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Medicines Use Review (MUR) - what GPs and Practice Managers need to know
What is the Medicines Use Review & Prescription Intervention Service?
The Medicines Use Review (MUR) and Prescription Interventions Service is the first service in the Advanced level of the NHS Community Pharmacy contract. It is a structured review that is undertaken by a pharmacist to help patients to manage their medicines more effectively.
The MUR involves the pharmacist reviewing the patient's use of their medication, ensuring they understand how their medicines should be used and why they have to take them, identifying any problems and then providing feedback to the prescriber, as appropriate, via the NHS MUR form. The patient also receives a copy of this form. An MUR is not usually conducted more than once a year.
The Prescription Intervention Service is actually an MUR which is triggered by a significant problem with a patient's prescription, which would be over and above the basic interventions, relating to safety, which a pharmacist makes as part of the dispensing service.
MURs provide a way to:
" improve patients' understanding of their medicines;
" highlight problematic side effects & propose solutions where appropriate;
" improve compliance; and
" reduce medicines wastage, usually by encouraging the patient only to order the medicines they require.
An MUR is not:
" a full clinical review;
" an agreement about changes to medication;
" a discussion about the medical condition beyond that which is needed to achieve the above objectives; or
" a discussion on the effectiveness of treatment based on test results.
What does it involve?
As this is a concordance based review, the pharmacist will ask the patient to bring their medication (including purchased medicines) with them to the review.
Discussions with the patient may include:
" what the patient thinks each medicine is for and when and how they take it;
" how compliant they are with the prescriber's instructions;
" how and when they take medication labelled 'as required' or 'as directed';
" advice on tolerability and perceived side effects;
" dealing with practical problems in ordering, obtaining, taking and using medicines;
" identification of unwanted medicines, i.e. patient is no longer taking the medicine;
" identification of a potential change of dosage form to facilitate effective use with due regard to formularies and cost implications (the final decision lies with the patient's GP); and
" proposals for dose or strength optimisation, provided it does not impact on the patient's clinical management.
The review will be recorded on the NHS MUR form. A copy will be retained in the pharmacy, a copy given to the patient and a copy sent to the GP, as appropriate. There may be action points for all parties dependent on the outcomes of the review, but the majority will be patient orientated.
Who can have an MUR?
It is for the pharmacist to decide which patients receive this service. However, PCTs are able to recommend that pharmacists prioritise specific groups of patients.
MURs must only be provided for patients who have been using the pharmacy for the dispensing of their prescriptions for the previous three months (this does not however apply to Prescription Interventions).
Who can provide MURs?
Pharmacists must pass a Higher Education Institution competency assessment before they can provide this service. Reviews must be conducted in a consultation area, which ensures patient confidentiality. Once accredited, pharmacists are able to provide MURs for up to 400* patients annually. (*subject to conditions detailed in the Drug Tariff)
How are MURs funded?
The pharmacy will receive a nationally agreed fee from the PCT for each MUR conducted. The MUR service is funded by budgetary savings created as a result of changes in the medicines reimbursement prices of some generic medicines.
What are the benefits for Patients?
Improving a patient's understanding of their condition and treatment should:
" improve compliance with prescribed treatment;
" improve health outcomes;
" improve quality of life;
" increase ownership of their condition and treatment; and
" encourage self-care.
What are the benefits for GPs?
50% of patients do not comply with some element of their prescribed treatment, a large proportion of GP appointments are taken by patients with long-term conditions and a high proportion of hospital re-admissions in the elderly are a direct result of poor compliance with prescribed medication. Improving a patient's compliance with their treatment should improve their health outcomes thus reducing workload for GPs and unnecessary secondary care admissions.
A critical element to the success of MURs is effective face to face communication between GP practices and pharmacies - developing relationships, reaching a mutual understanding of protocols, parameters and preferred target patient groups.
Some practices and pharmacies have found it beneficial to coordinate MURs with practice medication reviews in order that the pharmacist and patient can deal with medicines use issues in an MUR prior to the GP's clinical medication review.
What are the benefits to Commissioners?
Improving patient care is at the heart of all developments within the NHS. Compliance with appropriately prescribed treatment is fundamental to ensuring that the outcomes of care are realised. Non-compliance can lead to:
" non-achievement of health improvement goals;
" unnecessary increased workload for healthcare professionals;
" increased secondary care admissions; and
" poor use of NHS resources.
Medicines Use Reviews conducted by community pharmacists can play an important role in achieving all stakeholder goals. It does not matter how clinically appropriate prescribed treatment is if the patient does not understand and follow the recommended regimen.
Where can you get more information on this service? www.psnc.org.uk/advanced