Case study: Supporting patients to take their new drugs correctly
Support for patients with new medication
Around 15 million people in England have one or more long-term conditions that are managed with medicines and other treatments. When patients start a newly prescribed medicine to treat a long-term condition, they can access free help and advice from their pharmacist through a scheme called the New Medicine Service (NMS). This scheme has been offered by more than 12,000 pharmacies since 2011 to support people starting their new medication to take the medicine correctly, talk about problems or concerns, and help them avoid unnecessary harm and admission to hospital.
The NMS is available to all patients starting a newly prescribed medication for hypertension, asthma, chronic obstructive pulmonary disease (COPD) or type 2 diabetes, or for those needing an antiplatelet or anticoagulant drug. Evidence has shown that patients’ adherence to a new medication for a long-term condition is formed in the first few weeks, with 15% of patients taking few, if any, doses, and 25% of the medicines being taken incorrectly. The NMS aims to engage patients at an early stage in their treatment, encouraging them to talk about problems and concerns early on, support them in adhering to their medication, and thereby improve their quality of care and reduce avoidable hospital admissions.
The NMS format involves a free, private consultation between a patient and pharmacist to find out about their experiences with their new medication. The meeting is arranged for two weeks after the patient picks up their prescription to discuss any questions or issues, such as side effects. After another two weeks, the patient and pharmacist meet again to see if the issues have been resolved and for further advice. Pharmacies receive a fee of £20-28 from the NHS for the service based on individual monthly targets.
A study funded by the NIHR Policy Research Programme has found that the scheme effectively supports patients with adherence to new medications and delivers better outcomes. The study, published in BMJ Quality & Safety, estimated the scheme has saved the NHS £558 million since it was set up.
Lead researcher from the University of Manchester, Professor Rachel Elliott, said: “NMS is based on our earlier work that shows people really need support when starting a new medicine for a long-term condition.”
Our study showed people are more likely to take their medicine as prescribed if they use the NMS. This means their long-term condition is better controlled, so they feel better and the NHS saves resources on unplanned hospital admissions.
Professor Rachel Elliott, lead researcher, University of Manchester
Evaluating the New Medicine Service
The NIHR-funded research team from the Universities of Manchester and Nottingham, and University College London, developed the study to evaluate whether the NMS was helping more people adhere to their medicine regimen compared with no additional pharmacy support (usual practice). They also wanted to know whether it provided value for money to the NHS.
As part of the study, the team held consultations with patients, pharmacists and prescribers of medication to discuss their thoughts on and use of the NMS. Community pharmacies were well engaged with the investigation because of the involvement of research pharmacists on the study team, Professor Elliott explained. “This is why the NIHR schemes to increase research capacity in health care professions are so important,” she added.
With support from the NIHR Clinical Research Network and NIHR Research Design Service East Midlands, a total of 504 patients from 46 community pharmacies were recruited and randomly allocated to receive advice through the NMS or usual practice.
The researchers found that after 10 weeks, NMS advice resulted in 10% more patients taking their medicines as prescribed. It also helped to reduce visits by patients to their GPs and hospitals, achieving savings of £21 per person, even after the cost of the NMS had been accounted for. As a result, NHS England commissioned the NMS scheme to be made available through approved pharmacies.
In the follow-up study, patients’ adherence to their medication was evaluated again after 26 weeks. This study found that 9% more patients adhered to their medication after NMS advice than with no additional support, indicating an ongoing benefit to patients from their regular medication. These findings have also been published in BMJ Quality & Safety.
Similar to the 10-week results, results from the 26-week study showed that payments from the NHS to community pharmacists for the NMS were absorbed by fewer visits by patients to NHS caregivers, and by reduced costs from wasted medication. The NMS scheme thereby reduced NHS costs by £104 per patient, from reduced ill health and attendance at GP surgeries and hospitals.
Dr Matthew Boyd, co-investigator for the study and Associate Professor in Patient Safety and Pharmacy Practice at the University of Nottingham, said “Since the adoption of the NMS there have been 5,348,000 NMS consultations with patients, with an estimated gain of 320,928 quality-adjusted life years [a measure of quality of life] and a net saving to the NHS of £558 million in long-term costs. Further to these measured outcomes, the opportunities for pharmacists to build greater relationships with their patients are incalculable.”
Prioritising effective use of medicines
Professor Elliott and the study team have shown how the NMS, through community pharmacies, can make a positive difference for people being prescribed new medicines, while alleviating pressure on NHS budgets.
The research findings contributed to the development of The Community Pharmacy Contractual Framework for 2019/20 to 2023/24, which sets out a plan for how community pharmacies will support delivery of the NHS Long Term Plan. The NMS continues within this framework with its own funding. Plans to include further medical conditions within the scheme to benefit more patients are being considered.
It is unusual to have such a clear trail from evidence to policy development, then to further research impacting on national commissioning decisions. This is also one of very few community pharmacy interventions to be so strongly evidence-based.
Professor Rachel Elliott
Making the most effective use of medicines for patients and the NHS is a key priority for pharmacists across the healthcare system, and offering the NMS supports the World Health Organization’s plan for a 50% reduction in the level of avoidable medication-related harm over the next five years.
Dr Boyd went on to say: “The NMS laid the foundation for the commissioning of many new community pharmacy advanced services - including the Community Pharmacist Consultation Service (CPCS) and the Discharge Medicines Service (DMS) - increasing the impact community pharmacy has on the health of our nation.”
Claire Anderson, Chair of the English Pharmacy Board at the Royal Pharmaceutical Society, said: “As medicine experts, pharmacists are well placed to make crucial interventions. The NMS has provided essential support from a pharmacist for those with long-term conditions and who’ve been prescribed a new medicine.
“With the service expanding and pharmacists having recently started the Discharge Medicines Service, we want to see pharmacies receive the necessary funding that will help to ensure that they can continue serving patients and delivering these services.”
The success of the NMS scheme has led to interest from other countries in developing evidence-based primary care services like the NMS, with similar services being trialled or made available in Scotland, Australia, Norway, Ireland and Belgium.