Reporter 456, 9 October 2000

Keep taking the tablets? Maybe not, says reforming pharmacist

Patients receiving prescribed drugs may be at risk of taking too little, too much or the wrong mix of medication – because current practice relies on them reading guidance leaflets that often go straight into the bin.

A survey of NHS patients in Leeds found that one in five claimed never to have seen the explanatory leaflet enclosed with their drugs – and of those who had seen it, eight out of ten did not read it through.

Culture change: Professor Theo Rayner sees the 'doctor's orders' approach to prescription as overdue for a rethink

Professor Theo Raynor, of the School of Healthcare Studies, said the research suggested that the healthcare professions have to rethink their approach to conveying medical information to patients, to make sure that they receive it, see it as relevant and understand how to act on it.

"We spend inordinate amounts developing and testing drugs and working out the best ways to prescribe them. But much less work has been done on what happens after the patient is handed the drug and the accompanying information," he said.

Professor Raynor, appointed to a chair of Pharmacy Practice, Medicines and their Users, is a founder of the pressure group Pecmi – Promoting Excellence in Consumer Medicine Information – which aims ‘to look at medicines issues through the patient’s end of the telescope.’

The new chair has been created to provide a focus for teaching and research in pharmacy practice and medicines use across the health disciplines at the University, building on existing links in the city, notably with the Pharmacy at the Leeds Teaching Hospitals Trust and Leeds Health Authority.

It is believed to be the first such post in the UK, focused not just on pharmacy but all those involved in medicines use including doctors, nurses and patients.

The group has led several successful initiatives to make medicines information provision more user-friendly, introducing British practitioners to models of best practice overseas and bringing together academics, industry bodies, product designers and health service agencies.

A key concept championed by the group is ‘concordance’ – the idea that a fully-informed patient should be a partner in decision-making about prescription.

This runs counter to the traditional idea of ‘compliance’, which reflects the notion of the patient having a duty to ‘follow the doctor’s orders’. The more modern usage, ‘adherence’, still seems to put an onus on the patient to obey, said Professor Raynor.

"Not every professional is signed up to the idea of concordance," he admitted. An attitude survey of newly qualified pharmacists, doctors and nurses, involving Dr Ken Hart of the School of Psychology and medical education unit lecturer Dr Jill Thistlethwaite, found ‘a significant minority’ still sceptical. Some seemed to consider it a form of ‘political correctness’ while others were concerned about the prescribing process becoming more time-consuming.

"The same is true of patients – there are those who would rather have the doctor tell them what to do. But the aim of the new approach is that patients should be as fully involved in their medication as they want to be.

"The proposed medication should be discussed in detail, including possible side-effects, alternative drugs, non-drug treatments and the pros and cons of going without treatment if the patient might get better soon without medical help."

Leaflets supplied in medicine packages are of limited size and cost manufacturers money, so they tend not to include more information than is demanded by European regulations, he added.

By contrast, pharmacies in theUS or Australia will print out comprehensive guides to the drugs dispensed.

Professor Raynor is a former clinical pharmacist and hospital pharmacy manager in Leeds and completed his PhD on medicines information for patients in 1991. He moved to the University in 1995 to head the new division of academic pharmacy practice.

As well as pharmacists, the team includes academics with GP, nursing and health visitor backgrounds. A new programme on prescribing management in primary care was launched this year, with GPs, pharmacists and nurses enrolled.

Research funders include the NHS health technology assessment programme and publications have appeared in the International Journal of Pharmacy Practice, the British Medical Journal and the Annals of Pharmacotherapy.

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