Consider patients’ biopsychosocial factors

In your interview with deputy chief pharmaceutical officer Bruce Warner (
The Pharmaceutical Journal 2015;294:420), you mention that: “A Cochrane review found that current methods to improve adherence to medicines are not effective and concluded that it is uncertain how adherence to medication can be consistently improved.”

Pharmacy has failed, and so has the government. If pharmacists cannot get adherence right then what role do they aspire to in the outcomes-based future?

People with long-term conditions are being short-changed by the NHS. Warner adds in the interview that “part of our programme is to build on what is already there, have it evaluated and bolster the evidence base”.

Pharmacists’ future roles depend on getting “the whole person care” right by considering patient’s biopsychosocial factors, as well as the medicines aspects.

Future job opportunities depend on pharmacists getting a number of things right at the same time and demonstrate a sense of urgency. They must ensure that:

1. Safety in use of prescribed and sold medicines is improved. By that I mean not just safe dispensing but also safe clinical outcomes.
2. Effectiveness of the medicines is improved. Presently, 50% of the prescribed medicines are wasted. Drug-induced (iatrogenic) diseases are on the increase.
3. Patient experience is improved. This means that they not only understand but actively participate in their therapy and improve chances of good outcomes.
4. Cost-effectiveness of the system and the individual’s treatment are improved.

In short, patients must be involved in reducing future risks, wastage, and feel empowered. Yet, current professions-led systems in hospitals, care homes and community are archaic and are failing to provide personalised care planning that can overcome a person’s limitations because of concerns, beliefs and values.

This approach encourages patients to select treatment goals and to work with clinicians and pharmacists to determine their specific needs for treatment and support.

Non-adherence to medicines happens because the system is based on biomedical quality and outcomes framework indicators linked to a dispensing (supply) system that leads to low patient expectations, not on biopsychosocial assessment of patients’ needs as in SelfCare Pharmacy practice — introduced at North East London Local Pharmaceutical Committee (LPC) — where patient expectations are raised.

At North East London LPC, we have trained more than 110 pharmacists to use psychological tools (health coaching) in combination with clinical tools to produce more predictable outcomes. We hope to provide a sound evidence base to secure a professional future for all professionally minded pharmacists.

Hemant Patel

Election candidate

English Pharmacy Board

Royal Pharmaceutical Society