Abstract
Polypharmacy is a common issue in patients with chronic diseases. Eastern-European countries and Iran are exploring possibilities for implementing the Medication Use Review (MUR) as a measure for optimizing medication use and ensuring medication safety in polypharmacy patients. The aim of this study was to gain insights into the development of the community pharmacy sector and map facilitators and barriers of MUR in Eastern Europe and Iran. The representatives of the framework countries received a questionnaire on community pharmacy sector indicators, current and future developments of pharmacies, and factors encouraging and hindering MUR. To answer the questionnaire, all representatives performed document analysis, literature review, and qualitative interviews with key stakeholders. The socio-ecological model was used for inductive thematic analysis of the identified factors. Current community pharmacist competencies in framework countries were more related to traditional pharmacy services. Main facilitators of MUR were increase in polypharmacy and pharmaceutical waste, and access to patients’ electronic list of medications by pharmacists. Main barriers included the service being unfamiliar, lack of funding and private consultation areas. Pharmacists in the framework countries are well-placed to provide MUR, however, the service needs more introduction and barriers mostly on organizational and public policy levels must be addressed.
Highlights
In older patients with multiple chronic diseases, polypharmacy and drug-related problems are increasingly serious concerns
The adapted standard includes three levels of medication review (MR): 1. Simple Medication Use Review (MUR) conducted in a community pharmacy by a community pharmacist; the pharmacist receives information about the medication regimen and patient’s diseases from the patient in a face-to-face interview and their general practitioner (GP); the service focuses on educating the patient on their diseases and medicines and detecting issues related to medication adherence and manifested drug related problems
Comprehensive MR conducted in a community pharmacy by a community pharmacist who has passed an additional course in clinical pharmacy; requires information on the clinical test results from the GP as the pharmacist evaluates the medication list for potential drug related problems
Summary
In older patients with multiple chronic diseases, polypharmacy and drug-related problems are increasingly serious concerns. Polypharmacy patients have an increased risk of experiencing adverse drug reactions, geriatric syndromes, morbidity, and decreased medication adherence. Polypharmacy is often necessary, it is important to differentiate inappropriate polypharmacy, which occurs when the patient is receiving medication without an evidence-based indication, their medicines fail to achieve therapeutic goals, they experience or have a high risk of experiencing adverse drug reactions or they are not able to properly take their medications [2]. MR services have been shown to improve medication awareness including improved medication adherence and decreased drug-related problems [4,5,6] The latter is important, as adverse drug events are the 14th leading cause of patient morbidity and mortality globally with a substantial proportion of such medicationrelated harm being avoidable [2].
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