Although poor adherence is directly linked to patient behavior, there is no definitive data that has defined a ‘non-adherent’ personality or revealed a relationship between adherence and the ability to follow self-care or lifestyle recommendations.14 Likewise, medication adherence has not been shown to be correlated to demographic variables such as age, gender, or race, although there is a weak relationship with lower education and income levels. There are many variables that can be factored into adherence behavior outside of demographic variables that have greater utility as a predictor of medication adherence behavior. Table 1 categorizes the predictive strength of consumer-related variables (and their interaction within the health care system) as they are presented in the literature.
Moreover, the decision to be adherent is unique for each medication, and driven by three factors: (1) the perceived need for the medication (related to their understanding of the disease and therapy): (2) the perceived concerns about the medication (related to side-effects and safety); and (3) the perceived medication affordability.
National Consumers League’s Approach
The National Consumers League has launched a medication adherence awareness campaign entitled “Script Your Future”. The multiyear effort focuses primarily on patients affected by diabetes, respiratory disease, and cardiovascular disease. It is a powerful campaign that educates the consumer that poor medication adherence can lead to consequences that affect their ability to take care of themselves and their loved ones, places undue emotional and financial burden on family members, and jeopardizes the ability to experience future family events and milestones. The campaign also encourages patients and health care professionals to better communicate about ways to improve medication adherence.
Physicians, particularly primary care physicians (PCPs) and other specialists that write prescriptions for chronic diseases, can play a key role in addressing medication adherence given that they represent the initiation of the prescription process and have the opportunity to develop a trusting relationship with the patient.
Patient satisfaction and value Patient satisfaction improved through enabling better self-care. The introduction of a system which enabled patients to view their test results, manage their medication list, and have secure messaging with their practice, resulted in 80% of responders (n = 448/560) saying the system facilitated their participation in their own care.
Another post-intervention survey found that 77–87% of 5391 patients across three sites who had online access to visit notes felt more in control of their care.
Of the clinician responses, 73 out of 104 (70%) felt that enabling patients to read their own notes online strengthened relationships, enhanced trust, and improved decision making.
Harnessing the information revolution
In April 2015, England became the first country in the world to enable its citizens to book GP practice appointments, order prescriptions and access their medical records online. By April 2016, over 95 percent of GPs were able to offer patients online access to their detailed health record.
This underpins our work to encourage better use of data and technology to extend patient choice, enable citizens to take more control, be more engaged in their own health and care, improve outcomes, and at the same time reduce the administrative burden on the NHS.
In February 2016, DH announced £4.2 billion of funding for NHS technology over the next five years, including £1.8 billion to create a paper free health and care system, following the publication in November 2014 of the National Information Board’s strategy, which will support the transformation of care. This funding is underpinned by a benefits case with efficiencies mapped out over the next five years.
In September 2015, we launched guidance for CCGs on extending electronic health records and the development of local digital roadmaps to realise a paper free health and care system by 2020.
Over 17 million patients are able to use the Electronic Prescription Service, which allows them to collect medicines direct from the pharmacy without visiting their GP, or even have them delivered. A third of all prescriptions are now transmitted electronically.
A new E-Referrals system was launched in June 2015, which provides a safe and secure mechanism for patients and referrers to select a provider of their choice and convenient time and date for their appointment.
Over 96 percent of patients now have an electronic SCR, which can be accessed by health professionals with the patient’s consent. Its use is increasing on occasions when urgent care is needed, with over 3 million views a year.
Case study: Learning from the Patient Online programme
The Swan Practice in Buckingham sees about 70 patients per day for tests and samples. Until recently, patients had to ring or visit the practice to get their results. Each call lasts approximately two minutes, but can easily take up more time when the patient wants the receptionist to read out the results.
Since August 2015, when the practice started offering online test results to their patients, the number of calls has dropped to 25 per day. This has freed up valuable time for both administrative and clinical staff.
