Almost every person around the world will at some point in their life take medicines to prevent or treat illness. Medicines have forever altered our ability to live with disease, and generally increase the duration of our lives. However, medicines do sometimes cause serious harm if taken incorrectly, monitored insufficiently,or as a result of an error, accident, or communication problem. In this lecture, we will look at medicine- related problems from the professional and political view. These are the issues of medication safety, non-adherence to medicines, and prioritizing in health care. In the US alone, medication-related errors are estimated to cause a staggering 100,000 deaths and increase healthcare costs by about a $136 billion every year. In the much cited report, To Err is Human: Building a Safer Health System by the Institute of Medicines in the USA, it is stressed that the members of the team are more than the healthcare practitioners. A team includes the practitioners, patients, and technologies used for the care of these patients. Whenever possible, patients should be a part of the care process. This includes attention to their preferences and values, their own knowledge of their condition, and the kinds of treatments including medications they are receiving. Patients can in this way help the healthcare system to develop safety systems and assist in combating the important public health problem of medication errors while also helping themselves. Let's move to another important document that has increased the focus on patient safety and has embraced the importance of the patient perspective on medicines use. This is the Medication Without Harm Document, which is part of the World Health Organization's Third Global Safety Challenge. In this report, it is stated that unsafe medication practices and medication errors are a leading cause of avoidable harm in healthcare systems across the world. In the document, it is declared that to minimize harm is to empower patients, families, and their carers to become actively involved and engaged in treatment or care decisions, ask questions, spot errors, and effectively manage their medications. The document further notes that patients and the public are too often made to be passive recipients of medicines and not informed and empowered to play their part in making the process of medication safer. In this respect, the focus of the WHO is currently on three major challenges in medicines use: those of high risk situations, polypharmacy, and care transitions. High risk situations come about in certain clinical circumstances such as within patients in hospitals as the impact of medication errors is greater there than in ambulatory care. This may be related to the more acute and serious clinical situations in these settings and the use of more complex medications regimes. The patients in these settings are also more vulnerable to suffering dire consequences of medication errors. Polypharmacy is defined in various ways, but centers on the patient using many medications at the same time. Although polypharmacy should be dealt with within the healthcare systems and by professionals, patients can play a vital part if provided with the right information, tools, and resources to make informed decisions about their medicines. Care transitions occur when a patient moves between facilities, sectors, or staff members. This opens up for risk of medication errors. In transitions of care or when having many prescribing doctors patients are valuable and active participant in the process of keeping track of the medicines they use. Another prominent medication-related issue for healthcare and health policy has been the non-adherence to medicines. Adherence is defined in the report, Adherence To Long-term Therapies and Evidence for Action from the World Health Organization as the extent to which a person's behavior taking medication, following a diet, and/or executing lifestyle changes corresponds with their agreed recommendation from a healthcare provider. There are good reasons for the healthcare professionals and healthcare systems to focus on the problem of non-adherence to medicines. About half of all medicines in the developed countries are not being used as prescribed, and the situation is even worse in developing countries due to scarce resources. Not only is this a staggering number, but it has real health implications for patients. As an example, the CODE-2 study,which stands for Cost of Diabetes in Europe Type 2, found that in Europe only 28 percent of patients treated for diabetes achieved good glycaemic control, and that direct costs of complications caused by poor control of diabetes are three to four times higher than those of good control. For the very prevalent condition of hypertension, poor adherence contributes to lack of good blood pressure control in more than two-thirds of people living with hypertension. Also, for the very prevalent and debilitating disease, asthma, it has been estimated that savings by optimal control would be around 45 percent of the total medical costs. It has also been shown that poor adherence to medication among elderly patients with moderate to severe asthma leads to a five percent increase in annual physician visits, and conversely, better adherence leads to a 20 percent decrease in annual hospitalization for these patients. The patient's priority of medicines is another important aspect to consider. It has been shown that patients have vastly different ways of valuing their care and prioritizing what is important to them compared to healthcare professionals. Therefore, the patient's priorities should be included when seeking to improve medicines use in society. Let's now look at how the patient perspective has been used in efforts to improve medicines use. Over recent decades, many terms and synonyms have been used to describe and promote the patient perspective on healthcare, for instance, patient involvement, patient-centeredness, patient engagement, patient empowerment, patient participation, and shared decision-making. These numerous labels make the patient perspective complex to grasp. However, some consensus regarding its meaning exist. Patients are to play an active role rather than a passive one, establishing a partnership between the professionals and the patients. As Dr. Alan Cribb stresses in a report for the Royal Pharmaceutical Society of Britain in 2011, "it is important that patients are being 'worked with' rather than 'worked on' ", or as the UK National Health Service formulates, "no decision about me without me". The patient perspective concept originally set out to focus on the interaction between patients and providers in relation to prescription, decision-making, and the use of medicines. Since, ideas about the patient perspectives have developed to concern not only involvement in one's own medical care, but also patients involvement collectively. Furthermore, a distinction is made between the patient perspective in clinical practice and in health policy. These four approaches to patient perspective: individual, collective, clinical practices, and broader health care policy-making are not isolated and can influence each other. The patient perspective, and thus patients can be incorporated at multiple levels, such as policymaking, research and drug development, and in treatment and management of their own diseases. The patient perspective addresses concerns prominent in today's healthcare. With a focus on using resources wisely, treatment must be effective and concurrently ethical towards all patients. Involving patients in decisions about their own medicines has the potential to increase their understanding, benefit their health outcome, as well as their level of satisfaction, and thereby their quality of care. In addition, involving patients individually or collectively in the development and practice of health services and intervention, it is not only respectful to patients, but makes healthcare relevant and reflects their perspective and their values. Furthermore, allocation of resources is thought to be more cost-effective if patients are involved. The patient perspective of medicines use is particularly important to consider. The use of medicine is the most common intervention in healthcare, and because medicines use operates at the interface between clinical practice and real life. It is well established that medicines are perceived differently by lay people than experts, which leads to differences in what is seen as rational and appropriate use. Medicines are products that the majority of the population does not want, and as pointed out by Charles and Birna and Krska, it is essential for both policymakers and health professionals to recognize and accept that no policy or intervention involving treatments, care, and services will be successful unless the patient perspective is recognized, acknowledged, respected, and understood. Often, though, the viewpoint of experts and that of the patient can be at odds. We hear more about this in Module 3. In the next video, researcher Dr. Sofie Lau will share her findings on patients' experiences with medicines, and talk about the importance for policymakers to understand the patient perspective. Thank you for your attention.
