Harkness Project Title: Towards an Understanding of Medication Non-Adherence in the Elderly with Multiple Illnesses
Mentors: Steve Soumerai, Sc.D., and Dana Safran, Sc.D.
Placement: Harvard Medical School/Harvard Pilgrim Healthcare
Biography at time of Harkness Fellowship: Rachel Elliott, a 2004-05 Commonwealth Fund Harkness Fellow in Health Care Policy and Practice, is an academic pharmacist with a background in hospital pharmacy and doctorate training in health economics. After completing a Ph.D. from Brunel University, she became a clinical lecturer at the University of Manchester and is currently professor of medicines and health at the University of Nottingham's School of Pharmacy. Her research and teaching focus on health economics, and she has obtained, or been part of, grants for both primary and secondary research in anaesthesia, rheumatology, surgery, emergency contraception and medication adherence. Elliott is one of very few pharmacists in the U.K. with training and experience in health economics, and she initiated a research program that applies the most up-to-date and robust health economics research methods to medicines and pharmacy practice.
Project: Elliott’s study aimed to explore and describe how multiple illnesses affect patients’ decisions about adherence, and to identify whether, and how, people “trade” between medicines or diseases. Twenty community-dwelling seniors were recruited for the study, and a series of interviews were carried out with them over three months on potential factors affecting adherence. These included knowledge and beliefs about their diseases and medications.
Career Activity Since Fellowship
- Professor in Health Economics, University of Manchester, 2016
- Lord Trent Professor of Medicines and Health, University of Nottingham School of Pharmacy, 2007
- Patient Safety Advisory Committee, National Institute for Health and Clinical Excellence, 2007
- Appointment to NICE Appraisals Committee, 2006
Current Position: (updated 10/2017)
- Professor in Health Economics, University of Manchester
E-Mail: [email protected]
Selected Publications:
SHABARUDDIN, F.H., CHEN, L.-C., ELLIOTT, R.A. and PAYNE, K., 2013. A systematic review of utility values for chemotherapy-related adverse events PharmacoEconomics 2013. 31(4), 277-288.
AVERY, A.J., RODGERS, S., CANTRILL. J.A., ARMSTRONG, S., CRESSWELL, K., EDEN, M., ELLIOTT, R.A., HOWARD, R., KENDRICK, D., MORRIS, C.J., PRESCOTT, R.J., SWANWICK, G., FRANKLIN, M., PUTMAN, K., BOYD, M. and SHEIKH, A.. A pharmacist-led information technology intervention for medication errors (Pincer): a multicentre, cluster randomised, controlled trial and cost-effectiveness analysis Lancet 2012 379(9823), 1310-1319.
HARWOOD RH, GOLDBERG SE, WHITTAMORE KH, RUSSELL C, GLADMAN JRF, JONES RG, POROCK D, LEWIS SA, BRADSHAW LE, ELLIOTT RA AND MEDICAL CRISES IN OLDER PEOPLE STUDY GROUP (MCOP). Evaluation of a Medical and Mental Health Unit compared with standard care for older people whose emergency admission to an acute general hospital is complicated by concurrent 'confusion': a controlled clinical trial. Trials 2011; 12, 123.
* Serumaga B, Ross-Degnan D, Avery AJ, Elliott RA, Majumdar SR, Zhang F, Soumerai SB. “Effect of pay for performance on the management and outcomes of hypertension in the United Kingdom: interrupted time series study.” BMJ 2011:342-d108.
PAYNE K, FARGHER E, TRICKER K, ROBERTS S, NEWMAN W, ELLIOTT RA and RATCLIFFE J. Valuing pharmacogenetic testing services: a comparison of patients’ and healthcare professionals’ preferences. Value in Health 2011; 14, 121-134.
NEWMAN, WILLIAM G, PAYNE, KATHERINE, TRICKER, KAREN, ROBERTS, STEPHEN A, FARGHER, EMILY, PUSHPAKOM, SUDEEP, ALDER, JANE E, SIDGWICK, GARY P, PAYNE, DEBBIE, ELLIOTT, RACHEL A, HEISE, MARCO and ELLES, ROBE,. A pragmatic randomized controlled trial of thiopurine methyltransferase genotyping prior to azathioprine treatment: the TARGET study. Pharmacogenomics 2011; 12(6), 815-26.
