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MURS IN DERMATOLOGY – BRINGING IT ALTOGETHER AT LOCAL LEVEL

MURS IN DERMATOLOGY – BRINGING IT ALTOGETHER AT LOCAL LEVEL. AINI ALCOCK, LEAD CLINICAL PHARMACIST IN DERMATOLOGY AND RHEUMATOLOGY, STHFT, 4.4.2011. MUR aims - general . Establish actual use Identify and resolve problems Identify issues affecting compliance

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MURS IN DERMATOLOGY – BRINGING IT ALTOGETHER AT LOCAL LEVEL

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  1. MURS IN DERMATOLOGY – BRINGING IT ALTOGETHER AT LOCAL LEVEL AINI ALCOCK, LEAD CLINICAL PHARMACIST IN DERMATOLOGY AND RHEUMATOLOGY, STHFT, 4.4.2011

  2. MUR aims - general • Establish actual use • Identify and resolve problems • Identify issues affecting compliance • Improve clinical and cost-effectiveness and reduce wastage

  3. Mur aims in dermatology - sheffield • Patients with acne, eczema, psoriasis • Rationale: to educate patients on how to use their skin medications appropriately e.g. effective use of emollients for patients with eczema.

  4. Establish actual use - ask the question • Does the patient understand the purpose of the treatment • which area of skin affected? • has your medication been explained to you? • have you been told the benefits of the treatment? • What is each systemic or topical treatment for? • Are topicals used correctly? • sequence of emollient and treatment (when, how often) • quantitity applied (how thickly)? • how long for? • Systemic treatments • keeping up with monitoring appointments if on DMARDs or immunosuppressants (ciclosporin, acitretin, azathiorprine, biologics)? • folic acid if on methotrexate?

  5. Identify and resolve problems with drug usage • IDENTIFY • treatment/maintenance • regular? • flare-ups • DNAs? • Rx reflecting the problem? • complicated regime? • management plan? • RESOLVE & INTERVENE • Simplify regime & reduce SES > GP • Advice & information (BAD leaflets, signposting) • top sheet of MUR form to GP with recommendations

  6. Identify issues affecting compliance • Patient/doctor relationship • Formulation suitable? • too greasy? • cannot swallow tablets? • too messy or smelly • Convenient to use? • complicated regime • Lack of knowledge • Attitude of those around you • family members, boy- girlfriend • stigma • Lifestyle • time spent on applying treatments • Identify drug-interactions and adverse effects • drugs that worsen the condition • nausea from MTX • Itching, burning • Happy with the treatment? • effective? • Quick response? • easy to use? • cosmetic? • safe? • faith in treatment? • motivated? • patients’ beliefs? • flare-ups when stop treatments?

  7. Improving clinical and cost-effectiveness of prescribed medicines and reducing wastage • Solutions - suggestions to GP & interventions • repeat dispensing • generic substitution • dose optimisation – step up/step down • Incorrect dosage instructions • Unwanted medicines /discontinuted medicines • need to wean from potent to maintenance? • hoarding? • regular medication not reviewed?

  8. Do … • Rehearse • Roll play • Killer questions and answers • Reflect • Give yourself marks 1-10 • Train staff • Search PMR • Empower staff • Contact GP surgery • Home visits • Advertise • Stick to time limits

  9. summary • Know when to refer • Get staff on board • GP • Practice • Simple regime • support with education material • Low frequency of doses • reminders, cues and prompts • Short duration • step-up/step-down • Life style factors

  10. It’s only skin • Some patients have very poor quality of life • Treat it as you treat heart disease, diabetes and cancer

  11. Thank you for listening • Any questions?

  12. References • Alcock A. Promoting compliance in psoriasis. PJ 2011;286:139-140 • Bellingham C. How to offer a medicines use review. PJ 2004;273:602 • Scottish Intercollegiate Guidelines Network. Guideline 121: The diagnosis and management of psoriasis and psoriatic arthritis in adults • Building confidence with MURs. Supporting Professional Development. Pfizer Listening to Pharmacy. Pfizer Ltd January 2010

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