MURs: a not-so-quiet revolution (original) (raw)
Related papers
Understanding the patient perspective of the English community pharmacy Medicines Use Review (MUR)
Research in Social and Administrative Pharmacy, 2013
Background: Health policy-makers and pharmacy's representative bodies seek to better utilize the skill of community pharmacists so as to support patients' use of medicines and associated health care outcomes. The English Medicines Use Review (MUR) is an NHS-funded community pharmacy service that aims to improve patients' knowledge of medicines and their use. MURs represent an opportunity for patients to gain additional help with their medicines as well as fostering inter-professional collaboration between pharmacists and general practitioners (GPs). Objective: To describe patients' perspective of the MUR service and their understanding of the value that they derive from it. Methods: This study employed a qualitative approach involving 10 weeks of ethnographic observation in two English community pharmacies. It employed observations of 54 patient-pharmacist MURs consultations and subsequent interviews with 34 patients. A thematic approach was used to analyze the data. Results: All patients reported feeling comfortable speaking with the pharmacist, who they saw as a knowledgeable expert on medicines. They appreciated the time spent with them in a private consultation. The MUR provided patients with reassurance about their medicines, that they were "doing the right thing." Despite these positive views, when asked to describe the purpose of their MUR, patients provided ambivalent accounts and reported that the consultation did little to improve their knowledge of medicines or affect how they used them. Conclusions: Patients' accounts of MURs suggested they held broadly positive views about the service. However, evidence that MURs were fulfilling their formal policy aims and intentions was limited. Policymakers and those seeking to promote community pharmacy's professional agenda should note the patients' perspective, assessment and perceived value of MURs in order to develop services, which are better tailored to patient need.
A qualitative study exploring the impact and consequence of the MUR Pharmacy Practice 2013
BACKGROUND: Pharmacy support-staff (pharmacy technicians, dispensers and Medicines Counter Assistants) support the delivery of pharmaceutical and retail functions of the pharmacy. Workflow is supervised and at times dependent upon the pharmacist's presence. Policy makers and pharmacy's representative bodies are seeking to extend the community pharmacist's role including requiring the pharmacist to undertake private consultations away from the dispensary and shop floor areas. However, support-staff voices are seldom heard and little is known about the impact such policies have on them. OBJECTIVE: The objective of this study is to explore the impact and consequences of the English Medicine Use Review (MUR) service on pharmacy support-staff. METHODS: Ten weeks of ethnographic-oriented observations in two English community pharmacies and interviews with 5 pharmacists and 12 support-staff. A thematic approach was used to analyse the data. RESULTS: Despite viewing MURs as a worthwhile activity, interviews with support-staff revealed that some felt frustrated when they were left to explain to patients why the pharmacist was not available when carrying out an MUR. Dependency on the pharmacist to complete professional and accuracy checks on prescriptions grieved dispensing staff because dispensing workflow was disrupted and they could not get their work done. Medicines Counter Assistants were observed to have less dependency when selling medicines but some still reported concerns over of customers and patients waiting for the pharmacist. A range of tacit and ad hoc strategies were consequently found to be deployed to handle situations when the pharmacist was absent performing an MUR. CONCLUSIONS: Consideration should be given to support-staff and pharmacists' existing work obligations when developing new pharmacy extended roles that require private consultations with patients. Understanding organisational culture and providing adequate resourcing for new services are needed to avoid improvisations or enactments by pharmacy support-staff and to allow successful innovation and policy implementation.
Medicines Use Review: adoption and spread of a service innovation
International Journal of Pharmacy Practice, 2008
Background Research has shown that implementation of community pharmacy Medicines Use Review and Prescription Intervention (MUR) in the first year of the service in England and Wales was less extensive than anticipated. Several barriers to MUR becoming accepted and embedded in the National Health Service (NHS) were identified.Objective To evaluate progress in the provision of the MUR service in England and Wales in its second year (April 1, 2006-March 31, 2007) compared with the first year; and to analyse trends from available national data from the third year of provision in 2007–2008.Methods The analysis drew on the following data sources: routine data on provision of MURs for community pharmacies in a stratified random sample of 31 primary care organisations in England and Wales, and national datasets on MUR provision from the Pharmaceutical Services Negotiating Committee and NHS Information Centre.Outcome measures The percentage of community pharmacies providing the MUR service, the numbers of MURs provided in 2006–2007 at pharmacy and primary care organisation level, and the extent of, and variation in, provision.Key findings The percentage of community pharmacies providing the MUR service increased from 38 to 67.2%. Overall, 62 559 MURs were provided (a more than four-fold increase on the previous year), representing 13.8% of the possible maximum. The mean number of MURs provided (per provider) increased from 36 to 85. For existing providers the mean number increased from 36 to 111 (median 78, range 0–423). For new providers the mean number was 52 (median 17, range 1–401). More than half (52%) of the pharmacies in the sample claimed for fewer than 50 MURs. Overall, 82% of MURs were provided by multiples and this percentage was lower among new providers (62%) than existing providers (89%). Thirty-three (8.1%) existing MUR providers had no recorded MURs in the second year: almost two-thirds of these (64%) were independents. Eleven pharmacies (1.5%) provided the maximum number of 400 MURs per year: all but one were branches of multiples. Of the pharmacies not yet providing MURs, 78% were independent.Conclusions Both numbers of MURs and numbers of providers of MUR services increased markedly during the service's second year. Those newly providing the service in the second year claimed for more than twice as many MURs as did those who had been ‘new providers' the previous year. Overall just over half of all providing pharmacies claimed for the equivalent of one MUR a week or fewer. Therefore the extent of ‘successful adoption’ of MURs is debatable. Differences in the level of provision continued between independent and multiple pharmacies in terms of both adoption of the service and the number of reviews conducted. As in the previous year, independent pharmacies were less likely to provide the MUR service and when they did the numbers conducted were lower than those provided by multiples.
