Post on 04-Oct-2020
transcript
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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