EDMANS, JUDI, CONROY, SIMON, HARWOOD, ROWAN, LEWIS, SARAH, ELLIOTT, RACHEL A, LOGAN, PHILIPPA, BRADSHAW, LUCY, FRANKLIN, MATTHEW and GLADMAN, JOHN, Acute medical unit comprehensive geriatric assessment intervention study (AMIGOS): study protocol for a randomised controlled trial. Trials 2011; 12(1), 200.
SALEMA, N.M., ELLIOTT, R.A. and GLAZEBROOK, C. A systematic review of adherence-enhancing interventions in adolescents taking long-term medicines Journal of Adolescent Health 2011; 49(5), 455-466.
STACK, R.J., BUNDY, C., ELLIOTT, R. A., NEW, J.P., GIBSON, J.M. and NOYCE, P. R. Patient perceptions of treatment and illness when prescribed multiple medicines for co-morbid type 2 diabetes: Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy 2011;. 4, 127-135.
CHAMBERS, DUNCAN, WORTHY, GILLIAN, MYERS, LINDSEY, WEATHERLY, HELEN, ELLIOTT, RACHEL, HAWKINS, NEIL, SCULPHER, MARK and EASTWOOD, ALISON. Should glycopeptides be used for prophylaxis in surgery with a high risk of MRSA infection?: A systematic review. Surgical Infections 2010; 11(5), 455-462.
ELLIOTT R,A, WEATHERLY H,L,A, HAWKINS N,S, CRANNY C, CHAMBERS D, MYERS L, EASTWOOD A and SCULPHER M,J. An economic model of switching from non-glycopeptide to glycopeptide antibiotic prophylaxis for surgery European Journal of Health Economics 2010; 11(1), 57-65.
SHABARRUDIN, F.H., ELLIOTT, R.A., VALLE, J.W., NEWMAN, W.G. and PAYNE, K. Understanding chemotherapy treatment pathways of advanced colorectal cancer patients to inform an economic evaluation in the United Kingdom British Journal of Cancer 2010; 103(3), 315–323
STACK, R, NOYCE, P, BUNDY, C, ELLIOTT ,R.A, NEW ,J and GIBSON, M. Intentional and unintentional non-adherence in type 2 diabetes: the effect of varying numbers of medicines Journal of Diabetes and Vascular Disease 2010; 10, 148-152.
AVERY, A.J., RODGERS, S., CANTRILL, J.A., ARMSTRONG, S., ELLIOTT, R., HOWARD, R., KENDRICK, D., MORRIS, CAROLINE J., MURRAY, S. A., PRESCOTT, R.J., CRESSWELL, K. and SHEIKH, A. Protocol for the PINCER trial: a cluster randomised trial comparing the effectiveness of a pharmacist-led IT-based intervention with simple feedback in reducing rates of clinically important errors in medicines management in general practices. Trials 2009; 10, 28.
ELLIOTT R A,. Non-adherence to medicines: not solved but solvable Journal of Health Services Research and Policy 2009 14, 58-61
STACK, R J, ELLIOTT, R A, NOYCE, P R and BUNDY, C. A qualitative exploration of multiple medicines beliefs in co-morbid diabetes and cardiovascular disease. Diabetic medicine : a journal of the British Diabetic Association 2008 25(10), 1204-10.
ELLIOTT, R.A., SHINOGLE, J., PEELE, P., BHOSLE, M. and HUGHES, D. Understanding medication compliance and persistence from an economics perspective Value in Health 2008; 11(4), 600-610.
THORNTON, J., ASHCROFT, D.M., O'NEILL, T.W., ELLIOTT, R.A., ADAMS, J, ROBERTS, C., ROONEY, M. and SYMMONS, D. A comparison of the effectiveness and cost-effectiveness of three strategies for reducing the lifetime fracture risk in children with juvenile idiopathic arthritis - a systematic review with additional unpublished data Health Technology Assessment 2008; 12(3), 1-187.
