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4th August 2009
Introduction
On 29th July 2009 the Royal Pharmaceutical Society of Great Britain (RPSGB) issued a press release outlining findings from a survey they had carried out which revealed ’how older people are taking a cocktail of medicine without fully understanding what they are or the side effects they are causing’.
Action
In response to their findings, the RPSGB is launching a campaign to urge older people to review the medicine they are taking by visiting their local pharmacist for a Medicine Use Review (MUR).
In addition to the RPSGB campaign, this is a timely opportunity for NHS commissioners, providers and community pharmacies to review how Medicine Use Reviews (MURs) are currently targeted locally, to ensure that all patients are achieving maximum benefit from them. This will include reviewing how the public are made aware of local MUR services; assessing training needs; and addressing communication issues that may be limiting the effectiveness of the service.
Background
On average older people receive many more prescription items per head compared to other age groups. In 2007 people aged 60 years and over received 42.4 items on average, while the average number of items for those aged 16-59 was 9.51. This figure, relating to the number of items prescribed to those aged 60 years and over, has increased consistently each year over the past decade.
MUR was the first advanced service, introduced in April 2005 as part of the new community pharmacy contract. MURs are offered by an accredited community pharmacist and are an opportunity for a person to have a face-to-face discussion with their local pharmacist about how they use and take their medicines.
Summary
Although many older people are very vigilant about taking their medicines, and some are more likely than younger people to stick to a regimen prescribed for them2, this RPSGB survey found that nearly half (43%) of over 65’s are currently taking over five medicines at any one time, with one in five admitting to not always taking the medicine as prescribed. It also identified that 60% of over 65’s believe that they either definitely or possibly have had a side effect from medicine, even though one in five of those said they did not get it checked out.
In response to these findings, the RPSGB is launching a campaign to urge older people to review the medicine they are taking by visiting their local pharmacist for a MUR. A MUR is an opportunity for a patient to have a face-to-face discussion with their community pharmacist about the medicines they are taking with an aim to;
- Help the patient to learn more about their medicines, what they are for, how they affect the body and how to take them to get the most benefit
- Identify any problems that the patient is experiencing with their medicines, e.g. unwanted side effects, problems with ordering, reading labels, opening blister packs or knowing when to take their medicines
- Improve the effectiveness of the medicines, ensuring that the most useful formulation is prescribed, e.g. liquid preparations may be available for patients with swallowing difficulties
- Support clinical and cost effective prescribing and encourage patients not to waste, over-order, or stock-pile their medicines.
What does this mean to medicines management?
The results of this survey highlight the potential problems that may face older people taking multiple medicines.
The NPC have been supporting organisations for over 8 years to improve the medicines management services they are offering to patients, including MUR. More recently the white paper, Pharmacy in England, Building on strengths – delivering the future, highlighted the need for MUR services to be prioritised to meet health needs. The findings from the RPSGB survey can be used together with local health priority information to help commissioners, providers and community pharmacies target MURs to people who will benefit most.
How does this relate to other publications or evidence?
The recommendation for older people to review their medicines with a pharmacist echoes those published in a summary of the chapter on ‘Medicine taking by older people’ from a review undertaken by the Medicines Partnership (2005)3, where they said that ‘Community and other pharmacists can play a valuable role in helping to reduce medication-related problems in this group [older people]” (whilst recognising its plurality and the need to treat all service users with appropriate respect for their autonomy as adults).
The RSPGB announcement also links to advice and recommendations suggested in the following documents and information available from NPC which may be of use to people wishing to make improvements in this medicines management area:
References
1 Prescriptions dispensed in the Community 1997 – 2007 The Health & Social Care Information Centre, 2008
2 Park et al (1999), Quoted from ‘A question of choice – compliance in medicine taking (3rd Edition), Medicines Partnership, NPC+, 2005
3 A question of choice – compliance in medicine taking (3rd Edition), Medicines Partnership, NPC+, 2005
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