Community pharmacy Medicines Use Review: current challenges

Abstract

With a growing aging population, the appropriate, effective, and safe use of medicines is a global health policy priority. One concern is patients’ non-adherence to medicines, which is estimated to be up to 50%. Policymakers seek to reconfigure medicine management services and consider community pharmacy as especially well-placed to improve medicine use. In England and Wales, a commissioned medication review service called “Medicines Use Reviews (MURs)” was made available in through the National Health Service (NHS) in 2005. This involves a patient–pharmacist consultation to improve patients’ knowledge and the use of medicines and to help reduce avoidable waste. However, over a decade since their introduction, questions remain over the extent to which the MUR policy has successfully been embedded in practice and translated into more effective use of medicines. The MUR intervention continues to hold many challenges ranging from poor public awareness and acceptance of MURs, organizational constraints, and issues over interprofessional collaboration. Many of these challenges are not exclusive to the MUR service, or even to the community pharmacy setting. Nevertheless, by identifying and exposing such challenges, an opportunity exists for policymakers and commissioners to seek to improve this service to patients. This narrative review explores the current challenges that face MURs. Damschroder et al’s consolidated framework for implementation research is employed to help organize these challenges from patient and professional perspectives across multiple contexts. Over the past decade, MUR policy and practice has continued to evolve, being shaped by research, organizational and professional influences, and policy. Reforms to the service suggest that the MURs are becoming more responsive to patients’ need and preferences. It is intended that this review will create impetus and scope for further debate, service reconfiguration, and ultimately service improvement.

Community pharmacist led medication reviews in the UK: A scoping review of the medicines use review and the new medicine service literatures

“…The MUR and NMS literature largely focuses on the introduction and early implementation of these services, with little detailed attention to process and outcomes for patients. The international literature of pharmacist-led medication reviews convincingly shows improved disease-specific and medication adherence outcomes 2 , but beyond the single NMS RCT 21 the effectiveness of UK medication related advanced services has not been evaluated, despite on-going challenges to 65 . Confidence that the specific aims of MUR and NMS consultations 8,9 will be achieved in practice is, therefore, limited by the research evidence available.…”

Professional identity in pharmacy: Opportunity, crisis or just another day at work?

“…Some proposed barriers include lack of time, autonomy, confidence, remuneration, information and recognition by both physicians and patients. [1][2][3][4][5][9][10][11] However, even as many barriers are addressed, resistance to change continues. [1][2][3][4][5] This is not a Canadian phenomenon.…”

“…Pharmacy around the world is experiencing the same resistance to practice change. 9,10 Other professions have looked to professional identity formation and its role in preparing health care practitioners to function in and adapt to changing health systems. Specifically, we propose that the absence of a clear professional identity in pharmacy [12][13][14][15] contributes to the profession's inability to embrace change and move forward.…”

A Qualitative Exploration to Understand Access to Pharmacy Medication Reviews: Views from Marginalized Patient Groups

“…The purpose being to resolve medicine related issues, concerns and to reduce avoidable waste [ 17 ]. Despite this service seeking to improve knowledge and use of medicines, significant variability in delivery has raised concerns, particularly that the service is not being targeted to patients who may benefit most from a review with a pharmacist [ 18 ]. There are low levels of evidence to support medication reviews for marginalized groups.…”