The study comprised of three stages; a literature review, quantitative analysis of electronic patient records, data from a patient questionnaire and qualitative analysis of patients’/members of the public’s views and opinions. These three stages form the three core chapters of the report, with a fourth chapter summarising the key findings and discussing the recommendations from the project.
The top-level scope of works undertaken to successfully complete the Aston Medication Adherence Study are as follows:
Chapter 1: Summary of the literatureThe initial literature search produced almost 5,000 abstracts for review and the final report cites almost 200 sources including scientific papers, government policy documents and professional guidelines.
The review highlighted the lack of research examining medication adherence in large populations in the UK. In its geographical setting, population size and diversity, this project may be unique.
Chapter 2: Analysis of the patient dataThe project methodology involved the analysis of aggregated prescribing data from the 76 GP practices within HoBtPCT supplying data to the interim electronic patient record (iEPR). The data retrieved related to patients who had any contact with contributing practices within the period between 2000 and 2010. A software programme was devised to calculate individual patient Medication Possession Ratios (MPRs) for all medication runs of interest. Although not a definitive indicator of adherence to a medication regimen (as the data does not indicate whether the prescribed medication was dispensed and/or subsequently taken by the patient), a low MPR value is a reliable indicator of non-adherence.
Chapter 3: Engagement with the HoBtPCT populationThe validity of the calculated MPRs (from Chapter 2) were investigated by triangulation of a selection of the results with both corresponding clinical values from the supplied data (see Chapter 2); but also by a self-reported measure of medication adherence as measured by the Modified Morisky Scale© (MMAS-8) questionnaire. In addition, seven focus groups were conducted with members of the public and the results highlighted areas where additional support and research is required to help support patients in taking long-term medication.
Chapter 4: Summary and conclusions
It has been demonstrated that by using currently available aggregated data from general practice prescribing systems within the area covered by HoBtPCT, it is possible to develop a computerised tool to calculate individual patient Medication Possession Ratios (MPRs) for oral pharmacotherapy used in the treatment of diabetes, dyslipidaemia and hypothyroidism.
The effectiveness of the developed methodology for the calculation of the MPR and its subsequent use in identifying those patients with low adherence levels to their medication was successfully validated by triangulation with both a self-reported measure of adherence via a patient questionnaire, and through the analysis of specific patient clinical values.
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