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Medicines use reviews - Find out how MURs benefit patients

Reviews by pharmacists can help patients and minimise wasted medication. By Professor Ruth Chambers

Professor Chambers: Pharmacies can target any patient whom they think will benefit from an MUR (Photograph: UNP)
Professor Chambers: Pharmacies can target any patient whom they think will benefit from an MUR (Photograph: UNP)

Medicines use reviews (MURs) started five years ago, to aid patients' understanding and encourage them to take their prescribed medication as directed. An MUR should mean it is more likely a patient will adhere to their medication, minimising drugs wastage.

What goes on in the pharmacy?
Pharmacies contract with their local PCT to provide up to 400 MURs per year from approved premises by accredited pharmacists, but many pharmacies do far fewer. Some PCTs request pharmacies target specific long-term conditions, such as asthma or COPD.

The MUR then covers prescribed medication and inhaler technique, as well as potential interactions and side-effects from these and OTC medicines.

Pharmacies can choose to target any patient whom they think will benefit from an MUR. The patient must have been using their pharmacy regularly for at least three months.

There is great potential to improve medication management with benefits to patients' health and well-being, as well as cost benefits in reducing the likelihood of unplanned hospital admissions by better clinical management.

So a suitable pharmacy will have a quiet and private place for the pharmacist's one-to-one session with the patient.

MURs should take around 20 minutes, but may vary depending on the complexity of a patient's medication and level of understanding. They might be by booked appointments or opportunistic.

The pharmacist will work through with the patient:

  • Their knowledge of the medicine's use.
  • Is the medicine working?
  • Is the patient taking it?
  • Side-effects/interactions.
  • Monitoring effectiveness.
  • Relevant lifestyle questions and encouragement about sensible lifestyle habits - for example, diet, weight and smoking.

GP and pharmacist interaction
As a GP you have probably had a copy of a completed MUR form giving you feedback of what was discussed at the MUR meeting. But you may not have met the pharmacist who did the MUR or appreciated the purpose of the MUR.

The pharmacist does not have access to the patient's medical records from their pharmacy setting. So they can only put queries about the medication and the patient's clinical condition to the GP. It may well be that the GP has already considered those issues and decided that the current medication management is in the patient's best interests.

Optimising benefits from MURs
Selecting a patient who is on a range of medication within four weeks of being discharged from a hospital inpatient stay often generates benefits. The patient may not understand the purpose of the drugs they have been started on, may not be taking them at the right time or frequency, may still have different drugs prescribed before they were admitted to hospital. Also, they may have bought OTC drugs which could interact in dangerous ways.

That MUR can help their transition from hospital to primary care and their everyday life.

Doing an MUR before a patient is admitted for a planned hospital stay can help them understand and prepare for the hospital intervention and how and why their current medication controls their condition.

An MUR can reveal that patients who have been collecting all their medication have not been taking it for some reason, but have not felt able to tell their GP, who has remained oblivious because the patient has been regularly requesting repeat prescriptions.

Patients may ask for all medication on repeat each month even if some are PRN (as required) and only taken irregularly. They store up the spare drugs or throw them away and waste them.

A patient who pays for their prescriptions may confess at an MUR that they only request a proportion of the repeat drugs they are supposed to be taking, or cross out one of two on their repeat prescription before submitting it for dispensing because they cannot afford to pay for all of them each month.

It is particularly common for a patient to request a reliever such as salbutamol and not a preventive inhaler in this type of situation.

So optimise the benefits by contacting pharmacies near you that provide MURs and agreeing which types of patients the pharmacists will prioritise for MURs.

  • Professor Chambers was talking to Heidi Wright, policy and practice lead for England at the Royal Pharmaceutical Society, for this article

These further action points may allow you to earn more credits by increasing the time spent and the impact achieved.

  • Ask your local pharmacy that provides MURs if you can observe one or two with an accredited pharmacist. You will not only improve your understanding of the benefits of MURs, but also build a better working relationship with that pharmacy and its pharmacists.
  • Look at and register with the www.qi4pd.org.uk website to read more about the effectiveness of MURs; or www.psnc.org.uk to download an MUR form - and brief your GP colleagues.
  • Look out for the next six MURs that concern patients you usually care for. Call up the patient records and look at and reflect on what changes could or should be made to the cost or type of drugs prescribed to improve patient care and patients' likely adherence to the medication you prescribe.

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