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Rob Waller
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Medicine Review Process

9.2. Introduction

Review of  and medicine-taking is seen as an important aspect of health care. Professionals involved in prescribing and dispensing of medicines are currently reimbursed for reviewing medicines. General practitioners in the UK are remunerated for  via the Quality and Outcomes Framework (QOF). Community pharmacists are reimbursed for carrying out reviews which are called Medicines Use Reviews (MURs). The Dispensing Review of Use of Medicines (DRUM) is part of the Dispensing Services Quality Scheme for GP surgeries.

The terminology in this area is not standardised and is subject to change. The  Partnership Programme  defined  as ‘a structured, critical examination of a patient’s medicines with the objective of reaching an agreement with the patient about treatment, optimising the impact of medicines, minimising the number of medicine-related problems and reducing waste’. It is implicit in this definition that the patient is involved. In ‘Room for Review’ in 2002 they suggested four levels of medicine review – level 0 which is an ad-hoc opportunistic review; level 1 a prescription review which is a technical review of a patients list of medicines; level 2 is a treatment review which is a review of medicines with the patients full notes and level 3 which is a clinical medicine review which is a face-to face review with patients of medicine and condition. A review with the patient’s notes but not necessarily with the patient (as in level 2 as described above) fulfils the criteria for QoF. An MUR is described as a one-one conversation between people and pharmacists that are designed to identify any problems a person is experiencing with their medicines (Pharmacy in England White paper 2008) . Community pharmacists carrying out these reviews will not generally have access to clinical information about patients. The recent Pharmacy in England White Paper (2008)  reports that many people report satisfaction with this service but longer term impacts can not be assessed. The White Paper reports that government plans for MUR services to be prioritised to meet health needs and ensuring funding rewards health outcomes.

The National Prescribing Centre has recently revisited the topic in A Guide to  (2008). The guide aims to advise those providing and commissioning medicine reviews. This characterises 3 types of medicine review with an emphasis on the purpose of the review: Type 1 prescription review; Type 2  and  review and Type 3 clinical medicine review. The three types of medicine review replace the earlier levels of medicine review. This reclassification appears to make clearer the role of the review and the place of the patient and clinical information in different types of review.

The  were interested in whether there was any evidence that  improved either shared decision-making or . In this context medicine review has to involve a face-to-face meeting with professionals and patient. The professional involved was not pre-defined. The evidence search used ‘medicine review’ as a generic term.

9.3. Does medicine review increase shared decision–making or adherence?

Related references Evidence statements (summary of evidence)
All retrieved evidence There is conflicting evidence with regards to whether  increases .
Lowe (2000) ; Sturgess (2003) ; Bernsten (2001) ; Begley (1997) ; Nazareth (2001)  Four RCTs conducted in the UK shows that  increased  to prescribed medicine. One RCT showed no statistically significant difference in .
Lipton (1994) ; Hanlon (1996) ; Chisholm (2001) ; Taylor (2003) ; Grymonpre (2001) ; Sookanekun (2004)  There is conflicting evidence from six RCTs conducted outside the UK that  increases  to prescribed medicine.
Grymonpre (2001)  was carried out by pharmacists in all of the RCTs, except for one RCT where a trained volunteer undertook the review which was then reviewed by a pharmacist consultant.
Lowe (2000); Hanlon (1996); Grymonpre (2001); Nazareth (2001); Taylor (2003); Bernsten (2001) ; Begley (1997) ; Sturgess (2003)  Most of the RCTs included only participants over 65 years old.
 

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