Post discharge medicines use review (dMUR) service for older patients: Cost-savings from community pharmacist interventions

Ramsbottom, Helen; Rutter, Paul; Fitzpatrick, R

doi:10.1016/j.sapharm.2017.02.007

Cited by 11 publications

(10 citation statements)

References 13 publications

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“…The characteristics of the 41 MUR and NMS papers are described in Tables 1-5. Few studies employed an RCT or quasi-experimental design: one study (two papers examining effectiveness and cost-effectiveness) was an RCT 21,22 , one was a small (randomised) feasibility study 23 , and another recruited a non-randomised control group 24 . Three papers exclusively examined secondary data from pharmacy records [25][26][27] .…”

Section: Resultsmentioning

confidence: 99%

“…A quasi-experimental study of post-hospital counselling and community pharmacist MURs improved patients' knowledge of their medication, but was undermined by less than half of patients for whom a MUR was recommended actually receiving one 24 ; the primary reason was patients having their medicine delivered to their home, and thus not requiring a visit to a community pharmacy. Lack of mobility has also been identified as a barrier to conducting post-hospital discharge MURs in a small feasibility trial 23 . In a large survey-based evaluation of hospital referrals to a community pharmacy follow-up service, MUR (n=288) or NMS (n=241) consultations were the most common types of service provided (if provided at all), with results indicating that patients receiving a follow-up consultation (of any type) may have lower rates of readmission and shorter hospital stays 27 .…”

Section: A N U S C R I P Tmentioning

confidence: 99%

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

Stewart

Whittlesea

Dhital

et al. 2020

Research in Social and Administrative Pharmacy

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Section: Resultsmentioning

confidence: 99%

Section: A N U S C R I P Tmentioning

confidence: 99%

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

Stewart

Whittlesea

Dhital

et al. 2020

Research in Social and Administrative Pharmacy

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show abstract

“…There may be cost-savings if discharge MURs are more widely adopted. 53 However, there remain challenges including how to make it easier for pharmacists to offer the service to homebound patients, whether carers of patient not self-medicating can be offered the opportunity to participate in an MUR, and how to overcome unawareness and lack of patient-expected benefit that has shown to reduce patient engagement. 52 …”

Section: Mur Challengesmentioning

confidence: 99%

Community pharmacy Medicines Use Review: current challenges

Latif¹

2018

IPRP

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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.

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“…Any differences in outcomes might have partly been a function of patients' capacity to attend the MR compared with those who did not attend, for example, related to lesser morbidity and higher mobility, being more engaged or self-efficacious in their healthcare, rather than attributable solely to the MR. 19 20 84 It is also plausible that some of these usual care group patients were not contactable due to readmission into hospital shortly after their previous discharge. 75 The intervention, in this case the MR either as a process or programme, was often not described in a way to assist a realist approach, for example, detail was limited 20 21 47 or too complex or multifaceted 41 57-59 to understand with certainty which components were essential to achieving a positive outcome.…”

Section: Strength and Limitationsmentioning

confidence: 99%

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

2020

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BackgroundMedication reviews for people transitioning from one healthcare setting to another potentially improve health outcomes, although evidence for outcome benefits varies. It is unclear when and why medication reviews performed by pharmacists in primary care for people who return from hospital to the community lead to beneficial outcomes.ObjectiveA realist synthesis was undertaken to develop a theory of what works, for whom, why and under which circumstances when pharmacists conduct medication reviews in primary care for people leaving hospital.MethodsThe realist synthesis was performed in accordance with Realist And MEta-narrative Evidence Syntheses: Evolving Standards reporting standards. An initial programme theory informed a systematic literature search of databases (PubMed, Embase, Cumulative Index of Nursing and Allied Health Literature, International Pharmaceutical Abstracts, OpenGrey, Trove), augmented by agency and government sources of information. Documents were synthesised by exploring interactions between contexts, intervention, outcomes and causal mechanisms.ResultsThe synthesis identified 9 contexts in which 10 mechanisms can be activated to influence outcomes of pharmacist medication reviews conducted in primary care postdischarge. For a medication review to take place these include trust patients have in healthcare professionals, their healthcare priorities postdischarge, capacity to participate, perceptions of benefit and effort, and awareness required by all involved. For the medication review process, mechanisms which issue an invitation to collaborate between healthcare professionals, enable pharmacists employing clinical skills and taking responsibility for medication review outcomes were linked to more positive outcomes for patients.ConclusionsMedication reviews after hospital discharge seem to work successfully when conducted according to patient preferences, programmes promote coordination and collaboration between healthcare professionals and establish trust, and pharmacists take responsibility for outcomes. Findings of this realist synthesis can inform postdischarge medication review service models.

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Post discharge medicines use review (dMUR) service for older patients: Cost-savings from community pharmacist interventions

Cited by 11 publications

References 13 publications

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

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

Community pharmacy Medicines Use Review: current challenges

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

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