Policy recommendations for improved medication adherence in Europe:  the ABC Project results. Professor  Przemyslaw Kardas...
Examination Diagnosis Prescription Adherence 2
...keep watch also on the faults of the patients,  which often make them lie about the taking of things prescribed ... Hip...
1   Jackevicius CA et al., Circulation. 2008;117:1028 –1036. 2   WHO Report, 2003 50% are non-adherent 2 25% 1 4
Vrijens B et al. BMJ 2008;336:1114-1117 6
Patient with late initiation but good execution Patient with suboptimal execution Patient with excellent execution but sho...
Simpson SH.  BMJ. 2006; 333(7557): 15.
Roebuck MC, et al. Health Aff (Millwood). 2011 ;30(1):91-9.   9
Roebuck MC, et al. Health Aff (Millwood). 2011 ;30(1):91-9.   10
11 Aim: to produce  evidence-based  policy recommendations  for European policymakers  for improved patient adherence and ...
12 <ul><li>Determinants  of adherence </li></ul><ul><li>Consensus terminology  allowing for effective benchmarking of inte...
<ul><li>Defining the problem </li></ul><ul><li>Any initiatives in respect to patient adherence to medications   should add...
<ul><li>A sound basis for intervention development </li></ul><ul><li>Interventions aimed at improving adherence must ackno...
<ul><li>Interventions to enhance adherence to medications </li></ul><ul><li>Interventions intended to manage adherence sho...
<ul><li>Implementation </li></ul><ul><li>The principles and practice of management of adherence should be included in curr...
<ul><li>ABC Project recommendations will help bridging the gap between science and practice in the field of patient adhere...
www. ABCproject .eu
<ul><li>Through mixed methods research, the ABC project team have shortlisted a number of policy recommendations which, if...
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Policy recommendations for improved medication adherence in Europe: the ABC Project results.

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GRF One Health Summit 2012, Davos: Presentation by Przemyslaw KARDAS, Medical University of Lodz, Poland, Republic of

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  • This section of t he presentation describes work to meet the overall aim of the ABC project, to develop policy recommendations for Europe to address and support medicines use by patients. Target of recommendations: Europe – European, national and local level Stakeholders – diverse group – policymakers, healthcare payers, healthcare providers, patients and carers, healthcare professionals, pharma, clinicians ABC sought to develop recommendations which have consensus across these groups. Broad wide task, broad wide recommendations: need to be broad so that adaptable and flexible for the divers nations of Europe with diverse healthcare systems, varying levels of sophistication and levels of response to the issue of medicines adherence. In developing these recommendations we hope also to be able to share good practice and examples of ‘what works’. Avoid reinventing the wheel, whilst appreciating that what matters and works works for one nation or one health condition won’t necessarily be wanted, needed or appropriate in another setting.
  • This section of t he presentation describes work to meet the overall aim of the ABC project, to develop policy recommendations for Europe to address and support medicines use by patients. Target of recommendations: Europe – European, national and local level Stakeholders – diverse group – policymakers, healthcare payers, healthcare providers, patients and carers, healthcare professionals, pharma, clinicians ABC sought to develop recommendations which have consensus across these groups. Broad wide task, broad wide recommendations: need to be broad so that adaptable and flexible for the divers nations of Europe with diverse healthcare systems, varying levels of sophistication and levels of response to the issue of medicines adherence. In developing these recommendations we hope also to be able to share good practice and examples of ‘what works’. Avoid reinventing the wheel, whilst appreciating that what matters and works works for one nation or one health condition won’t necessarily be wanted, needed or appropriate in another setting.
  • This section of t he presentation describes work to meet the overall aim of the ABC project, to develop policy recommendations for Europe to address and support medicines use by patients. Target of recommendations: Europe – European, national and local level Stakeholders – diverse group – policymakers, healthcare payers, healthcare providers, patients and carers, healthcare professionals, pharma, clinicians ABC sought to develop recommendations which have consensus across these groups. Broad wide task, broad wide recommendations: need to be broad so that adaptable and flexible for the divers nations of Europe with diverse healthcare systems, varying levels of sophistication and levels of response to the issue of medicines adherence. In developing these recommendations we hope also to be able to share good practice and examples of ‘what works’. Avoid reinventing the wheel, whilst appreciating that what matters and works works for one nation or one health condition won’t necessarily be wanted, needed or appropriate in another setting.
  • Fig 2 Time course of adherence/compliance parameters (execution, persistence) ‏
  • Policy recommendations for improved medication adherence in Europe: the ABC Project results.