CRANNY, G., ELLIOTT, R.A., WEATHERLY, H., CHAMBERS, D., HAWKINS, N., MYERS, L., SCULPHER, M. and EASTWOOD, A. A systematic review and economic model of switching from non-glycopeptide to glycopeptide antibiotic prophylaxis for surgery Health Technology Assessment 2008; 12, 1-200.
THORNTON, J., LUNT, M., ASHCROFT, D.M., BAILDAM, E., FOSTER, H., DAVIDSON, J., GARDNER-MEDWIN, J., BERESFORD, M.W., SYMMONS, D., THOMSON, W. and ELLIOTT, R.A. Costing juvenile idiopathic arthritis: examining patient-based costs during the first year after diagnosis Rheumatology; 2008; 47(7), 985-990.
MOORE, J.K., ELLIOTT, R.A., PAYNE, K., MOORE, E.W., ST LEGER, A.S., THOMS, G.M.M., POLLARD, B.J., KERR, J. and HARPER, N.J.N. The effect of anaesthetic agents on induction, recovery and patient preferences in adult day-case surgery: a 7-day follow-up randomized controlled trial European Journal of Anaesthesiology 2008.
ELLIOTT, R.A., CLIFFORD, S., BARBER, N., HARTLEY, E. and HORNE, R. The cost effectiveness of a pharmacy advisory service to improve adherence to medicines Pharmacy World and Science 2008; 30, 17-23.
ELLIOTT R A,. Is QUM an efficient use of healthcare resources? Journal of Pharmacy Practice and Research 2008; 138, 172.
ELLIOTT, R.A. Strategies for improving poor adherence to medication to optimize rheumatoid arthritis disease management Disease Management & Health Outcomes 2008; 16, 13-29,
Elliott RA, Shinogle J, Peele P, Bhosle M, Hughes D. “Understanding Medication Non-compliance From An Economics Perspective,” Value in Health 2008.
* Elliot RA, Ross-Degnan D, Adams A, Safran D, Soumeraiet S. “Strategies for Coping in a Complex World: Adherence Behavior Among Older Adults with Chronic Illness,” Journal of General Internal Medicine 2007; 22(6):805-10.
CHEN L-C, ASHCROFT DM and ELLIOTT RA,. Do economic evaluations have a role in decision-making in Medicine Management Committees? A qualitative study Pharmacy World and Science 2007; 29(6), 661-670.
FARGHER, E.A., EDDY, C., NEWMAN, W., QASIM, F., TRICKER, K., ELLIOTT, R.A. and PAYNE, K. Patients' and health professionals' views on pharmacogenetic testing and its future delivery in the NHS Pharmacogenomics 2007; 8(11), 1511-1519.
SESTON, E.M., ELLIOTT, R.A., NOYCE, P. and PAYNE, K., 2007. Women's preferences for the provision of emergency hormonal contraception services Pharmacy World & Science. 29, 183-189.
EL-BEIK, S. and ELLIOTT, R. Macular degeneration - Advances in treatment Hospital Pharmacist 2007; 14(5), 155-160.
GIDMAN, W., ELLIOTT, R., PAYNE, K., MEAKIN, G.H. and MOORE, J. A comparison of parents and pediatric anesthesiologists' preferences for attributes of child daycase surgery: A discrete choice experiment Paediatric Anaesthesia 2007; 17(11), 1043-1052.
FARGHER, E.A., TRICKER, K., NEWMAN, W., ELLIOTT, R., ROBERTS, S.A., SHAFFER, J.L., BRUCE, I. and PAYNE, K. Current use of pharmacogenetic testing: A national survey of thiopurine methyltransferase testing prior to azathioprine prescription Journal of Clinical Pharmacy and Therapeutics 2007; 32(2), 187-195.
ELLIOTT, R.A., ROSS-DEGNAN, D., ADAMS, A., SAFRAN, D.G. and SOUMERAI, S.B. Strategies for coping in a complex world: determinants of adherence behaviors among the elderly with chronic illness. Journal of General Internal Medicine 2007; 22, 805-810.
