Minister's Medicines Management Encouragement

15-March-2003 - The Health Minister Mr David Lammy had some encouraging things to say to pharmacists about medicines management when he addressed the dinner of the Pharmaceutical Services Negotiating Committee in London on March 3.

Mr Lammy said that medicines management services were swiftly becoming an established part of the community pharmacy and primary care trust repertoire.

He went on: "Medicines management means different things to different people and covers a wide range of processes, from when it is decided to prescribe a medicine, through supply and review to ensuring it is effective and remains the optimum treatment.

"So far your role has been mainly around supply. However, under any new pharmacy contract, the potential new GP contract and local initiatives funded by PCTs, we are looking for your role to be much bigger. Minor ailment clinics, repeat dispensing, supplementary prescribing and even independent prescribing all offer opportunities for you to contribute to medicines management and ensure that patients get the most out of their medicines.

"The scenario of opening a patient's bathroom cupboard and finding a stockpile of unused medicines will reduce, due to you being able to use your skills and experience to increase patients' knowledge and understanding of their medication.

"Medicines management therefore provides the right environment to: identify problems and devise appropriate solutions locally; engage professionals and patients; and deliver lasting benefits.

"Many millions of people will be able to benefit from wider adoption of these schemes."

Mr Lammy said that work was in hand on a generic medicines management framework for the National Service Frameworks dealing with longer term conditions such as diabetes and renal services, "where we can see a much enhanced role for pharmacists in monitoring patients, providing advice and bolstering compliance."

Mr Lammy said that a further £9.1m would be spent next year "to support the better use of medicines and development of the strategy."

On local pharmaceutical services, he said that they would make pharmacy the pivotal point in the interface between primary and secondary care. He added: "I have no doubt that LPS will encourage innovation, provide flexibility and help to make better use of your skills."

Medication Review Service

Speaking earlier at the dinner, Mr Barry Andrews (chairman of the PSNC) reminded the Minister that the PSNC had brought to him proposals for a new "medication review service".

He described this as a "structured intervention by community pharmacists benefiting particularly those patients on multiple medication and those with chronic, long-term conditions."

He went on: "It's a service that could be introduced quickly, and could deliver results quickly. We're confident the results could be impressive. Better and more improved medication. Improved prescribing patterns. Greater patient compliance. Better health outcomes.

"We are ready to start working on implementing medication review services. All we need is the green light from you."

On pharmacists treating minor ailments under the NHS, Mr Andrews noted that pilots in Scotland had been so successful that "the service was soon to be provided throughout the country."

He pointed out that minor ailment schemes were in place in nine PCT areas in England and urged that they be brought in nationwide.

On repeat dispensing, Mr Andrews noted that pathfinder trials were to go ahead and said that the British Medical Association had recently commissioned a survey which showed that 84 per cent of people asked were happy with the idea of obtaining their repeat medication direct from the pharmacy.

Pharmaceutical Care Adoption is for the Profession, Not Just Enthusiasts

15-March-2003 - The adoption of pharmaceutical care must be a project for the whole profession, Professor Douglas Hepler (University of Florida) said at a conference in Hilleroed, Denmark, in February. It was too much to expect of a few innovative pharmacists, he told participants at the conference, which was organised by the Pharmaceutical Care Network Europe.

Other points made by Professor Hepler were:

• The spread of pharmaceutical care requires inter-dependent "adoption" decisions by pharmacists, patients, physicians and payers
• Preventable drug related morbidities are so prevalent and costly that improved quality may be possible without additional total cost to the health care system
• Simulation [through mathematical modelling] confirms the theory of pharmaceutical care: safe and effective drug therapy requires appropriate monitoring, dispensing and follow-up and that cost-effective solutions are theoretically feasible
• A permanent change to pharmaceutical care will require a change in the market for pharmaceutical services
• Relax emphasis on pharmacy. Pharmaceutical care is not "about" pharmacy
• Focus on the real problems of medications use from patient and societal perspectives

A workshop at the conference noted that the formal concept of pharmaceutical care was an ideal, which might not be necessary for every patient. Given that, the minimum briefest encounter needed for every patient required answers to the following four questions (given the acronym GEAR):

• Is the patient actually Getting the medication and does he or she know how to use it
• Is the patient getting (or likely to get) the intended therapeutic Effect
• Is the patient having (or likely to have) an Adverse effect
• Does the patient know what is Required to intelligently participate in drug therapy

The information adduced by those four questions could lead to the detection and resolution of drug therapy problems. Further information about Professor Hepler's address and of other contributions to the conference can be found on the PCNE website.

