The IMAB-Qi study will design a package to help healthcare professionals use IMAB-Qi in medication reviews. We will then test whether IMAB-Qi helps patients take their medicines as prescribed, and whether it is safe and a good use of NHS money
Background
One in two people don’t take their medicines as prescribed for different reasons. Healthcare professionals in GP surgeries do medication reviews to make sure a patient’s medicines are right for them and support them to take them as prescribed. But patients and healthcare professionals often struggle to find the main reasons for not taking medicines as prescribed. This makes it difficult for them to find the right solutions. Working with patients, healthcare professionals and researchers, we have developed the Identification of Medication Adherence Barriers Questionnaire (IMAB-Q). IMAB-Q has 10 questions for patients to answer before a medication review. Their answers tell the healthcare professional the patient’s main reasons for not taking medicines as prescribed. Each question is linked to solutions that the patient can pick from with help from the healthcare professional when they meet for the medication review. The IMAB-Q combined with linked solutions is called the IMAB-Q intervention (IMAB-Qi).
When people do not take their medicine as prescribed it can become a big problem for individual people and society. It costs the NHS £40 million every year to admit people to hospital and treat health problems which could have been avoided if medicines had been taken properly in the first place. It is thought that in total, it costs the NHS £500 million each year to manage the health problems that occur when people do not take their medicine, and if medicines were taken properly, this cost could be avoided. On top of this, a further £300 million wasted on unused medication.
Project Aims
To develop an implementation package to deliver the IMAB-Qi in medication reviews and test IMAB-Qi’s safety, effectiveness and cost-effectiveness.
Project Activity
- In Work Package 1 we will established the barriers and enablers (determinants) of IMAB-Qi delivery within primary care medication reviews. To do this we tested the IMAB-Qi in five general practices in the UK with pharmacists, doctors and nurses. The testing session was undertaken with professional patient actors. Following the user testing HCP participants attended focus groups to share their experiences of delivering the IMAB-Qi and their perceptions about the barriers and enablers to delivering it in routine practice. This revealed 7 key barriers and enablers to intervention delivery.
- In Work Package 2 we developed an implementation package to address the determinants of IMAB-Qi delivery within medication reviews. Co design workshops were conducted to address the seven prioritised determinants. Co-design panels included patient representatives and a sample of Health Care Professionals and key stakeholders from each GP practice who are likely to be involved in IMAB-Qi implementation. A number of strategies were produced, and then refined and prioritised by the participants. Then, the final sub set of strategies were designed. These will be implemented during the feasibility study to facilitate adoption of the IMAB-Qi intervention in the context of the feasibility trail.
- In Work Package 3 we will test and refine the IMAB-Qi implementation package and trial processes. During WP3 all outcomes collected are to assess ability to set-up and deliver the study, rather than to demonstrate efficacy and effectiveness. This study will 1) evaluate whether or not we can identify and recruit a representative sample of patients with hypertension willing to consent to take part in the study across sites 2) evaluate whether we can collect outcome data including systolic blood pressure from patient participants at relevant time points throughout the study and 3) evaluate whether we can embed IMAB-Qi into primary care patient records and retrieve the data.
- In Work Package 4 we will estimate the safety and effectiveness of the IMAB-Qi delivered in a subset of medication reviews for patients prescribed at least one antihypertensive medicine. This will be conducted in the form of a clinical trial.
- In work package 5 we will estimate the cost-effectiveness of the IMAB-Qi delivered in a subset of medication reviews for patients prescribed at least one antihypertensive medicine.
Anticipated or actual outputs
This study will address the problem that current practice within primary care is sub –optimal in addressing medicines non-adherence.
This study will produce a usable questionnaire (with a user manual and set of learning resources) that can accurately identify patients who are non-adherent with taking their medicines. The study will also produce a set of useable behaviour change techniques that a person can use to help modify their behaviour to be able to take their medicines as they were prescribed. The study will also ensure that the questionnaire and behaviour change interventions can both be adopted by routine general practice in primary care.
Papers 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'
Brown et al, Final Report for the IMAB-Q Study: Validation and Feasibility Testing of a Novel Questionnaire to Identify Barriers to Medication Adherence - Pharmacy Research UK
Who is involved?
- Professor Debi Bhattacharya, University of East Anglia (Co-CI)
- Dr Sion Scott, University of East Anglia (Co-CI)
- Dr Johanna Taylor, University of York (Co-I)
- Professor David Wright, University of Leicester (Co-I)
- Dr Allan Clark, University of East Anglia (Co-I)
- Mr David Turner, University of East Anglia (Co-I)
- Professor Anthony Avery, University of Nottingham (Co-I)
- Mrs Nipa Patel, Ashford and St. Peter's Hospitals NHS Foundation Trust (Co-I)
- Professor Richard McManus, Brighton and Sussex Medical School (Co-I)
- Dr Jacqueline Martin-Kerry, University of East Anglia (Co-I)
- Dr Emma Sutton
- Dr Bethany Atkins
- Dr Caroline Smith
- Ms Claire Sussenbach,
- Maryam Khan
- Lawrence Woollard
- Luke Natali
- Sandra Barker
- Mahomed khatri
Contact
- Professor Debi Bhattacharya, D.Bhattacharya@uea.ac.uk
- Dr Sion Scott, Sion.Scott@uea.ac.uk