THORNTON, J., ASHCROFT, D.M., MUGHAL, M.Z., ELLIOTT, R.A., O'NEILL, T.W. and SYMMONS, D. Systematic review of effectiveness of bisphosphonates in treatment of low bone mineral density and fragility fractures in juvenile idiopathic arthritis Arch Dis Child 2006; 91(9), 753-761.
DAVIES, L., BROWN, T.J., HAYNES, S., PAYNE, K., ELLIOTT, R.A. and MCCOLLUM, C. Cost-effectiveness of cell salvage and alternative methods of minimising perioperative allogeneic blood transfusion: A systematic review and economic model Health Technology Assessment 2006; 10(44), 1-114.
ELLIOTT, R.A. Poor adherence to anti-inflammatory medicines in asthma: reasons, challenges and strategies for improved disease management Disease Management & Health Outcomes 2006; 14(4), 223-233.
ELLIOTT, R.A., HOOPER, L., PAYNE, K., BROWN, T.J., ROBERTS, C. and SYMMONS, D. Preventing non-steroidal anti-inflammatory drug-induced gastrointestinal toxicity: are older strategies more cost-effective in the general population? Rheumatology 2006; 45(5), 606-613.
BROWN, T.J., HOOPER, L., ELLIOTT, R.A., PAYNE, K., WEBB, R., ROBERTS, C., ROSTOM, A. and SYMMONS, D. A comparison of the cost-effectiveness of five strategies for the prevention of non-steroidal anti-inflammatory drug-induced gastrointestinal toxicity: A systematic review with economic modelling Health Technology Assessment 2006; 10(38), iii-183.
HUGHES, D.A., ELLIOTT, R. and PAYNE, K., 2006. Comments on NICE do not reflect expertise available within the profession [12] Pharmaceutical Journal. 277(7423), 484
CLIFFORD, S., BARBER, N., ELLIOTT, R., HARTLEY, E. and HORNE, R., 2006. Patient-centred advice is effective in improving adherence to medicines Pharmacy World & Science 2006; 28(3), 165-170.
PAYNE, K. and ELLIOTT, R.. Using discrete choice experiments to value preferences for pharmacy services International Journal of Pharmacy Practice 2005; 13(1), 9-20.
ELLIOTT, R.A., CANTRILL, J.A., PRICE, G., PARROTT, N., ALI, A., BOWRON, A., CHALLINOR, K. and GRAHAM, D. Secondary care roles in shared care for renal transplant patients British Journal of Renal Medicine 2005; 10, 27-29.
* Elliott RA, Majumdar SR, Gillick MR, Soumerai SB. “Medicare Drug Benefit: Benefits and Consequences for the Poor and the Disabled,” New England Journal of Medicine 2005; 26(353): 2739-2741.
ELLIOTT, R.A., BARBER, N. and HORNE, R.. Cost-effectiveness of adherence-enhancing interventions: a quality assessment of the evidence Annals of Pharmacotherapy 2005; 39, 508-515.
THORNTON, J., ELLIOTT, R.A., TULLY, M.P., DODD, M. and WEBB, A.K. Clinical and economic choices in the treatment of respiratory infections in cystic fibrosis: Comparing hospital and home care Journal of Cystic Fibrosis 2005; 4(4), 239-247.
ELLIOTT, R.A., THORNTON, J., WEBB, A.K., DODD, M. and TULLY, M.P.. Comparing costs of home- versus hospital-based treatment of infections in adults in a specialist cystic fibrosis center International Journal of Technology Assessment in Health Care 2005;21(4), 506-510
Elliott RA. “The US Health System Is Catching A Cold” (letter), Pharmaceutical Journal 2004; 273: 598
Elliott RA. “The Place Of Health in the US Presidential Election” (short paper), Pharmaceutical Journal 2004; 273: 640
Elliott R, Barber N, Noyce P. “Medication Adherence: Can Britain and the United States Learn Anything From Each Other?” Pharm J 2003; 271: 508-510