Medicines use reviews: a potential resource or lost opportunity for general practice?
BMC Family Practice, 2013
Background: Patient non-adherence to medicines represents a significant waste of health resource and lost opportunity for health gain. Medicine management services are a key health policy strategy to encourage patients to take medicines as they are prescribed. One such service is the English Medicines Use Review (MUR) which is an NHS-funded community pharmacy service involving a patient-pharmacist consultation aiming to improve patients' knowledge of medicines and their use. To date the evidence for MURs to improve patient health outcomes is equivocal and GPs are reported to be sceptical about the value of the service. This paper presents the patient's perspective of the MUR service and focuses on the importance of GP-pharmacist collaboration for patient care. Suggestions on how MURs may have value to GPs through the delivery of increased patient benefit are discussed. Method: A qualitative study involving ten weeks of ethnographic observations in two English community pharmacies. Observations were made of all pharmacy activities including patient-pharmacist MUR consultations. Subsequent interviews with these patients were conducted to explore their experience of the service. Interviews with the pharmacy staff were conducted after the period of observations. A thematic approach was used to analyse the data. Results: Fifty-four patients agreed to have their MUR observed of which thirty-four were interviewed. Seventeen pharmacy staff were also interviewed. Patients reported positive views about MURs. However, there was little evidence suggesting that pharmacists and GPs were working collaboratively or communicating outcomes resulting from MURs. MURs were conducted in isolation from other aspects of patient care. Patients considered GPs to have authority over medicines making a few wary that MURs had the potential to cause tensions between these professionals and possibly adversely affect their own relationship with their doctor. Conclusions: This study reveals the potential for effective GP-pharmacist collaboration to improve the capacity of the MUR service to support patient medicine taking. Closer collaboration between GPs and pharmacists could potentially improve patients' use of medicines and associated health care outcomes. The current lack of such collaboration constitutes a missed opportunity for pharmacists and GPs to work together with patients to improve effective prescribing and optimise patient use of medicines.
Background Patient non-adherence to medicines represents a significant waste of health resource and lost opportunity for health gain. Medicine management services are a key health policy strategy to encourage patients to take medicines as they are prescribed. One such service is the English Medicines Use Review (MUR) which is an NHS-funded community pharmacy service involving a patient-pharmacist consultation aiming to improve patients’ knowledge of medicines and their use. To date the evidence for MURs to improve patient health outcomes is equivocal and GPs are reported to be sceptical about the value of the service. This paper presents the patient’s perspective of the MUR service and focuses on the importance of GP-pharmacist collaboration for patient care. Suggestions on how MURs may have value to GPs through the delivery of increased patient benefit are discussed. Method A qualitative study involving ten weeks of ethnographic observations in two English community pharmacies. Observations were made of all pharmacy activities including patient-pharmacist MUR consultations. Subsequent interviews with these patients were conducted to explore their experience of the service. Interviews with the pharmacy staff were conducted after the period of observations. A thematic approach was used to analyse the data. Results Fifty-four patients agreed to have their MUR observed of which thirty-four were interviewed. Seventeen pharmacy staff were also interviewed. Patients reported positive views about MURs. However, there was little evidence suggesting that pharmacists and GPs were working collaboratively or communicating outcomes resulting from MURs. MURs were conducted in isolation from other aspects of patient care. Patients considered GPs to have authority over medicines making a few wary that MURs had the potential to cause tensions between these professionals and possibly adversely affect their own relationship with their doctor. Conclusions This study reveals the potential for effective GP-pharmacist collaboration to improve the capacity of the MUR service to support patient medicine taking. Closer collaboration between GPs and pharmacists could potentially improve patients’ use of medicines and associated health care outcomes. The current lack of such collaboration constitutes a missed opportunity for pharmacists and GPs to work together with patients to improve effective prescribing and optimise patient use of medicines.
