MEDICINE MANAGEMENT
David Pruce, director of PruceConsulting and former Director of Policy & Communications at The Royal Pharmaceutical Society, explores the clinical and fi nancial cost of non-adherence among dementia sufferers.
T
he problem of patients not adhering to medicine regimes is a costly one
for the NHS; not only does it compromise health outcomes, it puts the public purse under strain. Between a third and half of all medicines are not taken as recommended, resulting in between £36m and £196m- worth of preventable hospital admissions.1 For Britain’s 614,000 dementia sufferers,2 complying with doctors’ orders is an even greater challenge.
At a recent GP Commissioning Conference, NHS chief executive Sir David Nicholson underlined that for ‘the new NHS’ the onus is on caring for patients in their own home wherever possible. Indeed, practice man- ager Jose Tarnowski explained that a day’s admission to an acute hospital costs the same as a whole year’s care by a GP prac- tice.
While in-home care is a priority for NHS reforms, taking dementia sufferers away from a hospital or caring environment where medication can be administered and monitored dramatically increases the risk and cost of non-adherence. So with the NHS looking to make its drug budget work harder, what challenges do dementia sufferers face in complying with medicine regimes? And how can we overcome them (cost) effectively?
Keeping it simple
Memory loss is the greatest obstacle to ad- herence for patients with dementia. The fact that many dementia sufferers take a range of medicines to treat multiple condi- tions exacerbates the situation. Prescribers can encourage greater adherence by reduc- ing the number of medicines taken and the number of doses required each day. This in- volves reviewing the need for a medicine or using combination products containing two or more medicines in one tablet.
Historically, these products have been frowned upon because they are gener-
64 | national health executive Jul/Aug 11
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