Improved adherence with Medicines Use Review service in Slovenia: a randomized controlled trial

Background Based on several existing patient-oriented activities, Medicines Use Review (MUR) service was standardized and officially adopted in Slovenia in 2015. Service aims to provide adherence support and ensure safe and effective medicines use. Therefore, the aim of the study was to evaluate the benefits of MUR in Slovenia, primarily the impact on medication adherence. Methods A randomised controlled trial was performed in community pharmacies to compare MUR with standard care. Patients were randomised into either the test (patients received MUR by a certified MUR provider at visit 1), or control group. The study primary outcome was self-reported adherence to multiple medications, assessed by electronic ©Morisky Widget MMAS-8 Software at the first visit (V1) and after 12 weeks (V2). A sub-analysis of intentional and unintentional non-adherence was performed. MUR impact was defined as the relative difference in ©MMAS-8 score after 12 weeks between the test and control group. A multiple linear regression model was used to predict MUR impact based on baseline adherence (low versus medium and high). Several secondary outcomes (e.g. evaluation of drug-related problems (DRPs)) were also assessed. Results Data from 153 (V1) and 140 (V2) patients were analysed. Baseline adherence was low, moderate and high in 17.6, 48.4 and 34.0% patients, respectively. In the low adherence subpopulation, test group patients showed a 1.20 point (95% CI = 0.16–2.25) increase in total ©MMAS-8 score (p = 0.025) compared to control group patients. A 0.84 point (95% CI = 0.05–1.63) increase was due to intentional non-adherence (p = 0.038), and a 0.36 point (95% CI = − 0.23-0.95) was due to unintentional non-adherence (p = 0.226). Additionally, statistically significant decrease in the proportion of patients with manifested DRPs (p < 0.001) and concerns regarding chronic medicines use (p = 0.029) were revealed. Conclusion MUR service in Slovenia improves low medication adherence and is effective in addressing DRPs and concerns regarding chronic medicines use. Trial registration ClinicalTrials.gov - NCT04417400; 4th June 2020; retrospectively registered.

Medicines use review service in community pharmacies in Spain: REVISA project

Background Community pharmacy services play an important role in controlling some factors related to medicine use and patients can benefit from these services to improve the adherence and knowledge of their medications, besides to reduce medicine-related problems. Objective The aim of the REVISA project is to carry out a study on preliminary implementation of the medicines use review service in Spanish community pharmacies. Setting Sixty-four community pharmacies from all regions of Spain. Method A preliminary implementation, cross-sectional multicentre study was conducted using a convenience sample of voluntary community pharmacies. A structured interview enabled to pharmacists to obtain a better understanding of patient’s medicines use. Main outcome measure Medicines use review-related time and cost, satisfaction and willingness to pay. Results A total of 495 patients were enrolled. The mean age of the patients was 66.1 years, with the majority females (56.4%) and a mean consumption of 5.7 medicines. A total of 2811 medicines were evaluated and 550 referral recommendations were made (29.8% to Primary Care). The mean time employed by the pharmacists in the medicines use review service was 52.8 min (medicines use review-related cost of €17.27). Most patients expressed a high level of satisfaction with this service (98.5%) and a willingness to pay for it (84%). Conclusion Medicines use review service in community pharmacies in Spain can be delivered, that it appears to be acceptable to patients and that most patients said they would be willing to pay for it. This service may offer an opportunity to promote inter-professional collaboration between pharmacists and general practitioners.

Medicines use review service in community pharmacies in Spain: REVISA project

Background: Community pharmacy services play an important role in controlling some factors related to medicine use, and pharmaceutical services integrated with primary healthcare services are critical to achieve the desired outcomes and to significantly reduce harms that can otherwise arise from multiple medicine use, such as non-adherence or medicine-related problems. The aim of the REVISA project is to carry out a study on preliminary implementation of the medicines use review (MUR) service in Spanish pharmacies through pharmacist-led initiatives to obtain a better understanding of patients’ medication adherence and medicine-related problems, together with satisfaction and acceptability of the service and whether patients might be willing to pay for it in the future. Methods: A preliminary implementation, cross-sectional multicentre study was conducted using a convenience sample of voluntary community pharmacies from all regions of Spain. Descriptive and logistic regression analyses were undertaken. Results: Sixty-four community pharmacies participated and a total of 495 patients were enrolled. A slight predominance of women (56%) was noted, with a mean age of 66.09±14.71 years and a mean consumption of 5.68±2.97 medicines. As results of MUR, a total 550 referrals were made. Non-adherence with the medication (OR=1.74; 95% CI: 1.17 to 2.58), polypharmacy (OR=1.50; 95% CI: 1.02 to 2.20) and help with medication (OR=3.03; 95% CI: 1.45 to 6.34) were associated with referrals. Patients were adherent for 68.3% of their medicines. However, at the patient level, only 31.5% were adherent. Polypharmacy patients older than 65 years increased the risk of non-adherence (OR=1.56; 95% CI: 1.06 to 2.30).The mean time employed by the pharmacists in the MUR was 52.80±31.52 minutes (MUR-related cost of €17.27). Most patients expressed a high level of satisfaction with the MUR service (98.5%) and a willingness to pay for it (84%). Conclusions: The MUR service in community pharmacies in Spain can be delivered, that it appears to be acceptable to patients and that most patients said they would be willing to pay for it. Pharmacists self-reported the length of time taken to deliver a MUR although the feasibility of incorporating into everyday practice would need to be assessed.

