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“Medicines use review conducted in community pharmacy"

Professor Ian Chi Kei WongDepartment of Health Public Health Career Scientist

The School of PharmacyUniversity of London

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• The National Health Service (NHS) is a state-funded healthcare delivery model.

• Traditionally prescribing and dispensing are separate:– Medical practitioners are prescribers – Pharmacists are medications providers

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Medical and Pharmaceutical Services

• Primary care medical services are provided by General Practice – Also employ other health professionals such

as practice nurses and practice pharmacists

• Primary care pharmaceutical services are provided by community (retail) pharmacies

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Community pharmacy• Community pharmacies

are not employees of the NHS

• Contractors • On average each

pharmacy provides 100 hours per week service to the NHS

• 80% of income come from the NHS, mostly from dispensing.

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Recognitions

• Government has recognised the skills of community pharmacists.

• Community pharmacists have taken on extra roles (enhanced services)– Smoking cessation– Supervised administration of methadone – Medicines Use Review (MUR)

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Medicines Use Review

• This service includes medicines use reviews undertaken periodically, as well as those arising in response to the need to make a significant prescription intervention during the dispensing process.

• Medicines use review is about helping patients use their medicines more effectively.

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Aims of Medicines Use Review

To improve patient knowledge, concordance and use of medicines by:

• establishing the patient’s actual use, understanding and experience of taking their medicines

• identifying, discussing and resolving poor or ineffective use of their medicines

• identifying side effects and drug interactions that may affect patient compliance

• improving the clinical and cost effectiveness of prescribed medicines and reducing medicine wastage

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Where to conduct?

• Should normally be carried out face to face– community pharmacy – patients’ homes or – day care centres

• Only when it is not practical– conducted by telephone

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Requirements

• The consultation area should be clearly designated as an area for confidential consultations.

• Pharmacists providing the service should have passed an assessment, based on the nationally agreed competencies for the service.

• Courses are available from different universities.

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Interventions

• Advice on medicines usage (prescribed and OTC) to improve concordance

• Effective use of ‘when required’ medication• Ensuring appropriate use of different medicine

dosage forms e.g. inhaler technique • Advice on tolerability and side effects• Dealing with practical problems in ordering,

obtaining, taking and using medicines

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Interventions• Highlighting the following issues to the

prescriber by identifying and/or suggesting:– Medication with inadequate dosage

instructions or dose optimisation– Unwanted medicines – A change of dosage form to facilitate effective

usage;– Appropriate generic or branded products

which suit the patient– Other appropriate interventions agreed locally

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Record keeping

• A record of the medicines use review should be made on the patient’s pharmacy record.

• A summary of the medicines use review and any recommendations should be sent to the patient’s GP, using the nationally agreed recording template.

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Record keeping

• A copy of the medicines use review summary and recommendations should be given to the patient.

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Improve patient's QOL

Patient

Pharmaceutical Care Plans

Pharmacist Clinician

Communication & Agreement

Communication & Agreement Communication & Agreement

Roles of clinician, pharmacist and patient in Pharmaceutical care

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Safe and effective use of medicines

Patient

Medicines use review

action plans

Pharmacist Clinician

Communication

Communication Communication

Roles of clinician, pharmacist and patient inmedicines use review

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Up-to-date data

• The latest figures show that over 4,100 community pharmacies in England claimed payments for medicines use reviews in November 2006.

• Over 63,000 of medicines use reviews have been conducted.

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New Developments

• After a registered pharmacist has successfully completed an approved programme of training, they can be a– Supplementary Prescriber– Independent Prescriber

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New Developments

• Supplementary prescribing– Pharmacists are able to prescribe all

medicines under the terms of a patient specific “Clinical Management Plan” (agreed with patients & clinicians).

• Independent prescribing– Pharmacists are able to prescribe any

licensed medicine (except CDs & unlicensed drugs)