Engaging patients to access the community pharmacy medicine review service after discharge from hospital: a cross-sectional study in England

Abstract

Background The post-discharge Medicines-Use-Review (dMUR) is a commissioned service in England and Wales whereby community pharmacists facilitate patients’ understanding of their medicines and resolve any medicine-related problems. This service is poorly utilised. Objective To explore the impact of raising hospital patients’ awareness of dMURs on their uptake. Setting Hospital in South East England. Method Patients on medical wards with at least one change (medicine, or dose regimen) to their admission medicines were provided with standardized written and verbal information about the service. Participants were responsible for their own medicines and anticipated that they would be discharged home. Structured telephone interviews conducted 4 weeks after discharge explored any medicine-related issues experienced, and reasons for engaging, or not, with the dMUR service. Responses to closed questions were analysed using descriptive statistics. Responses to open questions were analysed thematically. Ethics approval was obtained. Main outcome measure Proportion of patients who received a dMUR and their motivations or barriers to accessing the service. Results Hundred patients were recruited and 84 interviewed. Their mean (SD) age was 73 (11) years. They were taking a median (range) of 9 (2–19) medicines. 67% (56/84) remembered receiving information about dMURs. Nine (11%) had attempted to make an appointment although four had not received the service because the pharmacist was unavailable. Most (88%) were not planning to access the service. The most common reason given was poor morbidity or mobility (13/31, 42%). Conclusion The use of written and verbal information to encourage patients to use the dMUR service had minimal impact.

A realist synthesis of pharmacist-conducted medication reviews in primary care after leaving hospital: what works for whom and why?

“…Recruitment in community pharmacies was less successful when added on to other roles. 37 42 Patients consented to MR when recruited by HCPs they knew, trusting their recommendation. 17 53 65 However, reliance on referrals by doctors significantly reduced the reach of potential patients compared with hospital or community pharmacy initiated MR processes, unless the referral process was highly coordinated and supported, linking to CMOC 7.…”

“…Patients and HCPs perceptions of benefit from an MR influences their willingness to participate in, refer to or conduct an MR. O2: low rates of referral to and participation in pharmacistled MR. 36 46 53 O3: patients seek out specialists, GP or community pharmacist to address concerns or concerns are not met. 37 3. Awareness of MR programmes and referral pathways by healthcare professionals.…”

“…O1: patients participate in MR. 17 23 76 O2: patients decline to participate in MR. 37 O9: issues may be missed and strategies to resolve issues cannot be easily actioned. 22 23 75 80 O11: pharmacists or patients do not schedule appointments after discharge.…”

“…Patients preferences and priorities changed once they were home, when they had to reorganise their lives and juggle multiple appointments. 53 77 Patients participated (scheduled and attended) an MR when perceived benefits outweighed their health and other priorities and effort required to attend, 37 but frequently that balance did not tilt in favour of the MR. 18 19 37 50 51 53 78 CMOC 6: when life after hospital has to be reorganised, patients may or may not schedule and attend MR appointments because they weigh their priorities and effort against perceptions of benefit differently.…”

Patient and public perception and experience of community pharmacy services post-discharge in the UK: a rapid review and qualitative study

“…In this way, patients would benefit from a perceived sense of relational continuity which they have reported feeling from accessing care from their GPs. 58 Another significant enabler would be the trust in, and promotion of CP services by other healthcare providers. The same review by the King's Fund identifies a lack of awareness by other healthcare providers of the contribution that community Open access pharmacists can make, meaning that these stakeholders do not actively support uptake and acceptance of CP services.…”