The safety of patients is paramount, but healthcare inevitably carries risks. Understanding and managing these risks is vital to secure the best outcomes.
Staff are encouraged to report all patient safety incidents, whether minor or serious, and increasing numbers of reports are seen as a good sign of an improving safety culture. The National Reporting and Learning System is the most comprehensive database of patient safety information in the world, having amassed over 12 million reports since it was established in 2004. Over 1.7 million incidents were recorded in the last year, a pleasing increase of over 10 percent on the previous year, suggesting greater awareness and transparency around patient safety. Ten patient safety alerts were issued in 2015/16, based on these incident reports. This increase in incident reporting should not be taken as an indication of worsening patient safety, but rather as an increasing level of awareness of safety issues amongst healthcare professionals and a more open and transparent culture across the organisation.
Personal health records have been defined as:
- an electronic application through which individuals can access, manage and share their health information in a secure and confidential environment
- a tool for collecting, tracking and sharing important, up-to- date information about an individual’s health or the health of someone in their care
While there is no universal agreement in these definitions, they contain broadly similar themes: focusing on data repositories that can be used to securely store and manage personal medical information. These data repositories can be further classified into three distinct sub- categories
based around their integration and communication with provider systems:
- stand-alone: solely patient-recorded and maintained
- tethered: a read-only link to an electronic medical record
- integrated: asynchronous communications to/ from an electronic medical record.
Although the EHR and PHR have different end?user groups, they contain similar information. Ideally, they should be inter-operable. In the past few years, adoption of EHRs has been encouraged, whereas PHRs have not received the same level of attention. However, as Tang and Lansky and Ball et al discussed, the EHR alone may lack the ability to sufficiently motivate and engage patients to take a more active role in managing their own health, a condition found critical for improving care quality and efficiency . Therefore, PHRs have been recognized as a means of patient engagement. An EHR -coupled PHR, which is often referred as a patient?accessible EHR or tethered PHR , has been increasingly offered in the United States to patients as an institution?specific (limited to a certain organization) Internet portal by some large health care organizations (eg, Kaiser Permanente, Veterans Health Administration, Group Health Cooperative, CareGroup Health Care System, and Palo Alto Medical Foundation).
Due to the high incidence and prevalence of chronic conditions that generally require frequent monitoring and interventions, elderly people would benefit more because the PHR system could enable more coordinated and cost?effective communication and health care delivery.
The digital divide is defined as the gap that exists between individuals, groups, or communities in terms of the availability of ICT and the ability to use these technologies effectively.
Ten health conditions were found in the included studies. Seven of these ten health conditions had at least one study reporting benefit from the use of a PHR: asthma, diabetes, fertility, glaucoma, HIV, hyperlipidemia, and hypertension. Diabetes was the most studied condition with eleven of twelve studies showing benefit. Three conditions had studies that meth the criteria but did not show benefit of the PHR: cancer, idiopathic thrombocytopenic purpura (ITP), and multiple sclerosis.
70% of studies (16/23) reported benefits associated with PHR use.
However, there is no evidence that any study of the above provided evidence of better medication adherence or at least persistence.
Self-Manage Care – Using the PHR to make day-to- day decisions about care management, such as medication dosing, food choice.
This is the only grounds that medication intake was improved.
These conditions include: diabetes, hypertension, asthma, HIV, fertility management, glaucoma, and hyperlipidemia. Benefits were seen in care quality, access, and/or productivity. These conditions share several common characteristics: Each of these conditions is chronic. They have a significant benefit from self-management through behavioral changes. Many have an aspect of monitoring, either from the clinician or the patient (self-monitoring). Self-management is present in all. The seven conditions were conditions where the self-management behaviors could be suitably tracked in a PHR and were tightly linked to the feedback of monitoring/self-monitoring of indicators (Figure 3). For ex- ample, self-monitoring blood pressure in hypertension or glucose levels in diabetes allowed for more specific and direct feedback to patients using a PHR.