Blog and comment

Medicines - Can’t take, Won’t take - Unlocking the reasons

User Avatar Blogger . 18/02/2011 14:49:50
By Dr Joseph Bush, Lecturer in Pharmacy Practice, School of Life & Health Sciences

You could be forgiven for thinking that adherence – or more specifically non-adherence – to prescribed medication regimes is a relatively minor problem for the NHS.  However, non-adherence is a huge problem in all healthcare systems.  According to the World Health Organisation (WHO), in developed countries, adherence to long-term therapies in the general population is around 50% and is even lower in developing countries.  In England, between one-third and a half of all medicines prescribed for long-term conditions are not taken as recommended.  Estimates for the cost of unused or unwanted medicines in the NHS vary from £100 million to £300 million annually.  The economic costs are not limited to wasted medicines.   Non-adherence has the potential to limit the benefit of prescribed medicines.  A lack of improvement or deterioration in health has a direct impact on the NHS, with increased demand on GP surgeries and hospitals, all at an additional cost.

What makes figures such as those quoted above seem so shocking is that it seems a quite stunningly simple process to take a medicine properly – medication is prescribed; the patient is informed how to take their medicines; the patient obtains their prescription at a pharmacy; the pharmacist informs the patient how to take their medicines; ultimately the patient takes their medicines as instructed; [hopefully] the patient’s health improves as a result of taking medicines as instructed.  It would appear counter-intuitive for an individual not to take a medicine as instructed – why would a patient not take a medicine as prescribed?  Surely a patient who didn’t adhere to a prescribed medication regime could be considered be stupid, reckless or both.  To use Ben Goldacre’s Bad Science maxim “I think you’ll find it’s a bit more complicated than that”.

First of all in the scenario described above there is an assumption that the patient is a passive recipient of medical ‘wisdom’ and that it would be remiss of them not to heed said advice.  This is however, a spectacular over-simplification of what is at times a complex process.  The factors that can affect adherence to medicine regimes are myriad and diverse.  They straddle psychology, sociology, physiology, economics, pharmacology and logistics (and I make no claims that this list is exhaustive).

Obvious examples of factors which make adherence problematic include an inability to obtain the medicine in the first instance (through supply chain problems or an inability to pay for the medication for example), an inability to swallow solid dosage forms (this can be a particular problem in patients whose condition(s) leads to swallowing difficulties), unpleasant side effects of a medication and simply forgetting to take a dose.  There are however much more subtle forces at play that can determine whether an individual takes their medicines as prescribed or not.  For example, there are suggestions that some diabetic patients of South Asian origin may reduce the prescribed dose of medication that they ingest as they believe that medicines supplied via the NHS are more efficacious than those available in their countries of origin.  What is logical to one may seem preposterous to another.

It is into this maelstrom that the Aston Medication Adherence Study (AMAS) Team must throw itself (sounds overly dramatic – it’s not like we’re going to be climbing the north face of the Eiger or anything!).  First up is an assessment of levels of non-adherence amongst our study population.  This data will be analysed alongside relevant clinical markers (such as blood glucose or cholesterol levels) and patient self-reports in an attempt to devise a systematic approach to identifying non-adherence in vulnerable groups at the earliest possible opportunity.  While this itself is important, we also need to examine why our population do not always take their medicines.  This presents a tremendous opportunity to explore these factors amongst an atypical UK cohort – a hugely diverse population drawn from areas of significant socioeconomic deprivation.  It is only by understanding why people do not adhere that we can make constructive efforts to tackle medication non-adherence.  Improving levels of adherence will not only benefit patients but also wider society via decreased expenditure on costs related to non-adherence – highly pertinent amid the Government’s drive to deliver £20 billion of NHS ‘efficiency savings’ by 2014.

For more information check-out the Aston Medication Adherence Study (AMAS).

