It might seem patently self-evident, but time critical medication needs to be taken on time. Yet, the reality is that, all too often, it isn’t – and the consequences can be fatal.
An audit conducted by the charity Parkinson’s UK, published in September 2023, found that “58 per cent of people with Parkinson’s disease admitted to hospital in England did not receive their medicines on time every time, with little progress made since 2015”.
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Last month, a report from the Health Services Safety Investigations Body found a patient in a hospital emergency department should have received 18 doses of his Parkinson’s TCM over three days, but seven were not given and three were given late. He died four weeks later.
This situation arose in a hospital with trained medical staff on hand. Now, imagine the increased risks when TCM has to be taken at home, where medication adherence can be as low as 4 per cent, according to an influential report.
Medicine non-adherence, accidental or deliberate, is not new, but research has suggested it has a profound effect on health outcomes, and in terms of scale it costs the UK around £500m.1
If patients at home take the right medication, in the right dose, at the right time, then recovery times would be slashed, healthcare staff and resources would be freed up, and billions would be saved.
It is a seemingly simple problem, yet the solution (if there is just one) has proved elusive.
Could technology provide a solution?
Perhaps – but the fundamental problem is all too human.
If we accept that accidental non-adherence (simply forgetting to take your medicine) is inevitable, then we must examine the causes and impacts of deliberate non-adherence.
So, people are – to use another patently self-evident truth – human; they make mistakes. However, they sometimes also choose to paint a picture that may not necessarily be totally accurate – in short, they venture to deceive.
Digging into non-adherence
In a report from 2013, it emerged that half of the respondents said their non-adherence was due to “perceived lack of symptoms”; a staggering two-thirds said it was fear of side effects, and a quarter also reported that taking their meds didn’t fit with their daily lifestyle.
According to the same report, up to 50 per cent of medicines in England are not taken as intended, and up to half a billion pounds could be saved if adherence was improved in five key categories – asthma, type 2 diabetes, high cholesterol/coronary heart disease, hypertension, and schizophrenia.
Finding a solution to non-adherence could be a game changer for our healthcare system.
Remote possibility
I have been qualified as a pharmacist for more than 40 years and have dedicated my career to studying and designing solutions for non-adherence.
I believe the key is simply to watch patients taking the right medication, in the right dose, at the right time.
We have created an internet-based medicine administration monitoring service, staffed by registered pharmacy technicians who literally witness medication being taken.
It is the only guaranteed way to ensure adherence; everything else, even relying on carers or health visitors, is open to abuse.
PAMAN is based on having an audio-video device (Medihub) in patients’ homes, via which staff talk to patients and record them taking their medication.
Knowsley Council, which has been operating the PAMAN service for the past four years, made net savings of more than £1.6m providing the service for 100 patients.2
Liverpool City Council made savings of more than £400,000 in just one year, based on 100 patients.3
In both cases, the figures obtained by the PAMAN team show adherence levels rose from around 30 per cent to more than 97 per cent, resulting in fewer hospitalisations, fewer readmissions, and less wastage.
The system is so successful because a qualified pharmacy technician has “eyes on” the patient throughout the process.
A compound problem – non-adherence of TCMs costs lives
The issues surrounding non-adherence become increasingly serious for TCMs, which work by having a defined gap between administrations to maintain dosages.
If not taken at prescribed times, the clinical conditions that the medicines have been developed to manage will deteriorate.
The consequences, as we have seen, can be fatal.
The challenges in hospitals and care homes may require institutional change, but the simple application of technology can play a significant part in improving adherence at home.
PAMAN has a raft of fail-safes dedicated to managing the administration of TCMs, built around recognised clinical processes.
To find out more about improving patient outcomes while saving money, visit our website.
References
1. Michael Medley 2017
2. David Tyrrell, head of assistive technology, Knowsley Borough council 2024
3. A Wiliams, Liverpool City Council, adult social care department 2022
