Community Pharmacy Medicines Use Review (MUR) Service. Information for GP practices

Transcription

1 Community Pharmacy Medicines Use Review (MUR) Service What is the purpose of a MUR? Information for GP practices The underlying purpose of the MUR service is: To improve patient knowledge, adherence and use of their 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 adherence improving the clinical and cost effectiveness of prescribed medicines and reducing medicine wastage. A MUR is not: Discussion about changes to drug treatment Detailed discussion about the medical condition beyond the drug treatment Discussion on the effectiveness of treatment based on test results Full clinical medication review What does it involve? As this is a concordance based review, the pharmacist will ask the patient to bring their medication (including purchased medicines) with them to the review. The review will be recorded by the pharmacist on the MUR clinical record which will be retained in the pharmacy. If the pharmacist deems it to be necessary a follow-up MUR can be arranged with the patient. Communication A critical element to the success of MURs is effective communication between GP and pharmacist. Pharmacists are strongly recommended to contact GP practices to discuss MURs and in particular the protocols for referral and administration. Some issues to consider with the practice include: Are there specific patients within the specified groups that the GP would wish to be targeted? e.g. patients who do not regularly attend clinic for review patients commenced on a new device e.g. inhaler, insulin pen patients whose condition is poorly controlled newly diagnosed patients patients commenced on a new medication patients with issues relating to polypharmacy. Page 1

2 The pharmacist will communicate the outcome of the MUR with the GP practice: if there are recommendations being made to the GP if issues have been identified and the pharmacist considers it appropriate to share information with the GP. The outcome of the MUR will be communicated using the communication page of the MUR clinical record. A copy is included as Appendix 1. The pharmacist should also seek the practice s views on: The level of detail required on the communication documentation The point of contact within the practice for receipt of communication documentation How the practice will use the communication documentation The practice experience of the MUR service Who can have a MUR? A MUR can be carried out for all respiratory and diabetic patients who are taking multiple medicines including one or more of the following respiratory medicines included in the following BNF subsections: BNF Reference BNF subsection descriptor Adrenoceptor agonists Antimuscarinic bronchodilators Theophylline Compound bronchodilator preparations Corticosteroids Cromoglicate and related therapy, leukotriene receptor antagonists and phosphodiesterase type-4 inhibitors Insulins Antidiabetic drugs Pharmacists may initiate MURs, accept referrals for MURs from other healthcare professionals, where the patient has consented, and pharmacists can accept requests from patients for a MUR to be conducted as long as the criteria laid out in the specification are met. In a MUR the pharmacists will consider all the medicines a patient is taking, including those which are not prescribed and not just those that fall within the respiratory or diabetic target group. In order for patients to access the service they must give signed consent for their information to be shared with the GP, HSCB and Business Services Organisation. If Page 2

3 a patient refuses to give their consent then the pharmacy contractor may not provide the MUR service to them. Which patients could benefit most? Although the service may be offered to any patient who meets the criteria outlined described above it will be important for the pharmacist to identify patients who may benefit most from the service. Some examples are listed below but the practice may wish to work with the pharmacist to consider other patients who may benefit. For respiratory patients: Example A patient with asthma who is prescribed a large number of reliever inhalers A patient with asthma or COPD who has been prescribed a new inhaler device A patient with asthma using excessive quantities of combination inhalers used for both prevention and as a reliever A patient with asthma or COPD using a number of different inhaler devices A patient with asthma prescribed a combination inhaler infrequently A patient with COPD receiving frequent courses of rescue oral steroids A patient with COPD receiving frequent courses of antibiotics Why a review may be beneficial Good asthma control is associated with little or no need to use reliever inhalers. Frequent use of reliever inhalers suggests poor control. The patient may not be using their preventer inhaler regularly Important that the patient understands their new medicines and knows how to use the device correctly This regime is suitable for selected patients only who have received appropriate education. Overuse could lead to a higher than intended dose of inhaled steroid. The use of multiple inhaler types can lead to confusion and errors resulting in poor inhaler technique This suggests that the compliance with the combination inhaler is poor Patient may benefit from education about the appropriate use of rescue steroids Patient may require further monitoring and follow-up by their GP or practice nurse For patients with diabetes: Children (<18 years old) and patients with current gestational diabetes are excluded from the service as specialist services exist for these patients within secondary care. Page 3

