Patient and carer experience of obtaining regular prescribed medication for chronic disease in the English National Health Service: a qualitative study

Abstract

BackgroundThe increasing burden of chronic disease is recognised globally. Within the English National Health Service, patients with chronic disease comprise of half of all consultations in primary care, and 70% of inpatient bed days. The cost of prescribing long-term medications for those with physical chronic diseases is rising and there is a drive to reduce medicine wastage and costs. While current policies in England are focused on the latter, there has been little previous research on patient experience of ordering and obtaining regular medication for their chronic disease. This paper presents findings from England of a qualitative study and survey of patients and their carers’ experiences of community and primary care based services for physical chronic diseases. Although not the primary focus of the study, the results highlighted particular issues around service delivery of repeat prescriptions.MethodsWe conducted 21 qualitative in-depth interviews with 30 patients and family carers’ in two Primary Care Trusts in England. Participants were receiving community based care for diabetes, respiratory, neurological or complex co-morbidities, and ranged in age from 39–92 years old. We used a broadly inductive approach to enable themes around patient experience to emerge from the data.ResultsWhile the study sought to gain an overview of patient experience, the findings suggested that the processes associated with ordering and obtaining regular medication – the repeat prescription, was most frequently described as a recurring hassle of managing a long-term condition. Issues for patients and carers included multiple journeys to the surgery and pharmacy, lack of synchrony and dissatisfaction with the length of prescriptions.ConclusionMuch literature exists around medication waste and cost, which led to encouragement from the NHS in England to reduce dosage units to a 28-day supply. While there has been an acknowledgement that longer supplies may be suitable for people with stable chronic conditions, it appears that there is limited evidence on the impact of shorter length prescriptions on patient and carer experience, adherence and health outcomes. Recent policy documents within England also fail to address possible links between patient experience, adherence and flaws within repeat prescription service delivery.

A review of the literature and proposed classification on e-prescribing: Functions, assimilation stages, benefits, concerns, and risks

“…57 The literature shows that patients who have their prescriptions linked directly to a pharmacy experienced greater convenience in obtaining repeat prescriptions compared to those who submit an initial request before collecting their medications per prescription. 58 One of the most cited benefits of e-prescribing systems for patients in the UK is the Prescription Prepayment Certificate (PPC) electronic service. 11 This e-service provides patients with a certificate that enables them to acquire medication at a reduced cost by letting them pay the medication cost annually or quarterly.…”

Person-centred medicines optimisation policy in England: an agenda for research on polypharmacy

“…This includes sensitivity to the language used by patients and carers to describe what they regard as good quality care that meets their needs and priorities, which is not always the same as that used by services or in policy. An article on patients' and carers' experiences of obtaining repeat prescriptions provides an example of this approach (Wilson, Kataria and McNeilly 2013).…”

Clinical effectiveness and cost-effectiveness of issuing longer versus shorter duration (3-month vs. 28-day) prescriptions in patients with chronic conditions: systematic review and economic modelling

“…The most common reasons cited for being dissatisfied were the inconvenience of having to pick up the prescription/ tablets more frequently, as it interferes with the working day. 23 A qualitative study 61 that investigated patients with chronic conditions' experiences of repeat prescriptions in the NHS found that patients often described shorter prescriptions as a hassle. 61 Respondents reported that managing a repeat prescription was a time-consuming task.…”

“…23 A qualitative study 61 that investigated patients with chronic conditions' experiences of repeat prescriptions in the NHS found that patients often described shorter prescriptions as a hassle. 61 Respondents reported that managing a repeat prescription was a time-consuming task. In a response to a call for evidence for the DH's review of prescription charges for those with chronic conditions, Katherine White (chair of the Addison's Disease Self-Help Group) describes the 28-day prescription policy as disempowering, claiming that it causes anxiety for patients when they are running low on a prescription, and constrains their ability to travel.…”