Introduction

Research has consistently shown that patients experience a range of problems with their medicines and a persistent need for further information on their medicines. In addition, it has been noted that nonadherence is a significant problem, in particular for patients with a chronic condition. It is estimated that between 30% and 50% of these patients do not take their medicines as prescribed¹. The literature contains many explanations of why patients are not adhering,² however, we do not have detailed information about when this nonadherence starts.

We aimed to assess patients' problems with new medication for chronic conditions, the information they received and have further need for, their levels of adherence and how these change over time.

Method

A longitudinal survey was conducted, with data collection at 10 days, 4 weeks and 7 months. Participants received a semi-structured telephone interview at each time point and a postal questionnaire immediately after. Patients were recruited when presenting a prescription in one of 23 community pharmacies in South East England. They were eligible if they were starting a new chronic medication and were either 75 years or older or had a chronic condition defined as stroke, coronary heart disease, asthma, diabetes and rheumatoid arthritis. The telephone interview was used to discuss patients' problems and their concerns about their medicines, information received and level of adherence. The postal questionnaire included several scales including one to establish health status and one that measured satisfaction with information about medicines.

Results

252 patients were interviewed at 10 days and 51% (129) reported at least one problem with their new medication. A smaller sample (87) of these patients were interviewed at 7 months and of those still taking their new medicine, 24% (13) still reported having problems. A large proportion of patients reported feeling dissatisfied with information on the side effects of their medication at all three time points. Patients mentioned a substantial and sustained need for further information in all three interviews, 60%, 47% and 47% respectively, which was largely related to the effects and risks of the medication. At all times one in five reported having been nonadherent in the previous week. Patients were twice as nonadherent to their new medication as old ones.

Conclusions

The results of this study have supported previous findings in the literature that patients have problems with their medicines and are dissatisfied with information on their medicines. However, it goes further by providing documentation of how these information needs emerge over time. Patients starting a new chronic medication need help, information and reassurance. A new community pharmacy service may be most advantageous to meet the substantial unmet needs of patients who are newly started on a chronic medication.

References

1. Horne R. Adherence to medication: a review of the existing literature. In Myers and Midence (Eds) Adherence to treatment in medical conditions. Harwood Academic Press, 1998.

2. Dunbar-Jacob J, Erlen JA, Schlenk EA, Ryan CM, Sereika SM, Doswell WM. Adherence in Chronic Disease. Annual review of nursing research 2000; 18:48-90.