Medication Concordance

I’ve been doing some work concerned with patient concordance with medication in UK General Practice and have just completed a quick trawl through the literature.

I knew that patient concordance was not good, but what I see is truly worrying with data showing that  only about 40% are still taking the prescribed medication after 3 month across a range of treatments which one would expect to be long-term if not life long where poor concordance has serious sequelia.

People drop out at all stages of the process and while not all of the dropouts are easily visible to healthcare professionals much of it would be apparent from patient’s failure to request/collect repeat scripts or in the pharmacy where medicines dispensed go uncollected.

IT systems in both GP and pharmacy can easily identify these non-concordant patients but these does not seem to happen as much as might be expected, maybe in part at least because of the work involved in addressing the problem and the patchy success of attempts to do so reported in the literature.

The long-term cost of poor concordance in financial terms and in terms of morbidity and mortality is considerable and focused efforts at improving concordance should have a strong economic case. However, we see a problem here that inhibits many potentially quality improvements in the NHS namely that demonstrable cost savings don’t occur either in the budgets or timeframes that matter to those designing and delivering services. With the prospect of it doubling the drugs bill savings year hence or in someone else’s budget are not very alluring to commissioners.

Will things be different in the new world of GP Consortia? Maybe GPs commissioners  will be better placed to look at whole system costs, but I doubt they will welcome short-term cost hikes for long-term savings. Solving this problem, which affects not just medicines but a whole raft of technological innovations and non-technological service redesign, requires a new approach difficult to imagine in a cash-limited age of austerity. In the case of medicine maybe the industry can help with pricing approaches that reduce short-term cost in return for a share in long-term savings, but implementing such new approaches in the context of UK pharmaceutical price regulation is probably beyond the scope and ability of GP Consortia.

Existing IT systems in GP and pharmacy can help us identify non-concordance and we have evidence to inform interventions more likely to be effective. The Electronic Prescribing Service missed the opportunity to provide dispensing feedback to GP, but could be easily updated to do so and the Internet and mobile –devices offer new low-cost approaches to gain concordance. However, unless we create an environment that creates incentives to act I doubt we will make much progress.

I’m happy to share some of the literature once I have it consolidated, but for now here is a single paper which reviews much of the work