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Patient Feedback

Medication Reviews - the views of patients
The Medicines Partnership programme is a 2-year initiative funded by the Department of Health to help improve the use of medicines in the NHS and to help patients achieve maximum benefit from their medication. This is a very important issue for all age groups, and for older people in particular, since as people get older, their use of medicines tends to increase. As part of its work, the Medicines Partnership commissioned a small piece of work to look at the views of some older people and their carers about medication reviews. It was also decided that it would be appropriate to seek the views of some younger people with long-term medical conditions as part of this project. The views of those who took part in the project are summarised in this report, which informed development of the guide "Room for Review".
The recent context to developing medication reviews for older people is the National Service Framework (NSF) for Older People was published in May 2001. The NSF sets a number of important standards for NHS services for older people and the use of medicines is important to each of the NSF standards. One of the standards in the NSF is specifically about "medication review". This states:
 All people over 75 years should normally have their medicines reviewed at least annually and those taking four or more medicines should have a review 6 monthly.
An independent researcher was commissioned and arranged a number of discussion groups with older people and their carers. The participants for these groups were recruited in two ways:
  • With the co-operation of Age Concern London and local Age Concern groups
  • With the co-operation of two pharmacies (one independent pharmacy and one pharmacy that was part of a chain of pharmacies in a large retail store)
Participants suffered from a range of long-term medical conditions. All those involved (including those who were carers) took long-term medications, and a number of people regularly used more than 4 medications. The focus groups covered a range of topics including; compliance with medication, knowledge and experience of medication review, getting the best from the review, what was discussed in the consultation, where the consultation took place, who should be involved, what patients want from the review and how healthcare professionals can help patients get the best from the review.
A number of key themes emerged from the discussions; 
  • there was an enormous appetite to be involved in shaping the NHS in various ways and specifically to develop partnerships between patients and professionals in relation to medications.
  • professionals who answered questions honestly and listened to their patients' concerns were held in high esteem
  • worries about generic prescribing and "post-code prescribing" left a minority of people feeling that medication reviews were not designed to be in the patients' interest
  • the great majority of discussants relished the idea of regular medication reviews and there were many constructive suggestions made on what could be discussed at a medication review, who might be involved, and how they can be made to work best as a tool for partnership between active patients and professionals.
To learn more, and see exactly what patients had to say download the full report.

"Can We Help You?"  - A joint project of Age Concern Blackburn with Darwen, Blackburn with Darwen PCT and Blackburn with Darwen Social Services.
The "Can We Help You?" project was jointly planned by Age Concern Blackburn with Darwen, Blackburn with Darwen PCT and Blackburn with Darwen Social Services with the purpose of identifying gaps in services and support for older people within the borough. It is funded by SRB5 which means that it is currently operating in specific areas of Blackburn, until September 2005.

It is delivered by means of wide ranging, in-depth interviews with people aged 55 and over, usually in the persons own home. It covers all aspects of their situation, including health, housing, environment, transport, benefits, care and social activities. The interview identifies trigger issues, with those which can be met by current provision being referred on to other agencies. Gaps in provision are collated. People can self refer or are referred by other individuals or services. To date over 260 people have been interviewed.
The health aspect covers medical conditions being treated, medicines prescribed, mobility and falls, mental health, general physical wellbeing, sight and hearing.

The information gathered relating to medicines reveals:-
  • People over the age of 75 who are not aware of a review of their medicines taking place 59%
  • Need help getting a regular supply of their medication 49% of which
    Using pharmacist delivery service  65%
    Using family or friends  25%
    Struggling themselves  10%
  • Do not always take their medication the way the doctor wants them to 19% of which
    Not taking painkillers  12%
    Not taking frusemide  12%
    Not using inhalers  16%
    Other  60%
  • Have difficulty opening the containers 25% of which
    Problems with bottles and bubble packs  37%
    Problem with bottles  37%
    Problem with bubble packs  26%
  • Feel that their medicines could work better 14% of which
    Painkillers  32%
    Inhalers  8%
    Other  60%
  • Other problems related to medicines e.g. not sure what they are for, confusion between hospital and GP and side effects 18% of which
    Not sure what medicines are for  38%
    Need help to administer medication  23%
    Confusion between GP and hospital regarding medicines  13%
    Other  26%
The findings of the project point to a number of issues that need to be considered when trying to improve the situation regarding older people and their medication.

Most older people are not aware that they should be having their medicines reviewed regularly. They may have noticed the review date that is printed on the prescription renewal form but have no idea what it means and that they have a role to play in it. Many are not aware of the range of services provided by their pharmacist and therefore target any questions related to their medicines back to their doctor. A significant number are not aware of the reason they are taking particular medicines and therefore what the effect of stopping taking them would be. They also make their own decisions about their medicines without talking to their doctor. Indeed it often seems to be a case of feeling that they need to maintain the appearance of following the doctor's directions whilst making their own decisions. For many people the prescribing of medicines is something that is done to them and not with them; they see themselves to some extent outside the process.

When asked why they do not raise questions about their medicines with their doctor the commonest responses are;
  • I don't want to be a nuisance
  • I don't want to bother the doctor
  • I would be challenging their professionalism
  • They won't listen
  • If I ask questions they might think I am being awkward
The Future
The project will continue to support the Medicines Management Collaborative by gathering relevant local data that takes into account local provision and needs. Its flexibility means that it can tailor the type of information gathered to meet the requirements of the Medicine Management Service Collaborative in improving local provision. The project will continue to feed into the collaborative a local patient perspective.

The project also provides means of getting information from the services to the patients by ensuring that up-to-date advice about how medicine issues can be resolved locally is given during the discussion of issues with the client.

The overall message that is emerging from the work of the project is that for medicine management to be successful and to achieve the desired improvements, the patient must be engaged as an equal partner in the process.
Bernard Styan
Project Co-ordinator "Can We Help You"
Age Concern Blackburn with Darwen
The report of the "Can We Help You?" project is available to download below.

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