How to manage your medications at home

Medications can be helpful and even life-saving for many. Yet research shows that a large proportion of people are not taking them correctly. This is resulting in unnecessary side effects, adverse interactions with other medications and reduced health outcomes.

What the studies say

The Department of Health estimates that non-adherence to medication adds a massive £930m per year to healthcare costs in England. And a US study published in 2018 indicated that up to 50% of patients were not taking their medications as recommended.

"It's a huge problem," says Dr Ahmed Khan, General Practitioner at Roodlane Medical, part of HCA Healthcare UK. "It's bad for patients because it means their symptoms aren't controlled as well as they could be; it's a problem for clinicians because they can't judge whether a medication is working properly; and it's bad for the NHS in terms of waste, and the cost of follow-up appointments due to health conditions not being properly controlled."

A review of global medical adherence studies in 2015 concluded that non-adherence is a problem regardless of the type of drug, or whether the therapy is short-term or ongoing. It also indicates that multiple factors are involved in whether or not people take medications correctly.

Why aren't people taking their medications correctly?

Anshu Kaura, a pharmacist at a LloydsPharmacy in Buckinghamshire, suggests the main factors in medication non-adherence are:

• Someone's feelings and values towards the medicine, or their condition, and their understanding of their condition.
• Any medication issues such as side effects, cost if they have to pay for prescriptions, and the length of time to take effect.
• Culture, media, religious beliefs and misconceptions about medications.
• Illness, dexterity, ability to swallow, and memory.

These reasons were confirmed by a study in 2020 into why older people find it difficult to manage their medications effectively. The research also indicated there is need for medication self-management observation, monitoring, and assistance by healthcare professionals.

"Adherence starts from the consultation with the prescriber," says Kaura. Though with NHS GPs under pressure to keep patient consultations to 10 minutes, adequate communication is often a challenge.

Quick tips

If you're struggling to remember to take your medications or you find yourself caught short because you've forgotten to get another prescription, try out some of these tips to get the most out of your medication.

• Set up written reminders or electronic alarms for when to take your medication and when a repeat prescription will be due. For example, you could put sticky notes on your bathroom mirror or fridge, or an alert on your mobile phone.
• Incorporate taking medications into your daily routine - for example, after cleaning your teeth or with breakfast.
• Keep medicines in their original packaging (use pill boxes with caution). "Weekly pill box organisers might seem like the answer to sort out your meds,” says Sandra Gidley, president of the Royal Pharmaceutical Society and locum pharmacist. "But they're not always child-proof and it's not ideal to have medications around that aren't clearly labelled." In addition, some medicines cannot be left out of their original packaging for any length of time. It is worth pointing out, however, that if you take multiple medications, pill boxes can help you keep track of your medicines, as long as you take precautions.
• Could you benefit from blister packs? If you struggle with taking your medication regularly, your pharmacist may be able to pack your medication into blister packs. These are similar to pill boxes but keep all the medicines for a single dose in a sealed blister. Speak to your pharmacist - if they think this could help, they'll need to speak to your GP about getting weekly prescriptions set up.
• Prepare for repeat prescription requests. "Keep medications together in a cupboard so you can see them all stacked individually in boxes," advises Khan. "Then you can see when one is running low and you need to order more."
• Only use one pharmacist to ensure your repeat prescription is up to date and you are not taking duplicate medications dispensed by different chemists.
• Follow prescribing directions. Never crush pills, open capsules, or change or stop taking your medication without getting advice for your doctor or pharmacist.
• Write down what each medication is for and learn about why it's important to take. Ensure you have a list of the medications you are on and that a friend or family member has the list in case of emergency (your repeat prescription form will list these).
• If you notice any side effects, contact your pharmacist for advice. Do not suddenly stop a medication without checking first.
• Be prepared for emergencies or running out of medication.
• Ensure medicines are stored correctly and check expiry dates.
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Your medication toolkit

Research indicates that various tools can help with medication adherence, though the National Institute for Health and Care Excellence (NICE) does not endorse any particular intervention and suggests further evaluation is needed.

Alexa

"If you've got an Alexa at home you can set it to remind you when to take your medications," says Gidley. "A lot of people are using it now for this purpose, and because it is based on voice commands and reminders it's easy for elderly people to use once it's set up."

