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Adherence

Improving Adherence to medicines is crucial to the future sustainability of European Health systems, and Community Pharmacists have a crucial role to play

The cost of non-adherence can be calculated both in terms of generating additional costs for healthcare systems due to misuse or non-use of medicines leading to further treatment or even hospitalisation, and by simply wasting resources through the non-use of prescribed medicines funded by healthcare systems.

It has been estimated that there are 194,500 deaths a year in the EU due to miss-dose and non-adherence of prescribed medication. Non adherence is estimated to cost the European Union 125 billion Euro annually.

It is not difficult to conclude that action is needed. An appropriate balance between health, social, and economic policies, as well as multiprofessional and interinstitutional efforts is critical.

PGEU presented a booklet entitles 'Targeting Adherence' on the 13 May, 2008 at the European Parliament on the occasion of a lunchtime debate to discuss the topic with MEPs, representatives of patients’, consumers’, and health professionals’ organisations and of the Pharmaceutical industry, prominent researchers as well as some of Europe’s pharmacy leaders.

Following a success of the PGEU booklet on the 21st of September, 2011 PGEU along with EPF, CPME, and EFPIA held a lunch debate at the European Parliament in Brussels , which brought together perspectives of patients, doctors, community pharmacists and the research-based pharmaceutical industry presenting examples of best practices on adherence to therapies and demonstrating how a coordinated, multi-stakeholder and patient-centred approach – involving patients, their carers/families, health professionals, industry, and the public, is a key factor in improving patient safety and the quality of healthcare tailored to patients‟ needs. The event was hosted by three MEPs, Linda McAvan (S&D), who was replaced by MEP Roth-Behrendt, ChristoferFjellner (PPE) and Cristian Silviu Busoi (ALDE). Mr Raj Patel from NPA illustrated how pharmacists in the UK contribute to a better medicines management through the Medicines Use Review service.

CHRODIS Joint Action http://www.chrodis.eu/

The “CHRODIS” Joint Action aims to addresses chronic diseases and promote healthy ageing across the life cycle and is co-financed by the EU Health Programme. The objective of CHRODIS is to help EU countries and regions exchange good practices in tackling chronic diseases. A special focus is given to health promotion and disease prevention, multi-morbidity and diabetes and the PGEU intends to contribute our members’ good practices in these areas.

New Medicines Services

UK - http://psnc.org.uk/services-commissioning/advanced-services/nms/

In the UK the New Medicines Service (NMS) provides support for people with long-term conditions who have been prescribed a new medicine to help improve their adherence. This service, provided by pharmacists is initially focused on particular patient groups and conditions, such as those receiving medication for diabetes, hypertension, asthma and anticoagulant / antiplatelet medication. Patients are recruited at the point of dispensing, counselled on any relevant points about the new medication and provide consent to participate in the service. Within two weeks either a face-to-face (in-pharmacy) or telephone consultation takes place where the pharmacist conducts a semi-structured interview in order to identify any problems, side-effects, concerns or non-adherence to the new medication.

At this point referral can be made to the patient’s GP if required or appropriate advice can be provided by the pharmacist and a date arranged for a final consultation within a two week period. In either case, this interaction with the patient is also an opportunity for the pharmacist to provide dietary and healthy lifestyle advice to the patient. The service continues to be funded by the National Health Service and after the first 18 months of provision a total of 236,408 NMS cycles were completed representing a total of 224,554 patients.

France - http://ansm.sante.fr/Dossiers/Anti-vitamine-K-AVK/Prevention-des-hemorragies-provoquees-par-les-traitements-anticoagulants-anti-vitamine-K-AVK/%28offset%29/0

In France, a similar service began in early 2013 where patients are able to consult with their pharmacist on the management of their long-term anticoagulant medication (the so called ‘Vitamin K Antagonists’, VKAs). The service consists of at least two consultations a year with a pharmacist who provides appropriate advice and counselling on taking the medication and the associated clinical monitoring parameters, so crucial to the safe and effective management of this medication (e.g. maintaining a target ‘INR – International Normalised Ratio’ level when taking warfarin). If necessary, the patient can be referred to their GP upon giving consent for further management. The French administration initiated this service in order to reduce overdosing, excessive bleeding and associated hospital admissions as anticoagulants are the primary cause of iatrogenic incidents in France. 

This service is soon to be expanded to all include all anticoagulants, however as of the 15th of May 2014, 121.440 consultations had taken place involving 14.224 pharmacies. In France, much like the UK, a general framework for medicines services has been defined and later in 2014 a new service will be launched for asthmatics in France. This service aims to improve adherence to prescribed inhaler therapies, either as the patients start a new treatment or when they resume a previously prescribed treatment. It will involve at least two patient-pharmacist consultations in order for the patient to receive the appropriate information, guidance and advice.


Belgium

In Belgium, an Asthma Service was recently introduced where patients are able to have a highly structured conversation with their pharmacist when starting an inhaled corticosteroid for asthma. This service is initiated by the pharmacist, prescribed by a doctor or requested by the patient. As with the British and French examples above, two counseling sessions take place in the same pharmacy, several weeks apart with a recommended interview duration of 15 to 20 minutes.  In the first six months of this service almost 10.000 patients we enrolled and there are plans to widen the scope of the inclusion criteria, potentially broadening the service to even more patients in the future.