Medicines play a crucial role in maintaining health, preventing illness, managing chronic conditions and curing disease. However, there is a growing body of evidence that shows us that there is an urgent need to get the fundamentals of medicines use right.
Taken correctly, medicines make a huge difference to the health and wellbeing of patients. They provide cost savings for the National Health Service (NHS) by reducing the need for longer term, more expensive treatment, and help to shift care from hospitals into the community. Better access to effective medicines will support improved health outcomes and help address prescribing variations across the country.
However, we know that approximately 30–50 per cent of medicines are not taken as prescribed, leading to poor health outcomes and unnecessary hospital admissions, and that almost a third of patients do not follow a prescription 10 days after starting a medicine—55 per cent of these don’t even realise they are not taking their medicines correctly.
As well as this cost to the patients, there is also a cost to the NHS and to society in general from this suboptimal use of medicines. In an era of significant economic, demographic and technological challenge it is crucial that patients, the NHS and the taxpayer get the best quality outcomes from the medicines prescribed to patients.
Medicines optimisation is about ensuring that the right patients get the right choice of medicine, at the right time. By focusing on patients and their experiences, the goal is to help patients to:
improve their outcomes
take their medicines correctly
avoid taking unnecessary medicines
reduce wastage of medicines
Improve medicines safety.
Ultimately, medicines optimisation requires a holistic approach and partnership between health professionals and their patients to help encourage them to take ownership of their treatment.
Medicines optimisation looks at how patients use medicines over time. It may involve stopping some medicines as well as starting others, and considers lifestyle changes and nonmedical therapies to reduce the need for medicines.
This is known as “shared decision making”, the conversation between a patient and their health professional to reach a healthcare choice together. These conversations necessitate understanding of what is important to the other person and seeing things from each other’s point of view when choosing medicines. This helps ensure that health professionals prescribe medicines based on evidence, such as personal medical history or life experiences, and improve the chances of patients following a prescription correctly due to it fitting better in their life and for their specific needs.
This approach will require multidisciplinary team working to an extent that has not been seen previously. Health professionals will need to work together to individualise care, monitor outcomes more carefully, review medicines more frequently and support patients when needed. The pharmaceutical industry also has a key role to play working in partnership with the NHS.
Given the clear focus and significance of medicines optimisation, we have welcomed this month’s launch of NHS England’s Medicines Optimisation Prototype Dashboard, which represents a step in the right direction in helping the NHS explore how well-placed they are to optimise the use of medicines for patients in their local areas.
This prototype dashboard brings together a broader range of data that focuses on more than drug costs and volume, which has often been the Medicines Management approach of the past. We hope that it will help Clinical Commissioning Groups (CCGs) to think carefully about how well their local population is supported in its use of medicines both in the community and during a stay in hospital.
Past Medicines Management was interpreted as managing the costs of prescribing. This pressure was applied to newer branded medicines in particular, causing the UK to lag behind other countries in its use of newer, innovative medicines.
In November 2013, the pharmaceutical industry took an unprecedented step in signing a five year agreement with Government called the Pharmaceutical Price Regulation Scheme (PPRS), in which industry underwrites the growth in the branded medicines bill to agreed levels. This was done in recognition of the financial challenges facing the NHS and the need to improve the ability of clinicians to prescribe the right, evidence based medicines for their patients.
Ensuring that this opportunity is truly realised is the subject of on going discussions between industry and the NHS. This new focus on medicines optimisation is a helpful part of this landscape and tools, such as the Dashboard, will play a very useful role.
There is still work to be done to ensure that this tool works in the best interests of patients. The Association of British Pharmaceutical Industry (ABPI) will continue to work closely with NHS England to develop the Dashboard and ensure that the intrinsic value of medicines—to improve healthcare outcomes for patients—is realised.
The partnership is guided by the 'Medicines Optimisation: Helping patients to make the most of medicines' guidance, co-produced by NHS England, the ABPI, Royal College of General Practitioners (RCGP) and published by the Royal Pharmaceutical Society, which is available here.