Evaluation of the Cwm Taf University Health Board Domiciliary Medicines Use Review (Dom-MUR) Service

Abstract

The Medicines Use Review (MUR) Service is an Advanced Service in the community pharmacy contract in the United Kingdom (UK). It involves the pharmacist reviewing a patient’s use of their medication whose purpose is to improve patient understanding and adherence to medication and reduce medication waste. Since November 2012, the Cwm Taf University Health Board (UHB) in Wales has commissioned a domiciliary MUR (Dom-MUR) service, thereby providing housebound patients with equal access to MURs to those able to visit a community pharmacy. We aimed to identify the types of issues and interventions carried out by pharmacists as part of the Dom-MUR service. A database of Dom-MUR entries from December 2012 – March 2014 was obtained from the UHB. Issues and outcomes arising from Dom-MURs were categorised. Data was quantitatively analysed using Microsoft Excel® and GraphPad Prism®. Data from 194 Dom-MURs was included in the database. The mean number of issues identified per patient was 1.96 (SD±1.41). The three most commonly identified issues were related to ‘Patient Adherence (29%, n=110), ‘Patient Education/ Monitoring’ (21%, n=79) and ‘Medication Excess in Home’ (12%, n=47). The mean number of outcomes per patient was 1.97 (SD±1.48). Of the outcomes, 32% (n=122) involved the pharmacist contacting the GP surgery i.e. they could not resolve these issues themselves. Issues assigned to ‘Issues with Patient’s Condition’ were statistically less likely to be resolved by the pharmacist. The Cwm Taf UHB Dom-MUR service has the potential to be of value in terms of more appropriate and cost effective care. Developments within community pharmacy, such as access to patients’ health records and pharmacist independent prescribing, may benefit this service with the potential for pharmacists to resolve more issues themselves.