Are you using your medicines properly?

A new report by the Royal Pharmaceutical Society (RPS), published last week, highlights the fact that pharmacists need to improve patients' use of medicines. Apparently, between 30 and 50 percent of patients taking medicines for chronic conditions don't take them as directed, leading to ill-health and extra costs for the NHS.

Ensuring the best use of medicines, reducing the risks of side effects and making sure people are taking medicines properly and safely are core activities of all pharmacy services. A report in May 2013, also by the RPS, revealed that 'only 16 percent of patients who are prescribed a new medicine take it as prescribed, experience no problems and receive as much information as they need.'

But we can't put all the responsibility onto pharmacists. It's also up to us as patients to make sure we are taking prescribed medicines correctly (where possible). And while the reports focus on prescription medicines, this also apply to anything we buy over the pharmacy counter.

So how can you make sure you are using your medicines properly?

1. Speak out
The National Pharmacy Association's Ask your Pharmacist campaign stresses that you should always let your pharmacist know if you are:

• allergic to anything
• taking prescribed medicines from another pharmacist or hospital pharmacy
• taking over-the-counter (OTC) medicines or vitamin, mineral or herbal supplements
• pregnant or breastfeeding
• buying or collecting the medicines for someone else.

2. Always ask questions

Sometimes the instructions on the medicine label or in the supplied leaflet aren't clear (or in layperson's terms). So when picking up a prescription medicine or buying any OTC product for the first time, always ask:

• What is this medicine for? [Make sure you know which medicines are helping which symptoms or medical conditions,]
• How long does it take to work and will I notice the effects? [You may not notice blood pressure medicines doing anything, yet they will still be working in the background.]
• Why do I need to take or use it? [It's important to understand why you need to take a medicine and what will happen if you don't.]
• When should I take or use it? [How many times a day, morning or night etc.]
• How do I take or use it? [Make sure you know, for example, how to put eye drops in.]
• How long should I take it for? [Do you need to finish a specific course or do you need to keep getting new prescriptions each month?]
• What do I do if I forget a dose? [Do I take the next one, take it as soon as I remember etc?]
• Does it have any side effects? [What are the side effects? What do you do if you think you are experiencing any?]
• Are there any possible risks I should be aware of? [Some medicines can affect your liver, for example, so your doctor may advise that you have regular liver function tests.]
• Could it interact with any other medicines I am taking? [This includes over-the-counter medicines and vitamin, mineral and herbal supplements.]
• Will it still work if I have a stomach upset? [If you use oral contraceptives, for example, you will need to use condoms if you have a stomach bug as the contraceptive won't be as effective.]
• Can I take it with/without food or drink? [Some medicines, for example, interact with grapefruit juice.] 
• Do I need to store it any particular way? [e.g. in the fridge].

3. Find ways to remind yourself

If you don't always remember to take your medicines, what can you do to jog your memory?

• Get into a routine and stick with it.
• Fill up a dossette box with medicines for a week. So you will be able to tell if you forget a dose. 
• Link taking medicines with specific activities (e.g. the evening news, the morning paper TV programmes). 
• Set multiple alarms or reminders on your mobile phone. 
• Keep a diary or planner and tick off a dose once you have taken it.
• Ask your friends or family to remind you.

3. Access pharmacy services

If you are prescribed a new medicine for the first time for asthma, chronic obstructive pulmonary disease, type-2 diabetes or high blood pressure, ask your pharmacist about The New Medicines Services (NMS), which is free across England. If you are eligible, the pharmacist will answer many of the questions above to help you get the most out of your medicines and stay well.

If you are taking two or more prescribed medicines for a chronic conditions, you can have a free NHS Medicines Use Review (MUR). This service is available throughout England and Wales ('Managing your Medicines' is offered in Ireland and a 'Chronic Medication Service' is available in Scotland). During this personal consultation, your pharmacist can discuss the medicines you are prescribed, whether you are experiencing any problems or side effects and whether there could be a more effective way of taking them.

How is your asthma inhaler technique?

Today's big health story (so far) is a new report - Why asthma still kills - published by the Royal College of Physicians (RCP) to coincide with World Asthma Day. According to the report, nearly three-quarters of asthma deaths could have been avoided with better care and better access to medical help. The RCP report recommends that everyone with asthma has their inhaler technique assessed formally once a year and whenever the pharmacist dispenses a new device.

So what should you be doing to make sure you are using your inhalers properly?

1. Check your technique
I suffer from mild asthma - my symptoms usually only strike at the peak of the hayfever season or when I have a respiratory infection such as a cold. I don't need new inhalers very often, because I don't use them very often, but I don't recall any pharmacist checking my inhaler technique when dispensing my prescriptions since I was first diagnosed over 30 years ago. I think the fact that I don't use inhalers on a regular basis could possibly make me more likely to forget the correct technique.

Even if your pharmacist doesn't mention it to you, make sure you ask them to check that you are using your inhaler properly. There's nothing like a one-to-one practical demonstration. However, for general guidance, you can also visit Asthma UK's Using your inhalers page.

2. Get the right products
If you are having problems using your inhaler (because of arthritis in your hands, for example), speak to your GP, who may be able to switch you to a different type of inhaler or suggest products that can help, such as the Haleraid or Turboaid - you can't get these on prescription, but your pharmacist should be able to order them in for you. Spacers, which are available on prescription, make aerosol inhalers more effective by trapping the medicine inside so you don't have to worry about pressing the inhaler and breathing in at the same time.

Use inhalers appropriately
Also speak to the pharmacist about when you use your inhalers. The RCP report found that asthma patients are relying too heavily on their reliever inhalers (usually blue) and not enough on their preventer inhalers (usually brown, red or orange). Nearly half of those who died from an asthma attack had not had an asthma review with their GP or nurse in the previous year.

3. Write an asthma action plan
According to the RCP report, better education is needed for doctors, nurses, patients and carers to make them more aware of the risks of asthma, to spot the warning signs of poor asthma control and to know what to do during an attack. All patients should be provided with a personal asthma action plan (PAAP), to help them identify if their asthma is worsening and tell them how and when to seek help. Asthma UK has a useful Asthma Action Plan that you can download from the charity's Personal action plan page and take to your GP or asthma nurse to discuss and fill in.

4. Have a Medicines Use Review
You can also ask your local pharmacist if they offer a Medicines Use Review (MUR) - this is a free NHS service in a private consultation room. You can discuss all your medicines with the pharmacist, to check they are all necessary, you are using them properly and to solve any problems you may have.