“Medicines use review conducted in community pharmacy"

1. “Medicines use review conducted incommunity pharmacy" Professor Ian Chi Kei Wong Department of Health Public Health Career Scientist The School of Pharmacy University of London

2. 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

3. 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

4. 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.

5. 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)

7. 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.

8. 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

9. 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

10. 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.

11. 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

12. 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

13. 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.

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

19. Roles of clinician, pharmacist and patient in Pharmaceutical care

20. Roles of clinician, pharmacist and patient in medicines use review

21. 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.

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

23. 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)