Healthcare services and health systems all over the world are changing. As an integral part of these health systems, pharmacists, doctors, nurses and other healthcare professionals need to adapt and move forward to meet the needs of both patients and governments.
In our ageing society, evermore patients are facing chronic diseases, often leaving them to rely on more than one medicine to improve their health. Although modern medical treatments are saving lives, an increase in the lack of therapeutic adherence in patients - especially those that are polymedicated - is noticed across the continent. In other words, their behaviour does not correspond with the agreed recommendations or prescriptions of the doctor.
The numbers are clear on this matter. According to the World Health Organisation (WHO), one in two chronic patients in developed countries do not adhere to their medication. At a societal level, these startling figures are having deleterious effects, with an estimated 200,000 premature deaths per year in Europe stemming from medication non-adherence. Of these, approximately 18,000 are registered in Spain alone. The lack of medication adherence also comes at an enormous cost for EU member states, generating €125 billion in excessive healthcare expenses. In the case of Spain, this amounts to €11 billion that could otherwise be spent on frontline care or medical advances.
Pharmacies and healthcare professionals are well aware of these inefficiencies and have designed, developed and launched the Personalised Dose System (PDS), which dispenses medicinal products into pouches which contain the personalised units of medicine that an individual patient needs to take at a particular day and time. This system helps patients with taking their medicine correctly and on time, especially those polymedicated patients who often struggle to follow their treatments rigorously.
At its core, the implementation of an efficient dose dispensing system rests upon good co-operation between the general practitioners who prescribe drugs and the community pharmacists who ensure the medication is provided as prescribed by general practitioners. Community pharmacists are also relying on dose dispensing to reduce discrepancies between patient medication records and home care services, offer guidance for patients’ adherence, and promote disease prevention and health education.
While the personalised dose system is not needed for all patients, its introduction for certain groups should be mandatory. In Spain, the context of an ageing society and increasing cases of medication errors requires the urgent implementation of a dose dispensing system. Up to 80% of the total healthcare expenditure of Spain is devoted to chronic patients, half of whom do not adhere to their medication. In addition, three out of 10 patients stop taking their medication after having starting treatment, and almost half of chronic patients self-regulate their medication.
Although legislation to promote the implementation of dose dispensing is non-existent at a national level, some regional authorities in Spain already back this medical solution.
We at SEFAC believe that many of the problems faced by specific patient groups - chronic, dependent, polymedicated - in their daily lives could be alleviated or solved if pharmacists were more empowered and dose dispensing was put in place across the country, not only at a local level.
Even though dose dispensing is not yet a common practice throughout the EU, it has proven beneficial where it has been used, improving the quality of life of patients, resulting in decreased time dedicated to prescribing and dispensing medication (GPs and community pharmacists), ultimately guaranteeing better medication compliance in patients and a cost-effective clinical impact.
All healthcare providers share the mission of guaranteeing a safe, responsible, effective and efficient use of services, healthcare interventions and medicines, with the ultimate goal of optimising health outcomes. It is particularly worrying that there is no legal framework to support dose dispensing in many EU countries as an effective tool to improve medication safety, together with the pharmaceutical follow up, which could be articulated by reimbursing the pharmacists for the service.
- Dr. Adela Martín Oliveros is an expert and Board representative of Spanish Community Pharmacist Scientific Society (SEFAC).
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