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Case Study Five

 
 
CLINCAL MEDICATION REVIEW
Level 3 Practice pharmacist led medication review in South Sefton PCT 

Background
A practice based pharmacist started undertaking medication review clinics in April 2002, in a single-handed South Sefton GP practice, in a deprived area with a high rate of medicines use. Reviews were targeted at polypharmacy patients aged 75 years and over, in line with the NSF for Older People. The aim was to develop partnerships with patients to help them get the best out of their medicines. A polypharmacy review tool, approved by the Prescribing Sub-Committee of the PCT, was employed by the practice pharmacist during reviews to ensure consistency of approach.
 
Objectives
  • Help patients get the best from their medicines
  • Improve concordance
  • Reduce unmet pharmaceutical need
  • Increase the number of patients requesting medication reviews
  • Make better use of pharmacist skills.
 
Approach
  • Practice staff telephoned the patients to inform them of the purpose of the review and to arrange appointments to attend the pharmacist's clinic
  • At the review, the pharmacist:
  • Checks patients' understanding of reason for each medicine
  • Seeks to identify any problems with medication (eg forgetting to take medicines, side effects, practical difficulties)
  • Facilitates discussion with patients about their medicine taking
  • Identifies any potential changes to medication and support needed
  • Documents outcomes and follows up any agreed action
  • Advises patients how to contact the pharmacist if they have any questions before the next appointment
  • Pharmacist/GP makes any changes to the repeat system once the recommendations agreed with the patient are ratified by the GP. (Some types of changes did not need to be agreed with GP as authority had already been given to the pharmacist to action if appropriate)
  • Changes communicated to the patient
  • Patient's computer record annotated with the Read code 8B3V.
Following review, a sample of patients is asked to provide feedback on their experience of the process. The survey used was designed in conjunction with the PCT Patient Involvement Officer. Once all patients have been reviewed, re-booking for second of twice-yearly medication reviews will begin.
 
Results
The results of a survey of 40 patients after their initial medication review demonstrated:
  • The review contributed to a better understanding of their medicines (38 patients)
  • 38 patients were content with the location
  • 37 thought the length of the session was right (30 minutes per patient)
  • Many positive comments about the opportunity to talk to someone and to find out more about their medicines.
 
Comment
This is a good example of how a medication review process seeks to involve patients. There is potential for the service to further develop both partnerships and concordance, but it already demonstrates how health professionals can help patients manage their medicines better.
 
Contact
Graham Pimblett and Julia Bate, practice based pharmacists, South
Sefton PCT

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