4 Example Adult patients with type 2 diabetes A patient with newly or recently diagnosed diabetes A patient reporting side-effects with medicines A patient prescribed a new medicine for their diabetes or related co-morbidity (e.g. statin, antihypertensive) A patient with diabetes who has frequent hypoglycaemic episodes A patient whose diabetic control causes concern Why a review may be beneficial These patients are likely to have the greatest medicine management needs that the pharmacist will be able to address during the MUR This could be a good opportunity to engage the patient at an early stage, providing a good foundation of education. It is also an opportunity to signpost the patient to key educational resources e.g. the Diabetes UK online training These patients should be supported with appropriate information and advice. This may, for some patients, negate the need to move to more complex medication regimens. The patient may benefit from a review to ensure optimal adherence with, and therapeutic benefit from, the new medicine. The patient may benefit from a review of the causes of hypoglycaemia can be caused by medication, lifestyle or a complication of their diabetes The patient may benefit from an assessment of their understanding of how to manage their diabetes. Who can provide MURs? MURs can be provided by any pharmacy which has contracted with the HSCB to provide the service. Each year pharmacies will be able to provide MURs for up to 120 patients. A list of community pharmacies providing the service will be made available on the primary care intranet in due course. What are the benefits for Patients? Improving a patient s understanding of their condition and treatment should: Improve compliance with prescribed treatment Improve health outcomes Improve quality of life Increase ownership of their condition and treatment Encourage self-care Page 4

5 What are the benefits for GPs? Up to 50% of patients do not comply with some element of the prescribed treatment, a large proportion of GP appointments are taken by patients with long-term conditions and a high proportion of hospital re-admissions in the elderly are a direct result of poor compliance with prescribed medication. A recent study found that 42% of patients with asthma newly commenced on an inhaled corticosteroid will not request a repeat prescription within a six month period. Improving a patient s compliance with their treatment should improve their health outcomes thus reducing workload for GPs and unnecessary secondary care admissions. In addition to improving compliance, other potential benefits to GPs include: Providing further medicines-related information to GPs that can be discussed with the patient at their next GP appointment The recommendations from MURs for the GP can be helpful to support repeat prescribing management Supporting the practice in raising patient awareness of timing and the importance of the clinical review with the GP or practice nurse Supports long-term conditions management reviews Helps with the reduction of waste from unnecessary reordering and dispensing of medicines Further information Further information can be obtained from pharmacists providing the service and contact details are available via the primary care intranet at: AreaWebVersion.pdf Full details of the service specification, guidance for community pharmacists and documentation can be accessed via the BSO website at June 2014 Page 5

6 Community Pharmacy Medicines Use Review Service - MUR Clinical Record Appendix 1 CONFIDENTIAL Patient ID No. Sheet of To the GP: This patient recently received a Medicines Use Review (MUR) which identified the issues outlined below. Please consider the proposed recommendations. Patient details GP details Title: First Name: Surname: GP Name: H+C Number: Tel: Date of Birth: Practice Name: Address: Address: Name of other people present Review type: MUR follow-up MUR Review carried out face to-face with patient? Yes No If no, please state reason: Action plan Review identified or requested by: Pharmacist Patient Other: Written consent for MUR obtained: Yes No Date of review: Review carried out in the pharmacy? Yes No If no, please state reason and provide details of location Issue Recommendation Pharmacy details Pharmacist Name: Pharmacist registration no.: Pharmacy Name: Pharmacy Contractor No.: address: Address: Tel. No. Communication page This review is based on information available to the Pharmacist held on the pharmacy Patient Medication Record system and from information provided by the patient Page 6