Why is taking medicines as prescribed important?
For many people living with long-term conditions such as high blood pressure, diabetes and asthma, prescribed medicines can help them live well, remain independent and avoid serious future health problems. Despite this, around one in two people do not take their medicines as prescribed.
When people don’t take their medicines as prescribed, it is called medication non-adherence. This can reduce the benefits of treatment and increase the risk of health problems. Healthcare professionals (HCPs) often want to help, but understanding why someone is non-adherent is difficult because the reasons vary from person to person. People don’t always know what is stopping them from taking their medicines as prescribed, and some may feel uncomfortable discussing it with HCPs.
What has already been done to help people take their medicines
Over the past twenty years, HCPs and researchers have developed a range of approaches to support people to take their medicines as prescribed. These include medicine organisers, reminder systems and digital tools. While these approaches can be helpful for some people, they do not work for everyone. Support is more likely to help when it matches the reason a person is not taking their medicines as prescribed. For example, a reminder system is only likely to help if forgetfulness is part of the problem. If something else is getting in the way, a different type of support may be needed.
This highlighted the need for a different approach. Rather than offering the same support to everyone, we wanted to help HCPs understand what is stopping a particular person from taking their medicines as prescribed and identify support that is more likely to help. This led to the development of IMAB-Qi (Identification of Medication Adherence Barriers Questionnaire intervention).
A new approach called Identification of Medication Adherence Barriers-Questionnaire intervention (IMAB-Qi)
IMAB-Qi has two parts. The first is IMAB-Q which is a questionnaire containing ten statements designed to identify a person’s barriers to taking medicines as prescribed. The statements were developed through discussions with people prescribed long-term medicines and HCPs who support them. The questionnaire was then tested with over 600 people and shown to correctly diagnose a person’s barriers to adherence.
The second part is the “i” in IMAB-Qi. Once a person’s barriers have been identified, IMAB-Qi links them to a range of evidence-based support options. Patients and HCPs can then discuss these options together during a medication review and pick the support that is more likely to help that individual. These support options were developed with input from people with lived experience of taking medicines and HCPs who prescribe them. This helped ensure that IMAB-Qi is both evidence-based and practical to use in everyday healthcare settings.
“As someone with a visual impairment, taking medicines isn't always as simple as people think. Reading labels, distinguishing between different tablets and managing multiple medicines can be challenging. What I like about IMAB-Qi is that it helps HCPs understand the individual barriers people face, rather than assuming everyone's difficulties are the same.”
Mahomed, IMAB-Qi PPI member
Making IMAB-Qi work in everyday practice
Mahomed's experience highlights why support needs to be tailored to the individual. We worked with people who take medicines and HCPs to make sure the full IMAB-Qi approach could be used successfully in routine medication reviews. Their feedback helped us understand what would be needed for HCPs to use IMAB-Qi consistently in practice. This led to the development of training and support resources for HCPs.
Why are we carrying out a feasibility study?
Before testing whether IMAB-Qi improves outcomes for patients, we first need to understand whether it can be used successfully in routine healthcare settings. This is achieved by doing something called as a feasibility study.
The IMAB-Qi feasibility study will explore how patients and HCPs use IMAB-Qi during medication reviews and whether the approach fits well within everyday practice. We will also get feedback about their experiences of using IMAB-Qi so we can work out whether any changes are needed before moving on to a larger study.
If IMAB-Qi proves feasible to deliver, the findings will help us plan a larger study to assess whether helping HCPs identify an individual's barriers and match support to those barriers can improve medicine-taking and health outcomes.
We hope this work will contribute to a future where medication reviews move beyond offering the same support to everyone and instead provide support that is tailored to what each person needs.