I have recently discovered the UCL Lunch-hour Lectures - 40 minutes of fascination over lunch! Last week I listened to Nick Barber (nick.barber.org) talk about medicines - "Can't take, won't take - why patients don't take their medicines", and it was the best lunch I have had for a while!
In addition to being fascinating, Nick presented it in such an engaging way - using my favourite tool, patient story and personalising it! For example, he opened by rephrasing the title from patients to "we", since we are all patients, so brought it home and made it relevant!
He began with a little history from the Victorian times: in those times, people treated themselves since there was little concept of the "right thing to do" - which struck me as quite similar in a way to some rarer LTC today! Over a few generations we have lost that skill to self-manage and are only now starting to realise the importance of it, having become dependant on the growing bank of medical knowledge. When we talk of being stuck in the dark ages, maybe we are forgetting that there were a few specks of light there too?!
He explained with the help of some great visual examples the vast sums of money spent on drugs in England each year and the scale of the problem of non-adherence or non-compliance: 30-50% of people with LTCs don't take their medications as prescribed. Such is the scale of non-adherence, that improving adherence could be more beneficial than creating a new drug! He explained the reasons for non-adherence: intentional and unintentional, acknowledging that there is overlap between the two in most patients. Intentional means beliefs about the medications, that they won't work or will make it worse. Unintentional reasons are barriers such as forgetting and other errors.
As the lecture went on, Barber used patient stories to highlight examples of non-adherence and the reasons behind it. These patient stories were so powerful - really backed up what Nick was saying.
One of the most startling statistics was that within 10 days, two thirds of patients with chronic conditions said that had experienced problems with medications. Barber made the excellent comparison to any other product - such failings would be totally unacceptable. But the New Meds Service has been developed to try and reduce the initial problems patients experience with new medications. It was a patient-centred approach that "cared" - something relatively novel! In 2008, this was made government policy - which is encouraging - although like everything, it's not available to all patients (and I don't fall into their categories!!!). One theme that was identified was the importance of explaining the rationale behind prescribing drugs, and the impact that can have on compliance.
It was a fascinating insight into the academic thinking behind something so relevant to my life and all the self-management work I am so interested in. Thank you Nick Barber and UCL Lunch-hour Lectures!