DIABETES FRIO INSULIN-COOLING WALLETS
Those who have been diagnosed with
diabetes may be on a
considerable amount of medication. This can be overwhelming and adherence can be a problem
Table 1(10) table outlining what a MUR is and is not
A MUR is • Identifies if patients understand how medicines should be used • Discusses how patients should correctly use their medicines • Identifies if patients know how to use their medicines • Explains the conditions for which each medicine is used • Establishes whether patients use their medicines as prescribed • Identifies any issues affecting correct use of medicines • Identifies side effects that may be experienced from medicine use • Identifies any medicines no longer used • Reduce medicines wastage
A MUR is not • Discussion about changes to drug treatment • Discussion about the medical condition beyond the drug treatment • Discussion on the effectiveness of treatment based on test results • Full clinical medication review
> cerebrovascular damage). Medications would involve anti- hypertensives, statins and antiplatelet therapy.
Medicines Use Review Medicines Use Reviews (MURs) have been introduced in Northern Ireland from April 2013. Pharmacists are allowed to conduct an initial MUR and a follow-up MUR if one is deemed necessary. Currently 96% of pharmacies have been contracted, with the HSCB, to provide the MUR service. Since the introduction of the service over 72,000 initial MURs have been completed. (9)
What is the purpose of an MUR? The purpose of an MUR is to improve the patients’ knowledge and use of their medicine leading to an improvement in adherence. It is a structured review which should help patients to understand why they are taking their medication, to identify any problems and to find solutions to the problems in order to improve clinical outcome (see table 1).
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An MUR should be conducted face to face with the patient in the pharmacy. Provision of the service at another location should only be done by exception and in such cases, the reason for providing the service in this way must be documented in the clinical record.
Why offer MURs? Since its introduction in 2013, pharmacists have reported that they found conducting MURs very rewarding. It has also been reported that patients found the service as very beneficial. (11)
The provision of MURs allows pharmacists to use their professional skills and expertise to improve their patients’ quality of life. It allows the pharmacy to develop customer loyalty - the advice and support you provide to a patient will help to build a really strong customer relationship. A MUR will help to improve patient health outcomes and the cost effectiveness of prescribed medicines. (10)
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A critical element to the success of MURs is effective communication between GP and pharmacist. Pharmacists are strongly recommended to contact GP practices to discuss MURs and in particular the protocols for referral and administration. The GP may also provide information on target groups, e.g. those who do not routinely show up for appointments.
Documentation When undertaking an MUR there are a number of documents to be filled and retained. For an adult the data collected from each MUR should be kept for a minimum of 8 years from the date the service is completed and may be stored electronically. For children and young people the record should be maintained until the patient’s 25th birthday or 26th if the young person was 17 at the time the MUR service was provided. (10)
There is the Communication page which contains the details of the MUR, and an action plan which summarises any issues identified. This may only be shared with the patients GP if deemed appropriate by the pharmacist (recommendations for GP, issues raised that the GP may be required to be informed about).
If the action plan needs to be shared with the GP then this should be done so by a secure method. There is no requirement to provide the patient with a copy of the communication page unless the pharmacist considers it to be beneficial or it is requested by the patient.
Second would be the Consultation record. This should be used during the MUR to record the issues identified for all prescribed and OTC medicines. Finally there is the Summary page. This summarises the matters identified from the MUR, the action taken, any healthy living advice provided and the pharmacist’s assessment of the benefit of the MUR. (10)
Remuneration Each pharmacy is allowed a maximum of 120 MURs per year (10 per month).
Provision of the service will create an additional revenue stream for your pharmacy - current payment is £28 per MUR and £9 per follow-up MUR where this is deemed necessary (9)
. If
you carry out the maximum 120 MURs per year and follow up on an assumed 50% of patients, you could earn up to £3900 per year from MURs.
Conclusion Those who have been diagnosed with diabetes may be on a considerable amount of medication. This can be overwhelming and adherence can be a problem. Medicine Use Reviews are a cost effective and efficient way to improve patients’ health and understanding of their condition and medication regime. It gives pharmacists the chance to utilise our skills and expertise to the benefit of patient, business and job satisfaction. n
Bibliography 1. UK, Diabetes a Guide.
https://www.diabetes.org.uk/Guide-to- diabetes/What-is-diabetes/. [Online] 2. Type1, Clinical Knowledge Summary- Diabetes.
http://cks.nice.org.uk/diabetes-type- 1#!diagnosissub. [Online] 3. UK, Diabetes Causes. Diabetes UK. Causes and risk factors. Available at
http://www.diabetes.org.uk/Guide-to- diabetes/Introduction-to-diabetes/Causes_and_R isk_Factors/ (accessed 23.2.12. [Online] 4. Symptoms, Diabetes UK.
https://www.diabetes.org.uk/symptoms?gclid=C jwKEAjw86e4BRCnzuWGlpjLoUcSJACaHG55gU _aDV- bR36Su86iLrerTJwum3uhqv6R8A_8UYbgeRoC0 yDw_wcB. [Online] 5. WHO.
http://www.who.int/diabetes/action_online/basic s/en/
index3.html. [Online] 6. Therapy, Clinical Knowledge Summary- Insulin.
http://cks.nice.org.uk/insulin-therapy-in- type-1-diabetes#!scenario. [Online] 7. management, NICE Guideline- NG28 Type 2 diabetes in adults:.
https://www.nice.org.uk/guidance/ng28. [Online] 8. BP, NICE guidance N28 Recommendations.
https://www.nice.org.uk/guidance/ng28/chapter /1-Recommendations#blood-pressure- management-2. [Online] 9. Pharmacist, HSCB Letter to. HSCB letter to pharmacists-community pharmacy medicines use review service 2016/17, 4th April 2016. 10. MURs, Guidance for Cunducting.
http://www.hscbusiness.hscni.net/pdf/Guidance _for_conducting_MURs.pdf . 11. Newsletter, Pharmacy Reginal. PRN pharmacy regional newsletter, vol 1 issue 2, march 16
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