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Medication non-adherence: an overlooked target for quality improvement interventions
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  1. Bryony Dean Franklin1,2,
  2. Gary Abel3,
  3. Kaveh G Shojania4
  1. 1 Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust / UCL School of Pharmacy, London, UK
  2. 2 Department of Practice and Policy, UCL School of Pharmacy, London, UK
  3. 3 Medical School (Primary Care), University of Exeter, Exeter, UK
  4. 4 Department of Medicine, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
  1. Correspondence to Professor Bryony Dean Franklin, Director, Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust / UCL School of Pharmacy, London, W6 8RF, UK; bryony.franklin{at}nhs.net

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Quality improvement initiatives often focus on closing the gap between routine practice and the care recommended in guidelines—ensuring, for instance, that patients with chronic conditions receive prescriptions for medications demonstrated to improve health outcomes. However, this focus often ignores the even more basic problem: that many patients prescribed medicines for chronic conditions take them inconsistently or not at all. In one US study,1 patients who had recently experienced a myocardial infarction took key medicines intended to prevent further cardiac events only 35%–50% of the time, depending on the class of medication. Perhaps surprisingly, providing the medicines for free improved adherence by only a few percentage points. Other studies also report adherence rates of around 50% or less.2–5

Medication adherence thus constitutes one of the ‘big hairy problems’ or ‘big hairy audacious goals’6 of healthcare. As well as affecting patients’ long-term outcomes, non-adherence can increase healthcare costs through consumption of medicines below the threshold of adherence required for clinical benefit, as well as contributing to healthcare resource use such as hospital admissions.7 Disposal of what can amount to significant quantities of unused medication also presents an under-recognised problem.

Evidence for how best to address non-adherence remains unclear, with relatively few well-designed studies.2 We therefore welcomed the opportunity to publish an initial, positive report of an intervention to improve adherence in patients prescribed a new medicine for asthma or chronic obstructive pulmonary disease, hypertension, type 2 diabetes or an anticoagulant/antiplatelet agent.8 The intervention comprised an initial interview with a pharmacist (in person or by telephone) within 7–14 days of prescription, and then a follow-up interview (by telephone) 14–21 days later. The interviews identified problems related to adherence but also any areas for which patients felt they needed further information …

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