General questions relating to shared decision making
1. What do we mean/understand by patient involvement in decisions about medicinesNarrative using expert reviews
2. Does involvement in decisions about medicines influence adherence?Narrative review
3. Is it possible to increase patient involvement in decisions about medicines?Evidence review
4. What tools are available to help elicit patients beliefs about medicines?Evidence review
5. What tools are available to help elicit patients information needs about medicines?Evidence review
6. Does shared understanding of the diagnosis (need for treatment/symptoms) increase SDM?Not treated as question following agreement of model of shared decision making to use
7. How can a practitioner detect whether a patient agrees/disagrees with recommendation to take medicines?Evidence review
8. How can practitioners elicit patient’s preferences for involvement in decisions about medicines?Evidence review
9. What tools are available to support the patient in reaching an informed decision?Evidence review
10a. What information about medicines should be provided for patients in order to enhance SDM in regard to medicines?Narrative using expert reviews and GDG consensus
10b. How can information about medicines be provided for patients in order to enhance SDM in regard to medicines:Evidence review
11.
  1. Which are the specific/practical barriers and facilitators for individuals to allow them to engage in shared decision making?
  2. How can a HCP identify theses barriers and facilitators
  3. Is there a way of doing this so intervention can be targeted?
Not treated as separate questions following agreement of model of shared decision making to use
12. Do interventions to increase patient involvement increase length of the consultation?Evidence review
13. What ‘aspects’ of consultation style increase patient involvement in decision-making?Evidence review
14. What are the skills and competencies required from HCPs to deliver interventions designed to increase SDM about medicines?The GDG decided that recommendations on patient involvement and adherence indicate skills required and it was outside their expertise to decide on frameworks and competencies which should be agreed by professional organisations.
Questions related to adherence
15. How common is non-adherence?

What is the correlation between increasing adherence and clinical benefit?

What are the main causes of non-adherence?

Is adherence worse in vulnerable groups, if so which ones?
Narrative using expert reviews
16. What is the influence of side effects on adherence?Answered in review of patients experience of medicines
17.
  1. Which are the specific/practical barriers and facilitators for individuals in medicine taking?
  2. How can HCP identify theses barriers and facilitators
  3. Is there a way of doing this so intervention can be targeted?
Evidence review of patient experience
18. How can HCP tailor information to specific patient groups – cognitive capacity, cultural groupsEvidence review of patient experience
19. What are the needs of carers/families in affecting adherence?GDG consensus that carers and families needs for information are same as those of patients.
20. Is medicine taking altered by the purpose of medicine (i.e. symptomatic, preventive etc)?Not answered as separate questions – see evidence review for 17.
21. How do patients’ beliefs about medicines and HCP influence adherence?Not answered as separate questions – see evidence review for 17.
22. How can HCP elicit patients’ beliefs affecting non-adherence?Not answered as separate question
23. Which interventions are effective in increasing adherence?

(content of interventions, how delivered and who delivers them)
Evidence review
24. Dosing regime

Does change in dosing regime affect adherence?
Evidence review
25. Practical

Do prescription costs/charges affect adherence/how do patients handle cost issues?
Evidence review
26. Dosage formulation & packaging

Does drug formulation/packaging affect adherence?
Evidence review
27. Side-effects

Is there any evidence on interventions that aim to minimize side-effects in order to increase adherence?
Evidence review
28. Information and how delivered

How does the way and amount of the information that is presented (e.g. pictorial vs. written form) affect adherence?
Evidence review
29. Financial incentives

Do rewards affect adherence/what are they?
GDG considered not relevant to UK settings so omitted
30. Psychobehavioural interventions

Do specific forms of therapy (e.g. CBT) affect adherence?
Evidence review
31. Overall treatment plans

Is care planning important in affecting adherence?
  1. Do patient plans affect adherence?
GDG consensus to omit
32. Contract

Would a contractual agreement between HCP and patient affect adherence?
Evidence review
33. Effect of reminders

Do reminders (and what types of reminders, text messaging etc) help increase adherence? Are these more important before or after a review?
Evidence review
34. Patient identification of medicine

Does changing the name of medicines affect the way people take medicines?
GDG consensus to omit
35. Effect of self-monitoring of effect of medication

Does being involved in self-monitoring (e.g. of own blood pressure) help adherence? Does case-management affect adherence (i.e. by one specific person)?
Evidence review
36. Does effect of intervention differ according to which HCP delivers the intervention?GDG consensus to omit
37. What elements of the clinician-pt relationship influence adherence?Question developed on trust in doctor-patient relationship.
Answered as part of question 13.
38. What information regarding medicines should be provided for patients and practitioners on medicines when patients are discharged from secondary care?Narrative review and consensus
39. What is the role of the pharmacist or HCP in overcoming barriers to adherence?GDG considered that question not relevant following agreement of concepts in guideline.
40. What would impact adherence after the prescription is issued?GDG considered that question not relevant following agreement of concepts in guideline.
41. What is medication review?Does medication review increase patient involvement in decisions about medicines and adherence to medicines?


(question altered by GDG)
42. What should be the content of medication reviews?
43. When/how often and by whom should medication reviews be done?
44. Does the use of dosette boxes affect adherence to prescribed medication?Evidence review

After consultation it was brought to our attention that devices like dosette boxes may be classified under different headings and that some researchers label them as ‘reminders’ or as ‘packaging’. We therefore re-examined the papers included in the packaging review and reminder reviews and extracted those relevant to dosette-type devices. These we have termed multi-compartment medicine systems although there is no agreed term in the published literature.
45. How can practitioners assess adherence?GDG consensus
46. What are the advantages and disadvantages of self-report in assessing patient’s adherence?Evidence review
47. What information regarding medicines should be provided for patients and practitioners when patients are discharged from secondary care?Narrative review using expert reviews

From: Appendix B, Key Clinical Questions and Searches

Cover of Medicines Adherence
Medicines Adherence: Involving Patients in Decisions About Prescribed Medicines and Supporting Adherence [Internet].
NICE Clinical Guidelines, No. 76.
National Collaborating Centre for Primary Care (UK).
Copyright © 2009, Royal College of General Practitioners.

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