Norman Niven, pharmacist and chief executive of medication support service Paman, reflects on the problem of medication non-adherence and considers the role of electronic monitoring.

The NHS in England spends more than £19 billion per year on medicines, the second largest single expenditure after its workforce.

According to statista, community pharmacies dispensed over a billion prescribed items in England in 2023-24, an average of 20 items for every person.

But pharmacists will know there is a major disconnect between medicines being prescribed and medicines being taken.

Unintentional non-adherence is understandable and is seen mainly in older patients.

However, deliberately not taking medication requires a deeper analysis. Some patients say they have taken meds when they haven’t – part of the wider problem of patients lying to their doctor. This can have far-reaching consequences: alternative drugs could be prescribed; it adds cost, and feeds back false data on efficacy into the system.

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Medicines only work if they are taken. This is a problem that continues to cut across the NHS, pharmacies, and local authorities (as the funding source for the social care sector). It not only adversely affects health outcomes, but is also incredibly expensive.

What size is the problem of medication non-adherence?

A landmark World Health Organization report on adherence estimated that patients did not take between 30 and 50 per cent of medicines prescribed for long-term conditions.

Non-adherence has multiple knock-on effects: health systems are burdened by increased ill health, medicines waste, hospitalisation and emergency admissions.

I would argue that this can be addressed effectively by the judicious application of ubiquitous technology. Interacting with patients during their medication journey is the key.

Pharmacies are the obvious candidate for doing this. A 2023 systematic review of studies into the rate of medication non-adherence and its influencing factors, reported in the Electronic Journal of General Medicine, noted that medication adherence can be improved 'when healthcare providers, physicians, pharmacists and nurses interact more with patients through regular follow-up visits and appointments'.

The most comprehensive of those studies, a major Europe-wide analysis, concluded that ‘electronically monitored adherence feedback is potentially an effective approach to enhancing medication adherence’.

Some form of in-home monitoring capability means patients can be seen to be taking the right meds, on time, every time, and at the right dosage, obviating the need for a carer to visit each and every time.

In 2022, a trial used an audio/video hub to communicate with patients across two local authorities. Adherence rates increased from around 30% to 97%. Both local authorities reported significant cost-savings as a result of not having to send carers, and quality-of-life indices improved.

This could save time and cost for the social care sector, improve health outcomes, and reduce the need for hospital re-admissions for medication-related reasons.

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There is much more that could be done with such a system in place, including issuing reminders for appointments and management of repeat prescription ordering.

Improving patient outcomes together

Newly qualified pharmacists will be able to prescribe from September 2026. This will help alleviate pressure on parts of the NHS and add to the value pharmacies bring to their local communities.

However, community pharmacists do not yet have access to full patient records.

Pharmacies have the opportunity to add medication adherence monitoring to their basket of services. For this to be optimally effective pharmacies need full access to medical records, to see the full extent of the patients’ illness and medication history.

Addressing problems that cut across the NHS, pharmacies and local authorities can improve patient outcomes and help to save money.

Medication non-adherence is one such problem. For councils it means freeing up social care staff; for the NHS it means better health outcomes and reduced demand (fewer re-admissions), and for pharmacies it means an extra revenue-generating service.

The simple act of contacting patients each time their medication is due to be taken, then watching them take it, via a video call, has proved to be transformative in increasing adherence.

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Pharmacies are the prime candidates for supplying this service. But to make this work most effectively, they need to have access to patients’ medical records.

It is incumbent upon all stakeholders to work together to address the non-adherence issue – for everyone’s benefit.

Norman Niven is a pharmacist with 35 years of experience developing products and services to manage patient medicine adherence. He started out by setting up a high street pharmacy in 1984 and has since pioneered innovations in medicine adherence, including the NOMAD system, telmenow.com, MEDICONS and PAMAN. He was also a director and board member of Bupa Healthcare Services for six years.