title: The potential for using a Universal Medication Schedule (UMS) to improve adherence in patients taking multiple medications in the UK: a qualitative evaluation.
abstract: BACKGROUND
  Poor adherence to prescribed medication has major consequences. Managing multiple long-term conditions often involves polypharmacy, potentially increasing complexity and the possibility of poor adherence. As a result of the globally recognised problems in supporting adherence to medication, some researchers have proposed the use of reminder charts. The main aim of the research was to explore the need for and perceptions around the 'Universal Medication Schedule' (UMS). Looking at ways in which pharmacists and General Practitioners (GPs) could use the UMS in NHS settings.
  
  
  METHODS
  Semi-structured interviews were carried out with 10 GPs, 10 community pharmacists and 15 patients. Patients were aged 65 years and over, had multiple long-term conditions and were prescribed at least 5 medications. Interviews were recorded and transcribed and thematic analysis was conducted, using a framework approach to manage the data.
  
  
  RESULTS
  Attitudes towards the UMS were mixed with stakeholders seeing benefits and limitations to the chart. Practitioners proposed a number of existing services where they thought the UMS could easily be integrated but there was evidence of role conflict with GPs feeling it may be best placed with pharmacists and vice versa. The potential for the UMS to be used as a tool to aid communication between the different services involved in a patient's care was a key theme.
  
  
  CONCLUSIONS
  The UMS chart provides consolidated medicines information that might help to improve patients' knowledge and health literacy, which may or may not improve adherence but could help patients in making informed decisions about their treatment. One of the key benefits of using the UMS in practice is that it could be introduced across services. In this way it may aid in medicines reconciliation between healthcare settings to ensure continuity of message, improve patient experience and create more joined up working between services. Further research is needed to test implementation in different services and to assess outcomes on patient understanding and adherence.
authors.affiliation: NIHR School for Primary Care Research, Centre for Primary Care, Manchester Academic Health Science Centre (MAHSC), University of Manchester, 5th floor, Williamson Building, Oxford Road, M13 9PL, Manchester, UK. Cassandra.kenning@manchester.ac.uk.
authors.forename: Cassandra
authors.initials: C
authors.lastname: Kenning
authors.affiliation: Institute of Primary Care and Health Sciences, Keele University, Keele, UK. j.protheroe@keele.ac.uk.
authors.forename: Joanne
authors.initials: J
authors.lastname: Protheroe
authors.affiliation: Independent Pharmacist Researcher and Director- Green Line Consulting Ltd, Manchester, UK. Nicola@greenlineconsulting.co.uk.
authors.forename: Nicola
authors.initials: N
authors.lastname: Gray
authors.affiliation: Centre for Pharmacoepidemiology and Drug Safety Research, Manchester Pharmacy School, NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, University of Manchester, Manchester, UK. Darren.ashcroft@manchester.ac.uk.
authors.forename: Darren
authors.initials: D
authors.lastname: Ashcroft
authors.affiliation: NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Centre for Primary Care, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester, UK. Peter.bower@manchester.ac.uk.
authors.forename: Peter
authors.initials: P
authors.lastname: Bower
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001290:Attitude; D003142:Communication; D015897:Comorbidity; D005260:Female; D058005:General Practitioners; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D055118:Medication Adherence; D010353:Patient Education as Topic / Q000379:methods*; D010465:Perception; D010595:Pharmacists; D036301:Qualitative Research; D006113:United Kingdom