Consistency and replicability of a pharmacist-led intervention for asthma patients: Italian Medicines Use Review (I-MUR)

AimThis study aimed to assess the consistency and replicability of these process measures during provision of the Italian Medicines Use Review (I-MUR).BackgroundMedication review is a common intervention provided by community pharmacists in many countries, but with little evidence of consistency and replicability. The I-MUR utilised a standardised question template in two separate large-scale studies. The template facilitated pharmacists in recording medicines and problems reported by patients, the pharmaceutical care issues (PCIs) they found and actions they took to improve medicines use.MethodsCommunity pharmacists from four cities and across 15 regions were involved in the two studies. Patients included were adults with asthma. Medicines use, adherence, asthma problems, PCIs and actions taken by pharmacists were compared across studies to assess consistency and replicability of I-MUR.FindingsThe total number of pharmacists and patients completing the studies was 275 and 1711, respectively. No statistically significant differences were found between the studies in the following domains: patients’ demographic, patients’ perceived problems, adherence, asthma medicines used and healthy living advice provided by pharmacists. The proportion of patients in which pharmacists identified PCIs was similar across both studies. There were differences only in the incidence of non-steroidal anti-inflammatory drug use, the frequency of potential drug-disease interactions and in the types of advice given to patients and GPs.ConclusionsThe use of a standardised template for the I-MUR may have contributed to a degree of consistency in the issues found, which suggests this intervention could have good replicability.

9 Children/young people taking long-term medicines – a survey of the experiences of community pharmacists

AimTo identify the experiences of community pharmacists in caring for children/young people, or their parents/carers, taking long-term medicines.MethodA pre-piloted 13 point semi-structured survey, participant information leaflet, consent form and pre-paid return envelope were posted to all 354 community pharmacists who had dispensed a prescription from a single specialist paediatric hospital during November and December 2015. Community pharmacy addresses were obtained from the National Health Service Business Services Authority ePACT system. Telephone follow-up of non-responders and, if necessary, a repeat mailing was made from 3 weeks after the original return by date.Participants were asked about their experiences of undertaking a medication review with either children/young people or their parents/carers, medication-related problems presenting to them, adherence, information needs of patients/carers and what issues were reported to them from this group.The data were analysed using SPSS version 22 and NVivo version 10.ResultsA response rate of 76/354 (21.5%) was achieved. Eighteen (23.7%) respondents had undertaken a Medicines Use Review (MUR),122 (28.9%) a New Medicines Service (NMS)2 review and 16 (21.1%) had undertaken another type of medication review in a child/young person. Respondents reported that patients or their carers had presented to them with adherence issues including stopping the medicine (24, 31.6%) and changing the dose (28, 36.8%) without informing the prescriber. Patients or their carers had requested information from them about the indication (59, 77.6%), dose regime (63, 82.9%), administration (64, 84.2%) and adverse effects (58, 76.6%). Respondents also reported patients/carers experiencing difficulties obtaining further supplies of a medicine from their community pharmacy (47, 61.8%) and patients’ general practitioners declining to prescribe a medicine recommended by the patient’s hospital-based specialist (27, 35.5%).ConclusionThis study has demonstrated that children, and their carers, taking long-term medicines experience a range of issues that they present to community pharmacists. Many of these issues would fall within the purview of currently funded medication review services namely the NMS and MUR.1,2 However, the proportion of pharmacists in this study undertaking formal medication review with children or their parents/carers was low. Further work is required to demonstrate the outcomes that such a review could have in this cohort of patients.ReferencesPharmaceutical Services Negotiating Committee. MURs: The basics. What is the medicines use review and prescription intervention service? [Internet] 2016. Available from: MURs: The basics http://psnc.org.uk/services-commissioning/advanced-services/murs/murs-the-basics/ [Available: 19 May 2016].Pharmaceutical Services Negotiating Committee. New Medicines Service (NMS) [Internet] 2016. http://psnc.org.uk/services-commissioning/advanced-services/nms/ [Available: 19 May 2016].