    1. 1. Policy recommendations for improved medication adherence in Europe: the ABC Project results. Professor Przemyslaw Kardas Przemyslaw Kardas 1 , Wendy Clyne 2 , Simon White 2 , S McLachlan 2 , Dyfrig Hughes 3 , Emily Fargher 3 , Val Morrison 3 , Catrin Plumpton 3 , Bernard Vrijens 4 , John Urquhart 4 , Jenny Demonceau 4 , Fabienne Dobbels 5 , Tod Ruppar 5 , Kaat Siebens 5 , Sofie Vandenbroeck 5 , Sabina de Geest 5 , Pawel Lewek 1 , Michal Matyjaszczyk 1 1 Medical University of Lodz, Poland , 2 NPC Plus, Keele University, UK , 3 Bangor University, UK , 4 Aardex group , 5 K.U. Leuven, Belgium
    2. 2. Examination Diagnosis Prescription Adherence 2
    3. 3. ...keep watch also on the faults of the patients, which often make them lie about the taking of things prescribed ... Hippocrates, V - IV century BC 3
    4. 4. 1 Jackevicius CA et al., Circulation. 2008;117:1028 –1036. 2 WHO Report, 2003 50% are non-adherent 2 25% 1 4
    5. 5. Vrijens B et al. BMJ 2008;336:1114-1117 6
    6. 6. Patient with late initiation but good execution Patient with suboptimal execution Patient with excellent execution but short persistence (early discontinuation) 5 www.iAdherence.org
    7. 7. Simpson SH. BMJ. 2006; 333(7557): 15.
    8. 8. Roebuck MC, et al. Health Aff (Millwood). 2011 ;30(1):91-9. 9
    9. 9. Roebuck MC, et al. Health Aff (Millwood). 2011 ;30(1):91-9. 10
    10. 10. 11 Aim: to produce evidence-based policy recommendations for European policymakers for improved patient adherence and subsequent better use of medication, in order to obtain safer , more effective and cost-effective use of medicines in Europe Duration: Jan 2009 - Dec 2011 Budget: ~ 2 ’ 750 ’000 €
    11. 11. 12 <ul><li>Determinants of adherence </li></ul><ul><li>Consensus terminology allowing for effective benchmarking of interventions </li></ul><ul><li>Assessment of adherence-enhancing interventions in terms of their effectiveness and cost-effectiveness </li></ul><ul><li>Assessment of current practices of adherence management by healthcare workers </li></ul><ul><li>Assessment of industry involvement </li></ul><ul><li>Model curriculum for medical schools </li></ul><ul><li>Policy recommendations for European policymakers </li></ul>
    12. 12. <ul><li>Defining the problem </li></ul><ul><li>Any initiatives in respect to patient adherence to medications should address its 3 distinct elements: </li></ul><ul><li>i nitiation, implementation, discontinuation </li></ul>
    13. 13. <ul><li>A sound basis for intervention development </li></ul><ul><li>Interventions aimed at improving adherence must acknowledge the complex nature of non-adherent behaviour and be adopted at different levels of the healthcare system, that is patient level, provider level ( micro), organization (meso) and health care system (macro) </li></ul><ul><li>Interventions are more likely to promote a sustainable behaviour change if based on a consolidation of behavioural models across disciplines </li></ul><ul><li>Key targets for intervention include: </li></ul><ul><ul><li>improvement in self-efficacy </li></ul></ul><ul><ul><li>reducing barriers to medication </li></ul></ul><ul><li>Patients' preferences for the benefits, harms and convenience of medicines, influence their decision to continue taking a medicine and should be considered when developing new medicines, formulations or interventions </li></ul><ul><li>Determinants of non-adherence also differ by country </li></ul>
    14. 14. <ul><li>Interventions to enhance adherence to medications </li></ul><ul><li>Interventions intended to manage adherence should include, beside education, motivation and performance - based feedback to achieve measurable, pharmacologically sound goals </li></ul><ul><li>Management of adherence derives benefit from a 'system-based' approach, wherein each stakeholder has a specific role to play: </li></ul><ul><ul><ul><li>the patient, their family & relatives, healthcare providers, institutions, and healthcare systems </li></ul></ul></ul><ul><li>The effects of interventions wane over time, calling for innovative approaches to achieve sustainable management, validated by long-term program evaluation </li></ul><ul><li>Management of adherence in patients co-prescribed multiple medicines for chronic and acute conditions may require different approaches </li></ul>
    15. 15. <ul><li>Implementation </li></ul><ul><li>The principles and practice of management of adherence should be included in curricula for all healthcare professionals, but primarily doctors, nurses, and pharmacists </li></ul><ul><li>Educational framework requires 3 components: </li></ul><ul><ul><li>Competency framework, curriculum, diagnostic tool for assessing adherence, and practice based training modules </li></ul></ul><ul><li>Specific, evidence-based practice guidelines are needed </li></ul><ul><li>More evidence on the cost-effectiveness of adherence-enhancing interventions is necessary to inform policy </li></ul><ul><li>implementation </li></ul><ul><li>In order to help further benchmarking of both research, and interventions aimed at non-adherence, the use of uniform consensus terminology, and high quality scientific methodology is strongly advocated </li></ul>
    16. 16. <ul><li>ABC Project recommendations will help bridging the gap between science and practice in the field of patient adherence to medication. </li></ul><ul><li>Particularly, these recommendations will inform decision-makers, practitioners and experts from politics, government, IGOs, business, science, NGOs, media and the public on the effective and cost-effective strategies for improved patient adherence. </li></ul>
    17. 17. www. ABCproject .eu
    18. 18. <ul><li>Through mixed methods research, the ABC project team have shortlisted a number of policy recommendations which, if implemented, could </li></ul><ul><ul><li>improve patients’ </li></ul></ul><ul><ul><li>adherence to medications </li></ul></ul><ul><ul><li>in Europe </li></ul></ul>

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