A new tool to support medication adherence in patients with type 2 diabetes

Flow chart for the participant sampling process. Credit: BMJ Open (2022). DOI: 10.1136/bmjopen-2021-058467

After extensive research by Kingston University, partners including Observia, and health care technology company Observia, a pioneering behavioral diagnostic tool was developed to increase the number of type 2 diabetic patients who take their medication as prescribed.

According to the World Health Organization (WHO), only half of people with chronic diseases are taking their medication properly. Reports suggest that this could result in a loss of $290 billion in global economic growth. Due to diabetes affecting about 8.5 percent worldwide, and previous studies indicating poor medication adherence among type 2 diabetes patients, Kingston University, and Observia decided they would concentrate their research on that group.

Observia has developed the SPUR tool in order to better understand reasons for medication non-adherence. This refers to patients who fail to take their medications as prescribed. The Department of Pharmacy at Kingston University tested the tool to determine if it could reliably identify patients who are having trouble with their medicines and what the reasons might be.

The study, which measured SPUR against other patient-reported outcomes measures, that examine adherence, was published in British Medical Journal Open. It found that as well as measuring the extent of which patients didn’t take their medication as prescribed, it also identified the reasons for this—something previously developed tools have been unable to do.

In 2017, the SPUR model was born. This was part of a technology company’s efforts to understand the complex health behaviors of patients and decipher the reasons why they don’t adhere. It also supports the design and delivery tailored health interventions that address individual patient needs.

Joshua Wells, Kingston University Ph.D. candidate and lead investigator, worked with Professor Reem Kayyali, Head of Kingston’s Department of Pharmacy, on the project. He said that understanding why patients may find it difficult to take their prescribed medicines will enable tailored interventions to be made for each patient.

“Developing a holistic instrument that can measure how often a patient stops taking his or her medicines is an important next step in the journey of our organization as we seek to provide personalized patient care to those with chronic conditions. SPUR has helped to understand the behavioral, environmental, and social factors that cause non-adherence.

The study to test and validate the model was divided into three phases. The first established the foundations of SPUR and the second reviewed more than 100 health questionnaires to help inform the 45 questions that would test the model in the final phase of the project—which was led by Kingston University.

This phase included questions to assess the effectiveness and efficiency of the SPUR tool in measuring medication compliance in 378 patients with type 2. These patients were recruited through Kingston Hospital, South West London and community pharmacies. The National Pharmacy Association and Health Education Foundation supported this final phase.

As people across the globe face more hardships as a result of the cost-of-living crisis, having tools like SPUR to support patients is more important than ever. “Patients with special vulnerabilities, particularly those living in poverty, are more vulnerable and more at risk for chronic illness. This only gets worse with age. We are witnessing an aging population which requires a greater variety and complexity of medications to manage multiple chronic conditions. The rising costs of health care will only continue to increase health inequalities in Britain and the challenge that these patients face in managing their growing list of drugs,” he said.

Observia and Kingston University are working together to establish further relationships within NHS to support the integration SPUR model more widely. This is in a bid for improved day-to-day care of patients who take medication for chronic diseases. They also continue to validate the model in other languages, patient groups, and conditions other than type 2.

Study shows that giving medications free of cost leads to better adherence and cost-savings.

More information:
Joshua Sterling Wells and colleagues, SPUR: Psychometric properties of a patient-reported outcome measure for medication adherence in type-2 diabetes BMJ Open (2022). DOI: 10.1136/bmjopen-2021-058467

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London’s Kingston University

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