How taking your medicines can impact quality of lifeBy examining the links between adherence and quality of life, researchers are developing an innovative online platform to help people with diabetes, hypertension and high cholesterol
Empowering patients to avoid illness is essential to healthy ageing, according to Professor John Yfantopoulos, a leading health economist at the University of Athens. To help individuals manage their lifestyles and safeguard the long-term sustainability of health systems, citizens need access to real-time information on the factors that influence their health and quality of life.
One area where there is scope to make a major impact on public health is in improving the self-management of non-communicable diseases (NCDs). A good diet, regular exercise and adherence to prescribed medicines are proven to help, Prof Yfantopoulos says, adding that patients should play a central role in their care: ‘We should strive to live in a world with knowledgeable patients at the heart of the health system.’
Adherence to treatment has been shown to improve clinical outcomes for people with chronic conditions while reducing the risk of hospitalisation and saving resources. It also offers proven benefits to quality of life. A new research project will turn the spotlight on the behavioural factors shaping adherence and health-related quality of life in people with diabetes, hypertension and hyperlipidaemia.
The study is part of a broader programme called Project chAnGE, supported by UpJohn, a Pfizer division, launched under the European Innovation Partnership Action on Health Ageing (EIP on AHA). Project chAnGE aims to identify gaps in Europe in relation to healthy ageing in people with non-communicable diseases, and support the necessary changes in clinical practice.
Insights from the study will be used to build an innovative electronic tool to monitor quality of life, health status and adherence – equipping physicians and pharmacists with up-to-date information that they can use to identify those at risk, and empowering patients with the knowledge they need to take positive action.
‘The study builds on our previous experience studying adherence by adding data on quality of life in a robust cohort of patients with NCDs,’ Prof Yfantopoulos explains. ‘Our sample covers people in Greek cities, rural areas and the islands – it is a diverse and representative group.’
Measuring quality of life
Working with patient organisations and a network of hospitals across Greece, the team will connect with people living with diabetes, hypertension, and high cholesterol. The widely used EQ-5D-5L questionnaire developed by EuroQol will be used to survey patients about health-related quality of life. It asks about mobility, self-care, usual activities, pain/discomfort and anxiety/depression to give a holistic picture of people’s well-being. Patients will also complete dedicated adherence questionnaires as part of the survey process.
Because the questionnaires rely on patients to faithfully report their well-being and to say whether they rigorously followed their medication regimen, Prof Yfantopoulos believes that working with patient advocates is vital to ensuring accurate results.
‘If you do not have the support of patient groups, you may not get a realistic picture: some patients may be unduly positive about their wellbeing because they want to please the doctor, while others overstate the severity of their symptoms in the hope of receiving additional medical attention,’ he says. ‘Patients trust independent advocacy groups when they tell them to simply be frank with us about how they feel and whether they take their medication.’
To add further layers of data, face-to-face interviews will be conducted with the support of local doctors, while online survey data will also be collected. A training programme will be offered to 100 doctors from across Greece to support them in data collection and highlight the research findings. The blending learning course combines online education and face-to-face instruction.
The results will feed into an online Healthy Ageing Platform which will be accessible to patients, health professionals, policy makers, and healthcare administrators. This data can be combined with existing European databases to gain insights from ‘big data’ on the factors driving adherence and well-being in the growing number of people living with NCDs.
This offers opportunities for early intervention in patients at risk of non-adherence to medication, and subsequent declines in quality of life. An electronic questionnaire will be developed with the potential to be used online or face-to-face during hospital visits.
The patient-centred, data-driven approach is in keeping with the wider trend towards value-based healthcare – an approach that promises to inform measurably better patient outcomes and more efficient health spending. This would empower decision-makers to prioritise interventions that deliver outcomes that matter to patients and make optimal use of healthcare resources.
Healthy life years
As populations age and policy makers in Greece and the wider European continent focus on healthy ageing, Prof Yfantopoulos says NCDs and ‘social diseases’ will be centre-stage. That is why the team wants to look at the wider social, psychological and lifestyle factors shaping adherence, quality of life and healthy life expectancy.
‘Vitality is a crucial measure for older people,’ he says. ‘Social exclusion is so important; it plays a role in quality of life which may be linked to adherence and healthy behaviours.’
Greece is an ideal location for studying healthy ageing and NCDs. By 2030, one third of its population will be aged over 65. ‘Add to that our high proportion of tobacco users and high rates of physical inactivity,’ says Prof Yfantopoulos. ‘The need for action is clear.’
The study, expected to take 12 months, could help to change clinical practice in Greece and beyond – improving the quality of life of people with NCDs in the process.