Medication Review service redesign and commissioning Options and Examples

1
Medication Reviewservice re-design and
commissioningOptions and Examples

• Jonathan Mason
• Head of Prescribing and Pharmacy
• City and Hackney Teaching PCT

2
What are the options?

• Medicines use review (MUR)
• MUR plus
• Medication review

3
Medicines Use Review

• Advanced service
• Aims
• Improve patients' understanding of their
  medicines
• Highlight problematic side effects propose
  solutions where appropriate
• Improve compliance
• Reduce medicines wastage
• Not a clinical medication review

4
MUR Plus

• Additional elements to the MUR
• Increases clinical input to MURs
• Lifestyle interventions - smoking cessation etc.
• Clinical monitoring - blood pressure etc.
• Recommendations to change medication
• City and Hackney PCT - diabetes service and CHARM
  (asthma service)

5
Medication Review

• Clinical medication review
• Level 0 - ad hoc
• Level 1 - Prescription review
• Level 2 - Treatment review
• Level 3 - Clinical medication review

6
Medication Review - examples

• North Eastern Derbyshire PCT - technician-led
• Support GP practices with compliance aspects of
  medication reviews for older people
• Tool to standardise medication reviews
• Problems identified
• Patients not taking their medicines as prescribed
• Incorrect repeat prescription lists
• Side-effects
• Confusion over medication regimens
• Similar to MURs

7
Medication Review - examples

• Maudsley medication review service - nurse-led
• Services focus on the ordering, dispensing and
  monitoring of medication, including depot
  preparations
• Patients are regularly weighed and vital signs
  monitored
• Blood samples and ECG
• Nurses meet with carers
• Referrals made to dietician, welfare advisor,
  physiotherapist, etc.
• Medical staff review efficacy of psychotropic
  medication and side-effects

8
Medication Review - examples

• South Downs Health NHS Trust - medication review
  pharmacist
• In-depth clinical medication reviews for patients
  at risk of hospital admissions due to medication
  issues
• Visit patients at home (where possible) in order
  to carry out a medicines review
• Pharmacist has access to patients medical
  history from the GP surgery from their
  community matron where appropriate