IMAB-Qi: Improving Medication Adherence in General Practice: Developing and Testing a Support Package

Why is the research needed?

Around one in two people do not take their medicines as prescribed, for a range of reasons. Healthcare professionals in GP surgeries carry out medication reviews to ensure that a patient’s medicines are appropriate and to support them in taking them correctly. However, both patients and healthcare professionals often struggle to identify the underlying reasons for non-adherence, making it difficult to find effective solutions.

When medicines are not taken as prescribed, this can have serious consequences for individuals and for society. It is estimated that the NHS spends around £40 million each year on hospital admissions and treatments for health problems that could have been prevented through proper medication use. Overall, managing the consequences of non-adherence costs the NHS approximately £500 million annually, costs that could largely be avoided if medicines were taken as intended. In addition, a further £300 million is lost each year due to unused medication.

What are we doing?

The IMAB‑Qi study is developing a practical approach to support healthcare professionals during medication reviews, with the aim of helping patients take their medicines as prescribed. We will also evaluate whether this approach is safe, effective, and represents good value for money for the NHS.

At the centre of the study is the Identification of Medication Adherence Barriers Questionnaire (IMAB‑Q), developed with patients, healthcare professionals, and researchers. This short, 10‑question tool helps patients identify their main reasons for not taking medicines as prescribed before their review. Their responses are then linked to tailored solutions, which are discussed with a healthcare professional during the consultation. Together, these form the IMAB‑Qi intervention.

To support its use in practice, we first identified key barriers and enablers by testing IMAB‑Qi in five GP practices with pharmacists, doctors, and nurses, followed by focus groups. This informed the co-design of an implementation package with patients, healthcare professionals, and stakeholders, resulting in a set of practical strategies to support delivery.

We will now refine and test this approach through a feasibility study, focusing on recruitment, data collection, and integration into primary care systems. Finally, we will evaluate the safety, effectiveness, and cost-effectiveness of IMAB‑Qi in a clinical trial involving patients prescribed antihypertensive medication.

How are we working with communities, services and organisations?

We are working with patients and healthcare professionals in primary care to develop the research. By working directly with people who will be using IMAB-Qi we can boost the chances of it being successfully used routinely in medication reviews.

What will the impact and benefits of this research be?

This study will address the problem that current practice within primary care is suboptimal in tackling medicines non-adherence.

We will produce a practical questionnaire, alongside a user manual and learning resources, to accurately identify patients who are not taking their medicines as prescribed. We will also develop a set of behavioural change techniques to support people in modifying their behaviour and improving adherence. In addition, we will ensure that both the questionnaire and the behavioural interventions can be successfully adopted within routine general practice.

What do we have planned for knowledge mobilisation and implementation?

We will use the learning from the implementation and delivery of IMAB-Qi and any contextual factors that influence this. If IMAB-Qi is shown to be both effective and cost-effective, we will then look to roll out the intervention nationally. To do this, we will collaborate with key stakeholders to integrate knowledge and plan how IMAB-Qi could be used more widely in primary care.

Related papers, outputs and resources

Read the paper titled ‘Barriers to medication adherence in patients prescribed medicines for the prevention of cardiovascular disease: a conceptual framework'

Read the paper titled ‘Validation of the Identification of Medication Adherence Barriers Questionnaire (IMAB-Q); a Behavioural Science-Underpinned Tool for Identifying Non-Adherence and Diagnosing an Individual's Barriers to Adherence’

Read the final report for the IMAB-Qi study ‘Validation and Feasibility Testing of a Novel Questionnaire to Identify Barriers to Medication Adherence’

Who is involved? 

• Co-Chief Investigator: Professor Debi Bhattacharya, University of East Anglia (UEA)
• Co-Chief Investigator: Dr Sion Scott, University of East Anglia (UEA)
• Co-Chief Investigator: Dr Jackie Martin-Kerry, University of East Anglia (UEA)
• Co-Chief Investigator: Professor Richard McManus, Brighton and Sussex Medical School
• Co-Chief Investigator: Mr David Turner, University of East Anglia (UEA)
• Co-Chief Investigator: Professor David Wright, University of Leicester (UEA)
• Co-Chief Investigator: Professor Anthony Avery, University of Nottingham
• Co-Chief Investigator: Dr Allan Clark, University of East Anglia (UEA)
• Co-Chief Investigator: Mrs Nipa Patel, Ashford and St. Peter's Hospitals NHS Foundation Trust
• Patient and Public Involvement Lead: Laurence Woollard, University of East Anglia (UEA)
• Implementation Lead: Luke Natali, Health Innovation East 
• Trial Assistant: Rachel Gillings, University of East Anglia (UEA)
• Trial Coordinator: Lindsey Tashlin, University of East Anglia (UEA)
• Dr Bethany Atkins, University of East Anglia (Senior Research Associate)
• Sandra Barker, Patient and Public Representative
• Dr Lucy Clark, University of East Anglia (UEA)
• Maryam Khan, University of East Anglia (UEA)
• Mahomed Khatri, Patient and Public Representative
• Charmaine Rowe, Patient and Public Representative
• Dr Caroline Smith, University of East Anglia (UEA)
• Ms Claire Sussenbach, University of East Anglia (UEA)
• Dr Emma Sutton, University of East Anglia (UEA)
• Dr Johanna Taylor, University of York (UEA)

Get in contact

Email the project team at imabqi@uea.ac.uk.