BMJ Open, 2016
Introduction: Community pharmacy increasingly features in global strategies to modernise the delivery of primary healthcare. Medicine Use Reviews (MURs) form part of the English Government's medicines management strategy to improve adherence and reduce medicine waste. MURs provide space for patientpharmacist dialogue to discuss the well-known problems patients experience with medicine taking. However, 'underserved' communities (eg, black and minority ethnic communities, people with mental illness), who may benefit the most, may not receive this support. This study aims to develop, implement and evaluate an e-learning education intervention which is coproduced between patients from underserved communities and pharmacy teams to improve MUR provision. Methods and analysis: This mixed-methods evaluative study will involve a 2-stage design. Stage 1 involves coproduction of an e-learning resource through mixed patient-professional development (n=2) and review (n=2) workshops, alongside informative semistructured interviews with patients (n=10) and pharmacy staff (n=10). Stage 2 involves the implementation and evaluation of the intervention with community pharmacy staff within all community pharmacies within the Nottinghamshire geographical area (n=237). Online questionnaires will be completed at baseline and postintervention (3 months) to assess changes in engagement with underserved communities and changes in self-reported attitudes and behaviour. To triangulate findings, 10 pharmacies will record at baseline and postintervention, details of actual numbers of MURs performed and the proportion that are from underserved communities. Descriptive and inferential statistics will be used to analyse the data. The evaluation will also include a thematic analysis of one-to-one interviews with pharmacy teams to explore the impact on clinical practice (n=20). Interviews with patients belonging to underserved communities, and who received an MUR, will also be conducted (n=20). Ethics and dissemination: The study has received ethical approval from the NHS Research Ethics Committee (East Midlands-Derby) and governance clearance through the NHS Health Research Authority. Following the evaluation, the educational intervention will be freely accessible online.
Pharmacy World & Science, 2008
Objective of the study Medicines use review and prescription intervention ('MUR services') is the first advanced service within the NHS community pharmacy contract and is a structured review that is undertaken by a pharmacists with patients on multiple medicines. The objective of this study was to investigate factors that influence the number of Medicines use reviews (MURs) performed by community pharmacists and to explore community pharmacists' attitudes towards the service. Setting This study was conducted with pharmacists who were employed by one UK community pharmacy chain. Method A questionnaire was developed to investigate factors that influence the number of MURs performed and pharmacists' attitudes towards MURs. It consisted of a series of attitudinal statements together with brief demographic data. Questionnaires were distributed to a sample of 280 pharmacists accredited to provide the service during April and May 2006. Main outcome measure Factors affecting the number of MURs performed and community pharmacists' attitudes towards MURs. Results Sixty per cent (167/280) of pharmacists returned a completed questionnaire. Twenty-seven per cent of respondents had not performed any MURs, 43% had conducted one to 14 reviews and 31% had conducted 15 or more. Job title affected the number of reviews performed; respondents categorised as 'Store based' pharmacists performed significantly more MURs than those working as 'Locums' but not significantly more than 'Managing' pharmacists. Pharmacists reporting access to an accredited consultation area performed significantly more MURs than those who did not. Those working more than 20 h per week performed significantly more MURs than those working less. Gender, time since qualification, the pharmacy size and those having or currently undertaking a clinical diploma were not found to be associated with the number of MURs performed. Most respondents reported that MURs were an opportunity for pharmacist to use their professional skills in an extended role and patients would benefit from the service. However they reported concerns about GPs opinion of the service, lack of time and support staff to conduct MURs and were unhappy about consultation areas. Conclusion This study demonstrates that pharmacists perceive MURs to be an opportunity for an extended role and of value to patients. However, this study has identified perceived barriers, including the availability of a consultation area suitable for performing MURs, time to perform MURs and support staff. The number of MURs performed by pharmacists appears to be affected by the pharmacists' job title, their working hours and the presence of a consultation area. Additional support for 'locum' pharmacists was also highlighted and may be needed.
Community pharmacy: only innovation will deflect the disruptor beam
Journal of Pharmacy Practice and Research
context of overloaded general practitioner (GP) services that are struggling to cope with the current demands placed upon them. The same could be said for screening processes that may prompt people to attend their GP to access assessment and treatment (or at least a conversation) about previously undetected issues, such as high blood pressure, impaired glucose tolerance, atrial fibrillation or hyperlipidaemia. Perhaps it may be more useful to engage with consumers on these issues, rather than to indulge in knee-jerk protectionism and an unattractive brand of paternalism. A lingering question also remains about the role that professional organisations have to play in all of this. There is much to celebrate about the great strides that have been made in primary care pharmacy practice in recent times, but how effective has the profession's advocacy arm been in highlighting these? Pejorative and terse exchanges between professions do not progress the issues involved, but other approaches could. Many informed commentators hold the view that major investment is needed to allow more fruitful discussions between stakeholders to progress on equal ground, and that commissioning and funding more research may be a way to clarify where the value of innovative pharmacy practice lies. Mature and open conversations about the merit and worth of a broad range of pharmacy services are needed: health professionals and consumers alike would be well served to adopt a less cynical approach and to facilitate better visibility of benefit and value, rather than a discussion simply about the cost of medicines.