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Text and Adhere!

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A PJ news feed caught my attention recently – ‘Telephone support shows promise as aid to medicines adherence’. Now, I can’t help thinking, “well, yeah that makes sense”. Out of my circle of friends and colleagues I do not know anybody that doesn’t use/carry a mobile phone. The ‘alarm’ application has been on phones for many years now and, believe it or not, could actually be used to regulate an individual’s medicine regimen (enter chronotherapeutics via phones – you read it here first!). I just don’t see why this is big news.

In the article referenced below, the conclusion stated ‘The intervention was effective in reducing primary nonadherence to statin medications. Because of low marginal costs for outreach, this strategy appears feasible for reducing primary nonadherence. This approach may generalize well to other medications and chronic conditions’ (Derouse et al. 2012). In my opinion and this may be due to my distinct lack of knowledge, but surely this is flawed. Yes, getting text messages because you haven’t picked up your script probably would increase compliance, but for the wrong reasons. If someone was texting and sending me letters about my drugs, I’d go pick them up. I’d probably be pretty annoyed when I picked them up and I probably wouldn't take them!  

Haha, of course, I’m jesting. But adherence is not a subject to be taken lightly and there are a huge number of factors to consider when discussing it including:
  • How would you measure adherence? 
  • Is this an appropriate measure? 
  • Is the fact that the patient is in the trial, affecting their adherence? 
  • Did patients receive the same information?
  • Was the patient poorly adhering before the trial?
The list will go on and there is probably abundant research on the issues surrounding adherence. However, I did proceed to do a sneaky EMBASE/Medline/scholar search, but could not find any appropriate data relating the number of hospital admissions due to poor medication adherence. The reasoning behind this search was due to my interest in the cost of poor adherence - both finically, and for the patient’s well-being (this probably is difficult to quantify too). I did not find any directly relevant articles but there are many discussing issues in conditions such as type II diabetes and asthma.Although I have waffled on a while about the topic, I don’t really know that much, apart from what was taught at University. But in my opinion, proper counselling is necessary to improve compliance as I feel the more a patient understands, the more willing they will be to adhere. I would be interested to know how much discussion the prescriber had with the patient around the medicine, in the article mentioned above. It makes sense to me, that appropriate medicine use reviews and discharge counselling would improve adherence to medicines. This surely is obvious and should be pushed? As for the whole telephone thing, I’m sure there are some individuals/businesses that could design apps for medicines etc. Pharmacy should engage with IT, however, to the point of ringing/texting people? Isn’t that an admin job? I don’t know though, it’s just what I’ve been thinking about... To conclude, I think anything that improves patient adherence can only be a good thing. But, counselling should be at the forefront of the adherence battle. On a pre-reg note, finish my four week stint in Medicines Information tomorrow. I’ve learnt so much being in there and discussing information/problems with colleagues. It’s a shame I have to move to the dispensary... On another note, crazy news about the BNF for children in for the exam isn’t it? Nightmare.  ReferenceStephen F. Derose, MD, MS; Kelley Green, RN, PhD; Elizabeth Marrett, MPH; Kaan Tunceli, PhD; T. Craig Cheetham, PharmD, MS; Vicki Y. Chiu, MS; Teresa N. Harrison, SM; Kristi Reynolds, PhD, MPH; Southiida S. Vansomphone, PharmD; Ronald D. Scott, MD. (2012). Automated Outreach to Increase Primary Adherence to Cholesterol-Lowering Medications. Arch Intern Med. 1-6 Accessed on 06/12/2012.

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