Patients warned about the personal health risks of misusing medicine were almost twice as likely to heed the advice and take and it correctly, a new study has found.

New research from Boots UK, University College London, and Columbia Business School (US) — funded by the Department of Health and Social Care, found that the odds of patients following their medicine guidelines were 1.82 times greater if they were alerted ahead-of-time to the harm they could cause their body if they disregarded instructions.

The study published in the journal of Behavioural Public Policy, took place between July 2015 and March 2016 and used data from more than 12,000 people across 249 pharmacies based in London, UK. Four groups were featured in the study: personal health, no commitment, commitment only, and societal cost.

Participants in the personal health group were given a sticker by the pharmacist detailing the potential harm of medicine misuse when they purchased their medicine. The patients were then asked to sign and date the stickers, and they were encouraged them to put the stickers on their medicine packets. Pharmacists then contacted them between seven and 14 days after the medicine was purchased and asked them four questions to gauge whether they had followed their medicine guidelines or not.

The text on the warning sticker read: “Not taking my medication as prescribed could risk my health. I want to do all I can to improve my health, so I commit to taking this medication exactly as prescribed, or I will speak to my GP or pharmacist if I have a concern.”

The follow-up questions were: “Do you ever forget to take your medication?”, “Are you careless at times about taking your medication?”, “Sometimes if you feel worse when you take the medicine, do you stop taking it?” and “When you feel better do you sometimes stop taking your medicine?” Participants could only answer with a “yes” or “no”.

“Emphasizing to patients the personal costs of not taking their medicines properly appears crucial in motivating them to take their medication.” Said Dr Joe Gladstone, University College London, who co-led the research. “In contrast, telling patients about the financial costs to society, such as saving the NHS money had no benefit. Our research thus offers important new insights to improve patient’s health.”

The researchers felt that highlighting the personal health costs of medicine misuse was particularly important, because prior research suggests that people tend to discount personally unfavourable information.

Alongside the personal health group, there were three comparison groups. The no commitment group was a baseline control group, where participants consented to take part but were given no experimental intervention. In the commitment only condition, patients were given text asking them to commit to take their medication was prescribed. The societal cost group saw patients receive a sticker in their medicine leaflet highlighting the financial loss to the NHS for medication misuse.

The text in the societal cost group read: “The NHS loses £300 million per year from wasted medication. I want to do my bit to support the NHS, so I commit to taking this medication exactly as prescribed, or I will speak to my GP or pharmacist if I have a concern.”

The researchers explained there has been a push by policy makers in the last few years for the cost to the taxpayer of medicine misuse to be featured on the medication packet of leaflet. However, they found the societal warning made a negligible difference. In fact, only patients in the personal health group saw a significant rise in medication adherence out of the three groups compared to the no commitment group.

All participants were aware they were taking part in the study and had an overall average age of 57 years old.

The study was added to a pre-existing program called the New Medicine Service (NMS), a free scheme funded by the National Health Service (NHS) offered to patients in England prescribed a new medication for a long-term condition, like asthma, type 2 diabetes, antiplatelet therapy and hypertension. Patients with one of these conditions were invited to take part in the NMS by their pharmacist when picking up their medication for the first time. If the patient agreed to participate, they received an NMS leaflet, and these were used as the medium for the experimental manipulation in the current study.

In the UK, between 25 and 50 per cent of prescribed medication is not taken as directed. In the USA alone, medication misuse is estimated to cause over 125,000 deaths per year and lead to annual costs of $289 billion.

Read the article ‘Making medications stick: improving medication adherence by highlighting the personal health costs of non-compliance’ published in Behavioural Public Policy

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