The National Institute for Health and Clinical Excellence (NICE) has published new guidance for healthcare professionals aimed at improving support for patients in making decisions about taking the medicines prescribed for them.

Up to 50% of medicines prescribed for long-term conditions are not used correctly and prescribers need to recognise that most patients are non-adherent sometimes, says the guidance. It advises them to routinely access adherence "in a non-judgemental way" whenever they prescribe, dispense and review medicines, and also ensure that “robust” processes are in place for communicating with other professionals involved in the patient’s care.

Patients should be encouraged to engage in a two-way dialogue, so that they are involved in the decision to prescribe and their decision to use the medicine is an informed one, says the guideline. Therefore, healthcare professionals should explain the disease or condition clearly to the patient and how the medicine influences this. They should clarify what the patient expects from treatment and listen to any concerns they may have about it, such as whether it is necessary and what side effects might be possible, and assure them that, should they decide not to take the medicine, support and a follow-up review will be provided.

Other recommendations in the guideline - which applies to all healthcare professionals who prescribe or dispense medicines or who have a role in making decisions about medicines with patients - include that they should: - review the patient’s knowledge, understanding, concerns and view of their need for medicines at agreed intervals, because these may change over time; - adapt their consultation style to the needs of individual patients so that they have the opportunity to be involved in decisions about their medicines at the level they wish; and - establish the most effective way of communicating with each patient, considering for example if the use of pictures, symbols or an interpreter is necessary.

“Many patients feel that if they approach their healthcare professional about failure to take their medicines they will be told off. The reason why they can’t take a particular medicine may be because they can’t open the packaging or their hectic lifestyle may make it difficult to take medicines at the same time each day,” said Alison Bowser, service user representative and a member of the guideline development group. “The good thing about this guidance is that it opens a path to renegotiate how the patient and healthcare professional communicate about medicine. For example, if after receiving information a patient decides not to take medication, their healthcare professional will discuss with them alternative methods to minimise any risk. In the case of a patient with a heart problem, their healthcare professional may concentrate on trying a diet and exercise programme or give them help to stop smoking,” she added.

Consultant physician Dr Sean Kelly, another member of the guideline development group, pointed out that many patients are concerned about becoming dependent on medicines. The guideline encourages healthcare professionals to listen hard to their concerns and encourage them to ask questions, he said.

For pharmacists, the guideline represents “a golden opportunity” to engage in partnership with other healthcare professionals “to help deliver a first-class service for patients,” added group member Dr Mahendra Patel, a pharmacist lecturer and researcher. It recognises potential barriers and needs, which is important among those of black and minority ethnic origin, where heard disease and diabetes is highest in the country and compliance to treatment is poor, said Dr Patel.