Apps and habit trackers

If you live in Scotland, you could try downloading the Scottish Government's free Managing Multiple Medicines app to your mobile phone or tablet. Or if you live in a different region, try accessing one of the many 'habit trackers' or 'manage my meds' apps available online.

"Habit trackers can also be purchased as paper journals if you prefer to use a more traditional method of tracking your medications," adds Gidley. "Some people like to have a list to tick off manually so they know they've taken the medicine - keep it with your medications."

Patient Access

If you're a Patient Access user and you have linked your account with your GP practice, you will be able to see your medications and order repeat prescriptions online. If your nominated pharmacy is a Smart Pharmacy (currently only available in some areas), you will be able to track your medication as it is processed by the pharmacy and made available for pick up or delivery.

Medication Assistant is another new feature which, when enabled, will send you information to help you manage your medication more effectively. It can send you content and notifications tailored to the medication you're currently taking. Having a better understanding of your medications can help you to get the most out of them.

Smart bottles

'Smart bottles' have a cap with an LCD clock that counts the hours and minutes since the cap was last twisted on to the bottle. This indicates when the medication was last taken and is particularly useful for pain medication where there may be a risk of overdose. Smart bottles can also remind the user to take the medication via lights on the bottle. And they can send a message to a designated caregiver if a dose is missed. Each use of the bottle is recorded, so there is a log kept of when the medication was taken. You can buy smart bottles online and from larger pharmacies.

Help from your pharmacist and GP

Share your concerns

"People often don't want to bother their doctor again after their appointment, but you're not wasting their time, you're helping in the long run by getting the info you need to take your medication properly," says Khan.

Gidley adds that it is crucial to be honest with your pharmacist and clinician about whether or not you're taking your medication and any issues you're having.

"Your pharmacist will have lots of little practical ideas that could help you fit your medications in better with your daily routine and your diet," she explains. "Timing of doses, how to take medicines around food or alcohol, reminders and so on are all things we can help with. And if you're having side effects we can often give tips on how to reduce them or find an alternative medication that might suit you better."

Extra help for vulnerable patients

Some local health authorities offer cognitive behavioural therapy to patients who are struggling to take their medications. Others will print medication labels in extra large print for people who are sight-impaired.

"Medication administration record sheets, known as MAR charts, can be provided for free, to allow patients or carers to tick off when doses are taken," advises Kaura. "And we are also able to make up medicines in compliance aids such as pill boxes or blister packs for free if appropriate. This can be useful for elderly patients, with or without carers, to aid adherence to medication as it can help with memory concerns."

Review your medications

"Everyone on medication should be having an annual medicine use review," says Khan, "though some people require a shorter interval so it's worth checking with your doctor. There's a lot of catch up happening as a result of the pandemic, so things like reviews have slipped; make sure you ask for one if your GP practice doesn't call you, or check with your pharmacist."

As well as GPs, pharmacists offer medicine use reviews. As experts in medications, they can give you the same service to explain your medications and check that they're working, often at a more convenient time and location for you.

Khan suggests patients read the World Health Organization's (WHO) 5 moments for medication safety to ensure they are taking medications as they should and to manage ongoing adherence at home. The WHO pointers may be useful to discuss with your clinician.

"We can check that your medication is working for you and your lifestyle," says Kaura, "and advise on what to do if you're finding it hard to take your medications. For example, perhaps you could switch to liquid alternatives rather than tablets if you're having problems swallowing."

Get to know new medications

The NHS New Medicines Service ensures you have regular contact with a healthcare professional during the early days of starting a new medication, addressing any causes of concern early on. If patients are started on medicines with enough information and support, it is hoped they will be better able to manage medications at home.

When a patient is discharged from hospital with medication changes, their local pharmacist can offer support through discharge medicines services.

"There is lots of evidence to show that these post-discharge reviews have saved hospital re-admissions in areas where they have been formalised," explains Gidley. "When you come out of hospital it's a time when things can trip up around medications as you move back into GP care. To prevent any confusion around new medication, chat with your pharmacist to make sure everything is ordered.”

For further information and advice about managing medications, speak to your local pharmacist, GP or practice nurse.