Dr Christina Jackson
It was great to share the floor with Prof John Weinman, Prof Rob Horne, Dr Katerina Kassavou and Ricky Stoch talking about adherence at the Cambridge Festival, chaired by ex-NICE director of Public Health, Prof Mike Kelly.
As you’d expect if you get a bunch of adherence experts together, the complexities of the field rapidly become apparent. “Adherence” comprises multiple behaviours (starting medication, taking it as prescribed and continuing until the time comes to stop).1 There are literally hundreds of reasons why people might not adhere (as John noted, over 700 have been researched),2 and adherence varies between individuals and in the same individual over time.3 As Rob pointed out, there’s no personality trait or fixed characteristics of a “non-adherent person”. We’re all non-adherent some of the time. Add in to that the difficulties of measuring adherence, let alone finding consensus about appropriate interventions to improve adherence and one might be tempted to give up.
However, introducing the topic to people who haven’t engaged with it before reminds one how stark the numbers are. Non-adherence costs Europe about 125bn Euros per year, up to a third of medications are never initiated, about 50% are discontinued by patients within 2 years, and about half are not taken as prescribed.4 Added to that, in my opinion, two years of increases in depression, increasing distrust of medical professionals and lack of access (all corollaries of COVID-19) are only likely to exacerbate adherence issues.
From different starting points, the panel had some good examples of practical, scalable solutions. It’s good to hear of interventions being developed in different contexts: from a commercial, design-led perspective in Ricky’s case, an iterative research process in Katerina’s case and a hybrid in John’s intervention. John described an eminently scalable SMS intervention in which SMS messages using behaviour change techniques, tailored to an individual’s adherence barriers, were effective at changing unhelpful beliefs about medication and improving adherence to asthma preventer medication.5 Ricky’s low cost FebriSol product provides an alternative to blister packaging and gives people a visual aid to remember whether they’ve taken medication (via a sticky label that can be added to any medication bottle).
I left with a reinvigorated desire to see adherence prioritised in public health policy and confidence that we are developing scalable solutions.
- Vrijens, B., De Geest, S., Hughes, D. A., Przemyslaw, K., Demonceau, J., Ruppar, T., … & ABC Project Team. (2012). A new taxonomy for describing and defining adherence to medications. British journal of clinical pharmacology, 73(5), 691-705
- Kardas, P., Lewek, P., & Matyjaszczyk, M. (2013). Determinants of patient adherence: a review of systematic reviews. Frontiers in pharmacology, 4, 91.
- Jackson, C., Eliasson, L., Barber, N., & Weinman, J. (2014). Applying COM-B to medication adherence: a suggested framework for research and interventions. European Health Psychologist, 16(1), 7-17.
- Khan, R., & Socha-Dietrich, K. (2018). Investing in medication adherence improves health outcomes and health system efficiency: adherence to medicines for diabetes, hypertension, and hyperlipidaemia.
- Petrie, K. J., Perry, K., Broadbent, E., & Weinman, J. (2012). A text message programme designed to modify patients’ illness and treatment beliefs improves self‐reported adherence to asthma preventer medication. British journal of health psychology, 17(1), 74-84.