Division of Social Research in Medicines and Health, School of Pharmacy, University of Nottingham, East Drive, University Park, Nottingham, NG7 2RD, UK.
BMC Fam Pract. 2013 May 6;14:57. doi: 10.1186/1471-2296-14-57.
Patient non-adherence to medicines represents a significant waste of health resource and lost opportunity for health gain. Medicine management services are a key health policy strategy to encourage patients to take medicines as they are prescribed. One such service is the English Medicines Use Review (MUR) which is an NHS-funded community pharmacy service involving a patient-pharmacist consultation aiming to improve patients' knowledge of medicines and their use. To date the evidence for MURs to improve patient health outcomes is equivocal and GPs are reported to be sceptical about the value of the service. This paper presents the patient's perspective of the MUR service and focuses on the importance of GP-pharmacist collaboration for patient care. Suggestions on how MURs may have value to GPs through the delivery of increased patient benefit are discussed.
A qualitative study involving ten weeks of ethnographic observations in two English community pharmacies. Observations were made of all pharmacy activities including patient-pharmacist MUR consultations. Subsequent interviews with these patients were conducted to explore their experience of the service. Interviews with the pharmacy staff were conducted after the period of observations. A thematic approach was used to analyse the data.
Fifty-four patients agreed to have their MUR observed of which thirty-four were interviewed. Seventeen pharmacy staff were also interviewed. Patients reported positive views about MURs. However, there was little evidence suggesting that pharmacists and GPs were working collaboratively or communicating outcomes resulting from MURs. MURs were conducted in isolation from other aspects of patient care. Patients considered GPs to have authority over medicines making a few wary that MURs had the potential to cause tensions between these professionals and possibly adversely affect their own relationship with their doctor.
This study reveals the potential for effective GP-pharmacist collaboration to improve the capacity of the MUR service to support patient medicine taking. Closer collaboration between GPs and pharmacists could potentially improve patients' use of medicines and associated health care outcomes. The current lack of such collaboration constitutes a missed opportunity for pharmacists and GPs to work together with patients to improve effective prescribing and optimise patient use of medicines.
患者不遵医嘱用药是对卫生资源的巨大浪费，也是获得健康的机会损失。药品管理服务是鼓励患者按照医嘱用药的重要卫生政策策略。其中一项服务是英国药品使用审查（MUR），这是一项由国民保健制度资助的社区药房服务，涉及患者与药剂师的咨询，旨在提高患者对药物的了解及其使用。迄今为止，MUR 改善患者健康结果的证据尚无定论，而且据报道，全科医生对该服务的价值持怀疑态度。本文介绍了患者对 MUR 服务的看法，并重点介绍了 GP-药剂师合作对患者护理的重要性。讨论了 MUR 通过提供增加患者受益可能对全科医生具有的价值。
一项涉及在两家英国社区药房进行十周民族志观察的定性研究。观察了包括患者与药剂师 MUR 咨询在内的所有药房活动。随后对这些患者进行了访谈，以探讨他们对该服务的体验。观察结束后对药房工作人员进行了访谈。使用主题分析方法对数据进行了分析。
54 名患者同意观察他们的 MUR，其中 34 名接受了访谈。还采访了 17 名药剂师。患者对 MUR 发表了积极的看法。然而，几乎没有证据表明药剂师和全科医生在协作或交流 MUR 的结果。MUR 与患者护理的其他方面是孤立进行的。患者认为全科医生对药物有权威，少数人担心 MUR 有可能在这些专业人员之间造成紧张关系，并可能对他们与医生的关系产生不利影响。
本研究揭示了 GP-药剂师有效合作的潜力，可以提高 MUR 服务支持患者用药的能力。全科医生和药剂师之间更紧密的合作有可能改善患者对药物的使用和相关的医疗保健结果。目前缺乏这种合作，这对药剂师和全科医生来说是一个错失的机会，无法共同努力提高有效处方并优化患者的药物使用。
