Transcript Strategic Fusion Model

Maximising MURs
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Eoghan O’Brien
Community Pharmacist
Portglenone
Objectives
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Definition
Why bother?
Barriers
Patient engagement
Paperwork
Consultation technique
Resources
What is an MUR?
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Aim: to achieve a concordant approach to
medicine-taking by:
Improving patient’s knowledge and use of medicines
Establishing patient’s actual use, understanding and
experience of taking medicines
Identifying, discussing and assisting in resolution of
poor or ineffective use of medicines by patient
Identifying side-effects and drug interactions that may
affect patient’s adherence
Improving clinical and cost effectiveness of medicines
prescribed to patients, thereby reducing the wastage
What it 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
Why bother?
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Why do you think pharmacists should conduct
MURs?
MUR Benefits - patients
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Improves adherence to prescribed medication –
50% of patients do not take some element of their
medicines as prescribed
Improves health outcomes – a high proportion of
hospital re-admissions of older people are as a direct
result of poor adherence to medication
Improves quality of life
Encourages or improves self-care and self
management of long term conditions
Reduces in wastage of prescribed medication
MUR Benefits –
Personal/Professional
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Enables better collaboration between
professions
Raises professional standards – big
opportunity which we must grasp. Tablet
counter/Glorified Shop Keeper or
Healthcare Professional?
Increased job satisfaction
Build patient relationships / loyalty
Transforming your Care shift left
GP Benefits
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Reduces workload by providing medicines
management
Improves health of local population
Highlights where patients are having difficulties
with their medicines
Barriers to carrying out MURs?
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What barriers can you think of that would
prevent MURs being carried out in a pharmacy
Barriers to carrying out MURs?
Lack of:
 Motivation
 Training
 Confidence
 Time
How can you overcome these?
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What solutions can you think of?
Some solutions to barriers
Get the right training:
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HSCB Guidance for conducting MURs
NICPLD
NPA / UCA
C&D – COPD Sept 2016
Practical intervention – learn more by doing
The more you do the more confident you will
become
Lack of confidence
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The first few won’t be great – accept this &
learn from them (and every subsequent one!)
Keep it simple – try to cover a few key points
Get on the same level as the patient
Be organised
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Make use of PMR
MUR Prescription Alert Stickers attached to
scripts for collection
Involve other staff in process
Tangible items/information leaflets at hand
Identify patients & have paperwork ready in
advance
Filing system for paperwork
Engaging with Patients
How do you engage with patients?
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Can you think of any techniques?
How do you engage with patients?
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Make appointment – phone no/email. Send
reminder. Bring meds
Explain what’s involved and how long it
will take
‘Here’s something the board wants me to
do. Can you do me a favour?’ approach
Have you got a few minutes to go over your
inhalers/medicines? ☺
Before handing over prescription!
Paperwork
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SOP
Consent form
Clinical record
Reporting back to GP / nurse
Month end
Monthly monitoring
 Claim forms
All in HSCB Guidance for conducting MURs
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Make it Tangible
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Sugar lumps in food/beverages display
In-check Dial
Patient inhalers
Placebo Inhalers
CO Monitor
Tar Jar
Sugar Table
Consultation technique
Health Education England
Standards for pharmacists delivering patient
consultations - March 2014
 Educating patients
 Building a relationship with them
 Respecting their individual needs in order to
recognise them as partners in their healthcare
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http://www.consultationskillsforpharmacy.com
Good communication between
pharmacist and patients?
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Patient-centred approach (Parallel with TyC)
Treating patients as individuals, and working in partnership
with them
Shared decision making with patients, while considering the
patient’s own values, beliefs and expectations
Ask patient for best solution
View patient holistically
Although the pharmacy professional is the expert in
medicines, the patient is also an expert within the
consultation with respect to their health and social situation
Be prepare to adapt to patients needs & learning style.
Some like to come up with solutions; others like to be told
what to do.
Questions
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Can you think of any good questions to ask
patients during the consultation process?
General Questions
How are you getting on with your medicines?
 What medicines do you take and how often?
 Do you know why you are taking each of these medicines?
 Do you ever miss taking your medicines?
 What reminds you to take it? Is it part of your daily routine?
 Are you having any problems with your medicines, or
concerns about taking or using them?
 Are you having any side effects or unexpected effects which
you think might be due to your medicine?
 Can you show me how you use your inhaler/insulin device?
Don’t try to memorise these!
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For patients with asthma
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Do you think your medicines are working?
Do you feel that your asthma is well
controlled?
How many times did you use your reliever
inhaler in the last week?
If you could make one thing better for your
asthma what would it be?
Patients with COPD
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Supplies of steroids and/or antibiotics for
exacerbation:
Do you know when you should start using
your antibiotics/steroids?
If the patient uses a spacer device:
 How often is it cleaned?
 When was it last replaced?
Patients with diabetes
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Have you received any formal structured diabetes education
programme? e.g. DESMOND?
Do you test your blood glucose levels? (not every patient needs
to do this).
Do you know why you test your blood glucose levels?
If you are testing, do you know what to do with the results? If
not – signpost the patient back to whoever asked them to test
their blood glucose in the first place.
Are you aware of the symptoms of a ‘hypo’?
If you had a hypo, would you know how to treat it?
Are you aware of the long-term effects of not managing your
diabetes correctly, and how to reduce the risk of these effects?
Are you aware that some types of medication can have an impact
on driving?
Empathy
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http://ed.ted.com/featured/BXaLcbG4
Compliance
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PMR useful
Fear of hypo – unusual with metformin
GI Side effects
Related health issues
Diabetes
 Annual foot check
 Annual eye test
COPD
 Inhaled steroid therapy only recommended for
exacerbations FEV1 < 50%
Lifestyle issues?
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Opportunity to address cause as well as manage
symptoms
Smoking
Nutrition
Stress Management
Exercise
Yoga
Nutrition
Nutritional Advice
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Overweight and obesity are linked to more
deaths worldwide than underweight
WHO Obesity Factsheet No311
Confusing – conflicting information out there
Reduce processed foods – forgotten what these are?
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Refined carbohydrates & sugar
Processed vegetable oils
Sweeteners
Health claims on packets
Interpreting food labels
Dr David Unwin
Asthmatic/COPD some foods may affect some
patients– raise awareness
Approach to address lifestyle?
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Empowerment
Ask the patient what they want to achieve
‘What would you like to do to improve your
health?’
‘What barriers/challenges are you
experiencing?’
‘How can you address these?’
Ask patient to set goals/targets
Food diary
Impact of chronic stress?
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Sleep
Anxiety & depression
Energy
Nutrition
Stimulants
⇧BP, ⇧TC & ⇧BG
Considerations
 PC
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in consultation room
eCare
Engage with GPs
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Meet to discuss
Powerpoint presentation
Ask them how best to feedback
Can Do Approach
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There’s always time for what is important
You can find reasons for doing and for not
doing the same thing
Whether you think you can, or you think you
can't--you're right
Obstacles are those frightful things you see
when you take your eyes off your goals
Henry Ford