Prescribed medication is by far the most common form of medical treatment. But, with such high rates of non-compliance – overall around 50% (NPC Plus 2007) – many people are not benefiting properly from the medicines they are prescribed. And it’s also such a costly waste for health services. A ‘don’t waste medicines’ campaign was launched recently in the health board area where I live, telling the public that the estimated cost of current waste would be enough to fund the training of 75 nurses, undertake 460 hip replacements or perform 260 heart by-pass operations (Murray 2008). That’s quite a thought.

There are many reasons why people don’t take the medications they are prescribed. The problem of ‘non-compliance’ (or ‘non-adherence’) has been the subject of much research over quite a long time. More recently, however, it has been recognized that non-adherence tends to escalate when patients are taking multiple medications and, of course, the prescription of multiple medications is becoming more and more common as the numbers of people with multiple chronic conditions continues to rise in the context of population ageing.

Research into medication compliance/adherence, however, has focused mainly on single-condition interventions. Improving compliance with multiple medication regimens in the context of co-existing conditions is obviously more complicated and, so far, it is much less well understood. All of this is explained by Williams et al. (2008) in the background to their paper on ‘medication adherence in people with multiple chronic conditions’ that we publish in this issue of JAN (pp. 132–143). Alison Williams, the lead author, is a postdoctoral fellow in the school of nursing at the University of Melbourne in Australia and some of her previous research involving patients with co-morbidities has also been published in JAN (e.g. Williams et al. 2007). The current paper is a systematic review. It was undertaken to find out what evidence is available that might help healthcare professionals, including nurses, to promote medication adherence in people living with multiple chronic conditions.

Like most systematic reviews, or so it seems, the body of past research ends up being pared down to just a small number of studies that are deemed to be both relevant and of adequate scientific quality. Williams et al.’s initial search found 248 seemingly-relevant abstracts from which 97 key papers were assessed and, finally, eight RCTs that examined medication adherence among people with at least three co-existing chronic conditions were selected for their review. Interpreting and comparing even this small group of studies was made difficult by different definitions and measures of ‘adherence’. For the moment, there is, in Williams et al.’s own words (p. 10), ‘minimal evidence to support interventions that improve medication adherence’ in people with multiple chronic conditions.

And so, like many other systematic reviews, the main value of this piece of work is the clear guidance it provides for future research, particularly in the form of well-designed intervention studies. In designing these studies, however, it is absolutely essential that researchers seek ‘user involvement’ because it is the people who are taking (and not taking) their medicines who surely are best placed to help solve the challenging problem of improving medication adherence.


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  2. References
  • Murray P. (2008) A prescription for success. In Connections (The Newspaper for NHS Lothian Staff) May/June, 26, pp. 89.
  • NPC Plus (2007) A competency framework for shared decision-making with patients. Achieving concordance for taking medicines. NPC (National Prescribing Centre) Plus programme for the Department of Health, UK, .
  • Williams A., Dunning T. & Manias E. (2007) Continuity of care and general wellbeing of patients with comorbidities requiring joint replacement: an Australian study. Journal of Advanced Nursing 57(3), 244256.
  • Williams A., Manias E. & Walker R. (2008) Interventions to improve medication adherence in people with multiple chronic conditions: a systematic review. Journal of Advanced Nursing 63(2), 132143.