Implementation of medication usereview services

Daisy Volmer and Liisa Randmäe

• 11.45-12.00 Introduction to the session

• 12.00-13.30 Country presentations and discussion: Estonia, Latvia, Lithuania, Croatia, Romania, Iran (via Skype)

• 13.30-14.00 Further developments of MUR service

• One of the public health challenges for Europe is inappropriate polypharmacy and medication non-adherence.

• Separate health care pathways contribute to suboptimal medication use and quality of treatment.

• Need for better integrated care, including the regular review of polypharmacy and adherence, in older and chronic patients suffering from multi-morbid conditions.

• Conducting comprehensive medication use review (MUR) presents the perfect opportunity to reduce unnecessary polypharmacy.

Medication Use Review (MUR)

• Structured and regularevaluation of patient’s medication regimen in order to• detect and offer solutions to

problems related to medication use;

• optimize medication use and

• improve health outcomes.

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MUR initiatives in Estonia

MUR working group

was established2017

Different

stakeholders

Standard for

MUR service

was established

2018Aim and levels of

MUR

Piloting MUR

services2019

Implementation of MUR service

Feedback from patients,

pharmacists and GPs

MUR standard for Estonia

Service level Data: source and content; setting; provider Service description

I Patient, GP, (e-medication list);

info about medications and disease

diagnose codes;

community pharmacy;

pharmacist, assistant pharmacist

Patient education about his/her medicines,

diseases;

repeating medicines use details

II Patient, GP, (e-medication list);

info about medications, disease diagnose

codes and clinical tests results;

community pharmacy, hospital pharmacy;

pharmacist

Patient education about his/her medicines,

diseases;

repeating medicines use details; evaluation of

medicines list for potential drug related

problems

III Patient, GP, (e-medication list);

info about medications, disease diagnose

codes and clinical tests results;

community pharmacy, hospital pharmacy,

GP center;

clinical pharmacist

Patient education about his/her medicines,

diseases;

repeating medicines use details;

in healthcare team development of treatment

plan and follow up of treatment outcomes

MUR pilot project

• Pilot project - implementation the first level of MUR as an extended service at community pharmacy based on the MUR standard developed in Estonia.

• The specific aims:• to identify existing or potential problems of patients related to their medicines or

diseases;

• to educate patients about their medicines and diseases and evaluate possible change in their knowledge after the MUR service;

• to get feedback to the MUR service from patients, pharmacists and general practitioners;

• to validate MUR service documents (data collection forms, feedback forms).

Description of the MUR project

The international MUR project

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• Current competencies and roles of community pharmacists

• Future competencies and roles of community pharmacists

• New developments and changes in pharmacy sector from 2019

Factors encourage MUR

Level

Patient Need for regular medication assessment

Professional Professional competency about medicinesIncreased understanding about importance of MUR amongphysicians and nurses

National Access to medical record by pharmacistExisting MUR standard

Global Aging population, polypharmacy, pharmaceutical wasteImprovement of pharmacist image

Factors hinder MUR

Level

Patient MUR is unfamiliar for patientsPharmacist is not seen as an expert of pharmacotherapy

Professional MUR is unfamiliar for pharmacists and other healthcarespecialistsHigh work load of pharmacists and other healthcare specialistsInsuffucuent clinical competency among pharmacists

National No service standardFinancing of MUR serviceLuck of privat consultation places at community pharmacyLimited access to patient data by pharmacistsCentral documentation system for patient´s data

Global

Implications for practice

• Development of MUR standard on the first level• evaluation tool and feedback tools

• More widespread provision of MUR service at community pharmacies• communication with patients and GPs about MUR service

• Ideas for development of MUR standard on the secondlevel• tools for evaluation of DRP

• Funding of MUR service• Communication towards government, pharmacy owners

Implications for research

• A review paper:• pharmacy practice initiatives in CEECs

• Original research:• Implementation of MUR service in the pilot partner countries (description of MUR

standards and service provision, feedback from community pharmacists)

• Feedback from patients and GPs to the results of MUR service

• Standardization of tool for identification of DRP• Drug interaction databases

• EU-7 PIM list for identification of potentially inappropriate medicines for older patients

• Look for funding to develop the project

Continuous collaboration!

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