My Non-Prescription Medicines prototype

If we allow patients to add non-prescription medicines to their clinical records and control who sees them, can clinicians use the extra information to make better decisions?

What was the problem?

Clinicians involved in prescribing, such as GPs and pharmacists, typically do not have visibility of the non-prescription medicines (NPMs) a patient may be taking when they prescribe or dispense medicines. Non-prescribed medicines include over-the-counter medicines, vitamins and herbal supplements bought from a pharmacy, supermarket or health food store.

In 2020, people spent £2.6 billion on over the counter medications in Great Britain. The most common purchases are pain relief, treatments for coughs and cold, and vitamins.

When prescribing or dispensing medications, clinicians rely on patients’ understanding, recollection and willingness to disclose any non-prescribed medicines they may have taken.

This means clinicians may be unaware of symptoms or conditions being self-managed, and creates a risk of drug-drug interactions (DDIs) or “clashes” between prescription and non-prescription medications, which have the potential to reduce the efficacy of drugs, or cause harm to the patient. Patients are often not aware of these risks, assuming non-prescription medicines are “safe”.

For example Warfarin, a common anti-blood-clotting drug which was prescribed 5.5m times per year in England, can interact with common non-prescription medicines including St John’s Wort, Ibuprofen and Daktarin, causing multiple symptoms up to and including death.

Patients rely on reading product packaging and advice leaflets or receiving advice from medical professionals to avoid clashes.

International studies have found that up to 3.9% of all Adverse Drug Reactions requiring hospital admission involved “self-medication”.

What could be the benefit of improving this?

1. Give clinicians a more comprehensive view of patients’ non-prescription medicines, to improve the advice they give and the safety of prescriptions
2. Give clinicians increased awareness of conditions being self-managed by patients
3. Reduce costs of prescribing duplicate medications if patient is already taking cost effective non-prescription medication
4. Reduce reliance on patients’ memory and own judgement of significance of non-prescription medicines
5. Preserve patients’ privacy by reducing the need to tell pharmacist about other medications in a public setting

Our hypothesis

What did we do?

We undertook research with clinicians, patients and behavioural scientists.

Through user research we discovered:

• There is broadly an awareness of medicine clashes, but the level of concern about it varies widely (more complex conditions saw higher levels of concern)
• Seven out of ten research participants saw value in their GP having access to information about non-prescription medicines
• There was high level of trust in pharmacists / GPs and their expertise, and recognition that the more information they have, the better they can understand patients’ health
• The moment when people would be likely to record a particular non-prescription medicine would generally be when taking it for the first time.
• Not all patients want to record or share information about their NPMs with clinicians, but others are very enthusiastic about the benefits it could bring

We developed, user-tested and iterated prototypes for how this could work within the NHS App, exploring how the process of recording non-prescription medications could work for patients, including methods of identifying medicines such as autocomplete for names, and scanning barcodes. We looked at how data providers such as supermarket loyalty cards could enhance the process for patients.

We also explored how much information about dose and frequency people would be willing to input, versus what is clinically useful for professionals to see - eventually finding that "regularly" or "only when needed" gave sufficient fidelity for a clinician to begin a conversation with a patient. We also investigated how user-entered data might then be coded into standards compliant records and clinical messages.

From the clinician side, we experimented with what a consolidated medicine record might look like when it combined physician-prescribed and patient-entered data.

Finally, we worked with Yorkshire and Humber Care Record to build a prototype which allowed the process to be tested from end-to-end with dummy data.

What did we learn

• This is not something that all patients wanted to use, but ones that did could gain considerable value
• Patients wanted to record non-prescription medicines they have stopped taking as well as those they currently are
• Providing information to clinicians should be a prompt for a conversation with the patient, rather than used to make decisions
• Warning about clashes would be useful and expected behaviour of an app like this for many users, but giving advice to patients requires much higher standards of clinical safety and medical device regulation
• Patients were more willing to share their non-prescription medicines with pharmacists than doctors, and would like control over who sees what
• Patients who are taking multiple medications, with complex needs, are the ones who are most likely to benefit

More information

If you would like to talk to us about this project, you can contact us at england.innovation.lab@nhs.net