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Social responsibility and sustainability

Blogger . 10/12/2010 11:39:21

By Dr John Blewitt, Director of the Lifelong Learning Centre, Aston University

Business is immensely important. It generates wealth and creates opportunity. It provides people with what they want through the incredible dynamic of producing goods and services. For many people, the ‘business of business is business’ or at least this is how many people used to see it. But not anymore. Business does not operate in a social, environmental or economic vacuum.

Most of us are now well aware of the massive challenges confronting the world in the 21st century – climate change, resource depletion, energy security, global poverty, biodiversity loss and a whole range of other risks and uncertainties. Given the immense power and potential of business to address these things it is now rather short sighted, indeed irresponsible, for business leaders and other practitioners to simply restate the old ‘business of business’ dictum. We are all on this planet together. In fact, we are part of it. We rely on it for everything including our capacity to generate wealth and opportunity. This means that many businesses are now looking seriously at their activities and missions from much wider, even holistic, perspectives.

New business models are being developed that will ensure wealth and opportunity is continually created in such a way as to bestow wide ranging social and environmental improvements. To do otherwise is becoming increasingly unthinkable.

A new MSc programme has been designed at Aston Business School to help existing and future business leaders to engage positively with the social, economic  and environmental agendas through their business practices. There is a lot to do because a lot is at stake.

Each week Carole Parkes and I will be offering our thoughts on issues of the moment and discussing some of the wider trends and tendencies that are affecting business, civil society and the environment everywhere.

Find our more about the MSc in Social Responsibility and Sustainability.

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Multiple perspectives

Blogger . 03/12/2010 14:49:17
By Cora Lynn Heimer Rathbone, Director of the Centre for Executive Development, Aston Business School

I’m back! Survivor of return Qantas flights to Hong Kong, untroubled by engine issues and dazzled by the lights of that amazing city.

On the edge of East meets West, the city and its surrounding islands are a hive of activity, a confluence of different perspectives, impressive wealth, advanced engineering and teeming crowds scurrying in orderly patterns.  Mall after mall displays branded boutique after branded boutique to the point that it all merges into one phantasmagorical unbroken line of luxury. No point shopping. Not many are. Price tags frighten even the most comfortably heeled. Those who grace the stores with their presence float between display cabinets, sometimes modelling a bag. Others, like my daughter – recently arrived, a young team-leader for a global player on a two-year assignment - nonchalantly try on the odd Rolex “not the one with the gold face but the one with the mother-of-pearl back. Yes that’s it, with the diamonds.”  I glance sheepishly at my own Rolex, gold-faced and diamonded, and smile at my justification some twenty years ago to splurge. 

A short one-hour ferry away, seemingly contrasting Macau beaconed. The quaint down-town displays its Portuguese roots as unsophisticated shop after unsophisticated shop around the pedestrianized area sells almond cookies - so dry that ten days on I can still remember the feeling of having my jaws temporarily cemented – and dried-meats in blood-coloured sheets that look like liquorish. That is one part of Macau, dominated by the unlikely ruins of St Paul’s Church at the base of the city’s fortressed walls. A short taxi ride away, across the water causeway, over an impressive expanse of suspended bridge, we came to The City of Dreams, Hard Rock Cafe and The Venetian. Imagine over 100 football pitches side by side, gambling machines and tables lined as far as the eyes can see and beyond, many filled with Chinese players, some empty but for the croupiers anticipating their guests. And this housed within a mega shopping centre the likes of which I, an American, had never seen before. In fact, the Venetian itself, within which the largest casino in the world is housed, is a replica of Venice, complete with sun-set sky, canals and gondolas with singing gondoliers.

With the backdrop of this dramatic city and its surrounding islands, where mere mortals could be excused for thinking that not even the sky is the limit, one can see the benefits of superimposing multiple perspectives to break-down barriers of linear thinking.

Why not then use this sure-tested approach most often associated with creativity and out-of-the-box thinking to inform and structure mission critical decisions? Indeed, how dare we make momentous decisions in splendid isolation, or in the company of those who share our perspectives, who like ourselves share similar experiences? Especially, but not exclusively, when we have the time, how is it that we fail to consult widely to inform a richer, fuller view of the issues at hand?

