves medicines adherence, PSNC finds

Services PSNC lead of NHS services Alastair Buxton (pictured) has said that NMS data, revealing improved adherence in a third of previously non-adherent patients, is vital in getting the service recommissioned.

The NMS has been hailed a success by pharmacy leaders after data showed the service was helping patients to take their medicines properly.

The figures, collected by PSNC through the PharmOutcomes database, covered NMS interventions provided to more than 224,000 patients between October 1, 2011 when the service was launched and September 30, 2012. It revealed that 32 per cent of non-adherent patients became more adherent to their medication following the intervention.

PSNC head of NHS services Alastair Buxton said the NMS was "clearly helping patients to take their medication properly". He hoped the results would prove the NMS service was "worth continued NHS investment".

"We need all the evidence we can get to persuade commissioners that pharmacy services are worth the investment" Alastair Buxton, PSNC

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"Without this analysis, we would be entering our next negotiations relying on purely anecdotal evidence to back up our claims that the NMS is a service worth continued NHS investment," Mr Buxton said.

"In a health service in financial crisis that would not have been a good position to be in – we need all the evidence we can get to persuade commissioners that pharmacy services are worth the investment."

Numark managing director John D'Arcy said the data was helpful in proving the investment that had been made in the NHS was "worth having".

"On a general basis the hypothesis that an intervention akin to an MUR will improve patient compliance and improve patient outcomes, that's well proven," he added.

But pharmacist Raj Jain at WR Evans (Chemist) Ltd t/a Manor Pharmacy said he thought more patients would have improved medicines adherence from NMS than the data showed and called for PSNC to provide more support to contractors to help them deliver the service.

"When the NMS financial structure was reassessed I think you would have got a better adherence from pharmacists to run the NMS in general," Mr Jain said. "[But] I would have thought that figure would have been higher," he added.

"I would have thought there could be more guidance to help pharmacists improve that figure, in the way of extra the PSNC."

The PSNC figures also showed that pharmacists gave 366,702 pieces of healthy living advice to patients while they provided the service.

Fifty-four per cent of interventions were provided for patients prescribed medicines for hypertension, 26 per cent for asthma/COPD, 11 per cent diabetes and 8 per cent anticoagulants/antiplatelet medicines.

The NMS is being evaluated by an independent research group to determine whether the Department of Health will continue to fund the service beyond April 2013.

Have you noticed the effect your NMS interventions are having?

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Julian Harrison, Community pharmacist

Does anyone know what measure of adherence was used to justify the stated 32% improvement?

James Bloodworth, Reporter, C+D

Patients reported back to the pharmacy to say whether they were more adherent to their medication or not, according to the report from PSNC.

I will go back to PSNC tosee if I can get any more detail.

Rajive Patel, Community pharmacist

I think the key here is to aggregate the data and come up with some very solid conclusions/evidence that support the intervention (NMS) as a very real solution to improving health outcomes and reducing both medicines waste and hospital admissions. If we can show that NMS goes part of the way to address QIPP, then under the governments current strategy, selling the NMS to the NHS should not be a problem.

A caveat: the data will need to be tested against quality and not quantity. For example, how can we show that the of the 224,000 patients, the 32% of the group that were previously non-adherent, what effect would they have had on the NHS resources if they had continued to be non-adherent.

Evidence from NHS literature suggest Adherence issues are one of the two most common reasons for hospital referral. Therefore from the data collected by the PSNC, 32% of the pool of patients identified for NMS, would potentially drain NHS resources.

In addition, the PSNC should ensure that pharmacists are adequately up-skilled to provide an effective service that can be sold to the NHS. This means pharmacists would need to become "health coaches". Please an expert from an article below:

"Adherence problems can be broadly divided into two categories: unintentional non adherence and intentional non adherence.

Unintentional non adherence refers to two main categories of patients; those with physical impairment and those with cognitive issues. Physical impairment around medicines, such as difficulty opening containers, is usually easily identifiable and amenable to simple measures. For patients who have cognitive issues, for example where there is a question around capacity for medicines taking, additional support from carers may be needed and this often involves multiagency support.

A health coaching approach is most useful for engaging patients who are intentionally non-adherence, such as patients who are ambivalent about medicines taking. These patients are classified as intentional non-adherent as they are exercising choice in not taking their medicines.

They are more difficult for clinical staff to identify and management involves addressing patients’ beliefs and values around medicines taking and the balance of perceived necessity for a medicine against their concerns.

For example, this may be a patient not prioritising taking their medicines because they don’t believe it is worth the effort. These patients represent a significant proportion of non-adherent patients and we suggest, are currently an under recognised group. Pharmacists in this service are developing their skills in the use of health coaching tools to support this group of patients.

Moving towards a concordant approach to medicines taking requires a change in thinking. The current skills gap can be addressed through training in the use of health coaching and for pharmacists this is particularly about integrating an education based approach to medicines support.

By focussing on the patient agenda through the use of coaching tools, pharmacists will improve patient adherence to and therefore outcomes from medicines. The new medicines service is the first step in acknowledging this. The challenge is to develop pharmacist skills further, in order to integrate coaching into every day pharmacy practice."

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