The Medication Adherence Puzzle: Are We Overlooking the Key Piece?

Should medication adherence become a national priority?

The emergence of the ICS (Integrted care systems) promises to join up health and social care. With a promising start, there’s lots of exciting work around shared care records, virtual wards and fall prevention.  Take falls for example, it’s estimated that the cost of falls to the NHS and Adult Social care is £6 million a day… £2.3 BILLION every year.  

Cardiff Council recently published information saying that the age bracket of Telecare Cardiff customers with the highest number of falls is 85-89 years old.  26.5% of falls that their Mobile Responders attended are due to a Long-Term Health condition.  Most of the falls were attributed to balance problems and Long-Term Health conditions.  The peak fall time was between 9-10 am in the morning.  Research conducted by YOURmeds looking at prescriptions issued within care homes found that 66% of patients within care homes took a medication that could lead to a fall due to either postural hypotension (low blood pressure), sedation, confusion, or unsteadiness. So why is medication adherence not considered when looking at fall prevention?

The World Health Organisation (WHO) recognises that only 50% of people take their medication as intended.  “Increasing the effectiveness of adherence interventions may have a far greater impact on the health of the population than any improvement in specific medical treatments.” The science has made groundbreaking medical advancements and ignoring the issues around adherence reduces the independence and health outcomes of the service users being supported.

Joining up health and social care

Bridgend Council recognised the issues and challenges around medication adherence and has effectively ripped up the rule book by using YOURmeds a smart medication management system and joining up the assets with health and social care.  YOURmeds is a smart medication management system that helps people take the right medication at the right time with the support of their network of family and friends.    YOURmeds has been integrated into the community pharmacy teams that identify patients with the following criteria. 

– Patients with mild/moderate cognitive decline 

– Those who need medication support but have no social care needs

– Patients waiting for social care assessments

– Patients presenting at A & E with medication adherence issues 

– Patients discharged from hospital

The community pharmacist identifies the referrals and sets them up on the YOURmeds system.  Once they have adherence levels over 80% the prescription is moved into the independent pharmacy network which are commissioned to provide quarterly reviews and medication within the YOURmeds system.

The early case studies are revealing insights that have surpassed the team’s expectations.  From discovering a financial safeguarding issue, supporting someone with advanced dementia to become 95% adherent with his medication, identifying a fall in the community that a pendant alarm failed to pick up but the team were alerted due to a missed medication round, and the impact on carers either through the use of the system for themselves or through peace of mind from the improved reporting. 

But you don’t know if someone has taken their medication?

Health data gathered can confirm medication has been taken.  You would expect someone’s blood pressure to reduce after they’ve taken their blood pressure tablets.  This question seems to stop some people from even considering the issue.  You can’t support people who are intentionally non-adherent; supporting people to improve their adherence is for those who want to be more adherent.  When YOURmeds service users start taking their medication on time the impact is easy to see in their feedback

“I feel 21 again!!

“My symptoms have stopped because I take my medication”

“Before YOURmeds, I would overdose on my medication because I couldn’t remember if I had taken it”

Improve independence and health outcomes and increase capacity in the system!

YOURmeds has brought medication support into the 21^st Century by digitising the humble dosette box and integrating the support network into the technology to support adherence.  On average our service users have an 84% adherence.  1 in 4 adherent rounds are due to the supporter nudge so it’s an important part of the system.  Stoke-on-Trent City Council are using YOURmeds as a way to evidence commission care packages. 

“YOURmeds is as easy as a medication dispenser can be so if a person struggles with maintaining their adherence through the system it gives us the evidence to commission care packages” – Peter Ball, Telecare and Rehabilitation Service Manager.

If a service user can’t use the YOURmeds system, it provides the council with the evidence to commission a care package.  A recent real-world written by the University of Chester recognises that 70% of visits were replaced with the YOURmeds service.

YOURmeds provides daily real-time data that can be used by clinicians and adult social care to provide person-centred care that improves health outcomes, increases independence, and reduces primary carer burden.