Decision-making that, like brainstorming, brings in people with diverse perspectives is sure to be more robust than otherwise. Combine this with a clear auditable process that captures the ideas of different individuals, especially when each represents a different interest group, and you create a situation in which challenge and constructive debate is guaranteed to flush-out poorly considered and blinkered standpoints. By involving all who have a stake in the decision, all who see the decision-situation from a different perspective, in the process of decision-making, you not only enlist the different factions that those individuals represent but you also come closer to ensuring a richer decision, a balance consideration of all mitigating factors in the decision that you ultimately take.
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Can the new Local Enterprise Partnerships (LEPs) deliver economic growth?

Blogger . 05/11/2010 15:29:34
By Graham Pearce, former Professor of Public Policy and Management, Aston Business School

The task of boosting economic growth and tackling regional inequalities could be undermined by plans in the Coalition Government’s Regional Growth White Paper to transfer powers to sub-regional consortia of councils and businesses working through Local Economic Partnerships (LEPs).

There are considerable uncertainties and potential risks, I believe, arising from the current reshaping of responsibilities for securing sustainable economic development at the sub-national level. My conclusion, in a nutshell is this, below. And I invite you, the reader, to give your comment in a bid to gauge, as a region, our collective reaction:

• LEPs will replace England’s nine Regional Development Agencies (RDAs) but collectively will have far smaller budgets. The scale of resources available to RDAs has not been sufficient of itself to make a significant impact on regional economic disparities and without political clout and some financial incentive LEPs could prove ineffective.

• The loss of RDA funds will be felt most keenly in Northern and Midland regions and, despite reassurances that resources for economic development will be distributed in favour of the less prosperous regions; reductions in public expenditure will exacerbate the longstanding economic disparities between the Greater South East and the rest of the country.

• The Government expects LEPs to tackle a range of policy issues that contribute to creating the right environment for business and economic growth. But the task of effective partnership working requires a considerable investment of time and energy. Moreover, the new Partnerships will be reliant on multiple funding streams administered by a plethora of government bodies, whose own budgets are threatened. Their room for manoeuvre will be severely restricted.

• LEP boundaries should reflect socio-economic realities, rather than administrative units. Nonetheless, the willingness of authorities to put aside local interests and provide a collective voice on issues that have a strategic dimension cannot be assumed. As the current bargaining around LEPs has revealed, parochialism remains a potent ingredient and rather than ‘natural’ economic areas LEPs are being defined according to arbitrary administrative boundaries. There is also the risk of unproductive ‘place marketing’ between LEPs to attract mobile investment and jobs.

• There is an underlying assumption that the key groups representing business are both willing and able to engage in LEPs - factors that are highly variable across business organisations and geographical areas. As volunteers, business partners do not want to be part of bureaucratic ‘talking shops’. Nonetheless, granting business interests an equal status with local authorities in LEPs may lead to undue prominence being given to economic considerations and may be incompatible with local authorities’ remit to deliver sustainable development in a public and accountable setting. As such they are likely to replicate the weaknesses of legitimacy associated with the RDAs and unelected regional assemblies.

• LEPs are expected to provide strategic leadership for the coordination and integration of sub-national spatial and investment priorities, where certainty is vital for both private and public sectors. There is virtue in seeking to coordinate such policies to maximise the effectiveness of public and private expenditure but this will depend upon authorities and their business partners demonstrating a capacity to enter into collaborative and long-lasting commitments, with the risk of significant geographical variations. Furthermore, the need for statutory planning across sub-regions is not currently recognised.

• The legacy of economic development knowledge and expertise in the regions, I think, should not be dissipated. Indeed, because there are economic opportunities and challenges that cannot easily be dealt with either nationally or locally, there remains a compelling case for establishing region-wide partnerships of local authorities, business leaders and other key partners to deal with strategic economic issues.
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