What medicines management means to patients

The term medicines management has been in use for a number of years but is, perhaps, a new term for many patients.

This article aims to cover 7 key questions in order to provide patients with an introduction to medicines management and to signpost patients to other sources of information.

Key Questions

• What is medicines management?
• What is medicines management in this project?
• What are the benefits that are proposed for patients who are offered this service?
• What is the intervention like?
• How do we know what patients think about this service?
• How will this help to inform future service delivery?
• Will this service be widely available?

What is medicines management?

The term medicines management is now used to encompass a range of activities intended to improve the way that medicines are used.1

In general, it is useful to think of medicines management as

'helping patients get the best from their medicines'

The use of medicines is the most common healthcare intervention made. It is thought that at least 20% of primary care trust funds will be spent on medicines and related services each year.1

Patients do not always use their medicines in the way that the prescriber intended - leading to avoidable ill-health and waste.1

A recent national survey conducted by the Picker Institute Europe identified that patients want more information about their medicines.2 One third of patients think that they are not given enough information about the drugs they are taking.

There is considerable potential in helping patients get the best from their medicines and there is a lot of activity in this area.

For more information visit www.medicinesmanagement.org.uk, www.npc.co.uk, www.concordance.org, www.doh.gov.uk

What is medicines management in this project?

The medicines management scheme that is being tested in this project takes the form of an interview between the patient and their community pharmacist in order to determine aspects of the patient's medication regimen and lifestyle that could be improved or that may be of concern to the patient.

It has been designed as a very patient-centred intervention.

The pharmacist, with consent from the patient, has access to practice-held patients record as well as pharmacy-held records, however, it is what the patient says and feels about their condition and treatment that is paramount.

For further detail on the this project see the Trial Summary section of the project website www.medicinesmanagement.org.uk

What are the benefits proposed for patients who are offered this service?

The actual benefits to patients are the subject of part of the evaluation of the project - results of which are due to be published in August 2004.

The proposed benefits to patients include:

• an improvement in patients understanding of medicines
• an improvement in confidence and compliance/concordance
• reduction/elimination of adverse drug reactions and side-effects
• a service that is accessible
• a service that can be targeted at the chronically ill

What is the intervention like?

Patients who have been recruited into this project have a confirmed diagnosis of coronary heart disease.

The intervention takes the form of a structured face-to-face interview with the patient.

Issues such as appropriateness of therapy, symptom control, patient understanding of why they are taking the medicine, indication whether the patient is taking the medicine, identification of any problems associated with taking the medicine, and lifestyle factors are all discussed.

Recommendations are then discussed and agreed with the patient or, where necessary, are sent to the patient's GP and are followed up by the pharmacist.

If the pharmacist determines that it is necessary to see the patient again, then another appointment is arranged with the patient. The patient may also be seen opportunistically for follow-up, for example, when the patient presents with a prescription or with a request for over-the-counter medication.

How do we know what patients think about this service?

Patient's experience of this service is a very important part of the qualitative evaluation of the study.

Patients were asked at the beginning of the study to complete a baseline questionnaire; they are also being asked to complete a questionnaire at the end of their 12-month intervention period.

The questionnaire asks some questions about lifestyle; about collecting and taking prescription medicines; what patients expect when collecting prescription medicines; their current state of health today; how much patient's health affects their usual activities; what the patient would like to happen when they visit the pharmacy, and patients travel to their doctor's surgery and to the pharmacy.

Researchers are also conducting patient interviews for a sample of patients after they have seen their pharmacist, midway through the intervention period and at the end of the intervention period. These exploratory interviews are being used to seek patients' experiences of the service.

How will this help to inform future service delivery?

What patients think about the study is very important in developing the service. What community pharmacists, GPs and other healthcare professional think is also very important.

The research team for this project, made up of expert researchers from Aberdeen, Keele and Nottingham Universities, are collecting both quantitative and qualitative data in order to evaluate the feasibility of this kind of a medicines management service being delivered from a community pharmacy.

The final report, due to be published in August 2004, will include recommendations on implementation - and these will very much be informed by patient opinion, as well as by other measures.

Will this service be widely available?

The service is not yet widely available - the way that the eventual service will look will be dependent upon the results of the project and will also be informed by other medicines management schemes currently in operation.

Medicines Management is a high priority area for the NHS and for community pharmacists. One of the ten key roles for pharmacy, as proposed by the Chief Pharmaceutical Officer, is to provide medicines management services, especially for people with enduring illnesses.

It has also been noted that chronic disease will be THE health issue of the next 10-20 years. The World Health Organisation definition and epidemiology of chronic disease states that chronic disease:

'places new long-term demands on health care systems. Not only will chronic conditions be the leading cause of disability throughout the world by 2020; if not successfully managed they will become the most expensive problems faced by our health care system'

There is therefore much scope for community pharmacists to help patients manage their medicines and their conditions so that patients get the best from their medicines and so that the NHS gets the best from the resources it invests in medicines.

Parts of the medicines management - for example, a service entitled medicines-use review focusing on concordance and on how patients use their medicines - may soon be more widely available as part of the terms of service that outlinine the services that community pharmacies provide.

These terms of service are currently under negotiation with the Department of Health - they offer promising opportunities for community pharmacies to continue to deliver high quality services that meet local health needs and are provided at the point of need.

1. MeReC bulletin Vol 12 Number 6 May 2002 available at www.npc.co.uk/merec.htm

2. The Pharmaceutical Journal Volume 271 Number 2760 page 141, 2 August 2003 available at www.pharmj.com

Helen Rhodes
Project Manager
The Community Pharmacy Medicines Management Project
e-mail helen.rhodes@psnc.org.uk
telephone 0191 2516064

December 2003