Page 31 - The SA Journal Diabetes & Vascular Disease Volume 9 No 4 (November 2012)

SA JOURNAL OF DIABETES & VASCULAR DISEASE
VOLUME 9 NUMBER 4 • NOVEMBER 2012 173
Medication Review
LOOKING BENEATH THE SURFACE:
THE ‘NO TEARS’ APPROACH TO
MEDICATION REVIEWS
S Afr J Diabetes Vasc Dis 2012;
9: 173–175
Dr Clare Hawley
GPSI and Associate Specialist in
Cardiology, Chesterfield, Derbyshire
Fewer than half of people •
living with long-term
medical conditions take their
medications as intended
People are more likely to take •
their medicines effectively
when they agree to their
prescription and feel involved
in the decision-making process
A medication review gives •
us the opportunity to ensure
safe and effective prescribing
while involving the patient in
decision-making
The NO TEARS tool provides •
a structured approach to the
medication review that can be
adapted to different consulting
styles
Responsibility for prescribing •
medications ultimately lies
with the clinician signing that
prescription
KEY POINTS
T en per cent of the annual NHS budget is
spent on medication, with about 75% of this
is prescribed in primary care. Ensuring that
this money really improves patients’ health is
vitally important. As the population ages, more peo-
ple require increasing numbers of medications for
chronic conditions and a third of elderly patients are
taking four drugs or more for a spectrum of condi-
tions. But this creates a major challenge – as re-
search reveals that fewer than half of these patients
take their medicines as prescribed. How can this
challenge be addressed? This new series will pro-
vide simple practical guidance on how to conduct an
effective medication review for a spectrum of long-
term cardiovascular conditions.
Studies of people with long-term medical condi-
tions estimate that fewer than half take their medi-
cines as prescribed. This includes under- and over-
using medicines and also those mixing prescription
medicines with items bought over the counter, as
well as herbal and complementary remedies. As
a result, people miss out on the potential benefits
of their medication or they may put themselves at
increased risk by taking the wrong dose or mixing
drugs that are unsafe when taken together. The esti-
mated cost to the NHS of medications wasted in this
way is more than £100 million each year.
The potential benefit of improved taking of medi-
cines is significant. A recent Cochrane review even
suggested that improving the taking of medicines
might have a far greater impact on improving clinical
outcomes than advances in treatments.
INVOLVING PATIENTS IN DECISIONS
It is widely believed that patients are more likely to
take their medicines effectively when they agree to
their prescription and feel involved in the decision-
making process. Good communication between the
patient and healthcare professional is essential in
this process and has been shown to improve par-
ticipation.
The medication review involves patients in pre-
scribing decisions and is designed to support them
in taking their medicines appropriately. It helps op-
timise safe and effective prescribing, potentially
improving health outcomes and patient satisfaction
with clinical care.
MAKING SENSE OF COMPLIANCE, ADHERENCE
AND CONCORDANCE
Over the years, the terms compliance, adherence
and, more recently, concordance, have been used to
describe what we mean when patients follow, or fail
to follow, the advice we give them.
Originally in Br J Prim Care Nursing
2012
Over the years, the terms compliance, adherence and, more recently, concordance, have been used to describe what we mean when patients
follow, or fail to follow, the advice we give them.
COMPLIANCE Patients do as they are told and take the medicines we intended
ADHERENCE Patients choose to take or not to take their medicines as advised. Non-adherence may be intentional or unintentional
CONCORDANCE The prescriber and patient work together to ensure the most appropriate medicines are prescribed and used in the
most effective way. This is what we hope to achieve
Making sense of compliance, adherence and concordance