Using behavioural science to improve effective medication use
Rob Horne, Professor of Behavioural Medicine at University College London School of Pharmacy, leads a research group focused on the psychology of medicines and understanding patient perspectives of treatment. In this series of short videos, he describes how behavioural science can inform consultations in community pharmacies and how behavioural approaches could underpin future developments in practice.
How behavioural factors affect the response to medication
Behavioural factors influence the “the whole issue of how patients engage with treatment and the issue of adherence”, explains Professor Horne. “Our psychology influences how well a pharmacologically active treatment works for us, but also our beliefs influence whether or not we get side effects – and these are some recent findings from our group”, he continues.
“Patients don’t come to the encounter with the pharmacist …. as a blank sheet that we can write the instructions on; they come with pre-existing ideas about the nature of their condition and about pharmaceuticals and whether that medicine is the best thing for them”, says Professor Horne. Understanding “what is in the patient’s head” and finding ways to discuss it can be critical for improving adherence.
Reviving the apothecary role and updating the remuneration model
Published evidence demonstrates the value of behavioural approaches. A case in point is the New Medicine Service (NMS) that was inspired by a study showing how a brief phone call from the pharmacist, designed to address belief barriers and practical difficulties, led to a significant Improvement in adherence.
However, Professor Horne believes that community pharmacists could be embracing a wider role to support the safe and effective use of medicines. They could also play a bigger role a bigger role in prevention of ill health, he says.
“We need to have a remuneration model that is fit for a 21st century public need and a 21st century pharmacy capability. I think I’m probably talking more in the realm of the ‘apothecary role’ than the pharmacist as a person who is limited to safe supply [of medicines]”, he explains. “Just funding pharmacy on the basis of safe supply is, in my view, a missed opportunity for governments and society”, he adds.
Computer-assisted triage to improve consultations
Some additional training may be required to enable community pharmacists to use behavioural approaches to improve outcomes for patients and a computerised triage tool could help to make consultations more efficient.
“We’ve developed digital tools that can triage patients by identifying concerns and doubts about treatment, addressing them not in a way that replaces the pharmacist but can prepare the patient for a discussion with the pharmacist ….. so that the pharmacy interaction becomes more efficient”, Professor Horne explains.
The use of such tools breaks down one of the barriers to constructive discussion between clinician and patient.
Reflecting on his work, Professor Horne says, “I believe that pharmacy is really, really underutilised all across the world – there’s much more that we can do”.