Medicines adherence: involving patients in decisions about prescribed medicines and supporting adherence

Reasons for the decision

NICE's guidelines on medicines adherence and medicines optimisation contain recommendations on best practice for use of medicines across the healthcare system, covering all patient populations and healthcare settings. Therefore, many interventions intended to support adherence and optimisation of medicines in specific groups of patients are relevant to these guidelines. The guidelines make overarching recommendations on strategies that are broadly applicable across the healthcare system and do not include recommendations on strategies or interventions for specific diseases or conditions.

Topic experts who advised us on this surveillance review indicated that overall, the recommendations are still valid and the principles underlying them remain unchanged. They also highlighted the increasing use of new technologies, which vary from apps designed for patients through to large health service computer systems.

Although the guideline on medicines adherence was developed before these technologies were widespread, the guideline on medicines optimisation noted that 'Better use of data and technology can give people more control over their health and support the medicines optimisation agenda.' Technological solutions should be appropriate for patients' needs and preferences in line with the principles of care as set out in these 2 NICE guidelines and NICE's guideline on patient experience in adult NHS services.

The new evidence identified in surveillance indicated that many technological interventions may be effective, including individual components such as text messaging, reminders or alerts, and more complex mobile and telehealth interventions. However, specific components of interventions did not consistently show benefit and many interventions may not be directly applicable outside the populations studied. The evidence identified in this surveillance review will also be considered in the context of the relevant disease-specific guidelines during scheduled surveillance of those guidelines.

More complex tools such as clinical decision support, which integrates with local health service processes and systems, need to be kept up to date in terms of clinical information and software versions and be applicable to local healthcare needs, as noted by the medicines optimisation committee when developing recommendations on clinical decision support. This means that evidence on specific aspects of clinical decision support may not be readily implemented in existing systems.

An area of interest is multi-compartment medicines systems. Both topic experts and stakeholders raised concerns about observational and anecdotal evidence suggesting that multi-compartment medicines systems may be overused and associated with inappropriate prescribing. Evidence identified in surveillance suggests that these systems may increase adherence, which supports current guidance. Other evidence in this area is insufficient in quantity and quality to establish whether multi-compartment medicines systems are themselves problematic, or if they are a marker of polypharmacy and possible inappropriate prescribing.

The guideline suggests these systems as one of several options to overcome practical problems associated with nonadherence if a specific need is identified. It also notes that any interventions to support adherence should be considered on a case by case basis and should address the concerns and needs of individual patients. Some of the concerns about multi-compartment medicines systems may be a sign of incomplete implementation of recommendations in NICE's guidelines on medicines adherence, medicines optimisation and multimorbidity.