Patients Recruited for RESPECT Trial

7-Jan-2003 - Recruitment of patients has now been completed for the MRC trial of pharmaceutical care formerly known as the OSPREY trial, but now renamed RESPECT because of a name clash.

The trial will look at the effectiveness of pharmaceutical care in reducing drug-related adverse events, and improving quality of prescribing and compliance. It will also look at the cost effectiveness of pharmaceutical care in the community and quality of life issues. The primary outcome measure will be appropriateness of medication.

Patients who are eligible to take part in the trial are 75 or over, live at home, take five or more medicines and use a pharmacy that has volunteered for the trial.

Data is to be gathered from 24 general practices and around 60 pharmacies in East Yorkshire and Hull.

Personal interview was used in recruiting patients, and some 760 have agreed to participate, exceeding the target of 700. Some 400 are expected to complete the trial, the final data collection phase of which will take place by the Spring of 2005.

The first training of participating doctors and pharmacists will be conducted in January 2003.

A training evening for pharmacists will cover the construction of pharmaceutical care plans and will be supported by a booklet on pharmacology and medical pathologies encountered when working with the elderly. A pharmacists' manual will also be provided; this will facilitate the preparation of care plans and invoicing for payment. A further training evening will be held for participating doctors and pharmacists.

The first intervention cohort will come on stream in March 2003.

News of progress of the trial is given in a newsletter put out by the trial co-ordinator, Stewart Richmond, based at the Department of Public Health and Primary Care at the University of Hull.

The Universities of Hull, York and Bradford are collaborating in the trial, which is located in East Yorkshire and Hull. The principal investigators are Dr Ian Wong, now of the School of Pharmacy in the University of London, but who was formerly on the staff of the school of pharmacy in the University of Bradford, Professor Peter Campion of the University of Hull and Professor Ian Russell of York University.

Medication Review Guide Published

20-Dec-2002 - A guide to medication review called "Room for Review. A guide to medication review: the agenda for patients, practitioners and managers" has been published by the Medicines Partnership and the Medicines Management Services Collaborative. The guide is available with a range of tools and materials to download. The guide has suggested the following definition for medication review: "A structured, critical examination of a patient's medicines with the objective of reaching an agreement with the patient about treatment, optimising the impact of medicines, minimising the number of medication-related problems and reducing waste".

Read the Guide

UK Government Establishes Intergrated Care Network

28-Oct-2002 - The Department of Health is joining forces with the Office of the Deputy Prime Minister to provide more support to local authorities and the NHS wanting to work in partnership. The Integrated Care Network will work with local authorities and NHS Trusts and Primary Care Trusts to help them develop resources to support their local communities.

The new partnership is expected to help local authorities and the NHS to use their resources more effectively and less duplication and fragmentation of services. This is expected to create a better standard of care and support for the people who rely on those services.

The move is follows on from the Care Trusts set up earlier this year, focusing on older people and people with mental health problems, the Government is also planning to set up Children's Trusts from December.

Health minister Jacqui Smith said: "The Integrated Care Network is key to developing more local partnerships, which will ensure that the people who rely on care from both health and social services get a better deal. The partnerships will focus on many groups including children, older people and the disabled, who will have experienced problems in receiving joined up services in the past. There are already many examples of effective joint working between local government."

Four LPS Proposals Approved

24-August-2002 - Four proposals for local pharmaceutical services pilot schemes were approved by the Department of Health. Three were preliminary proposals from primary care trusts in the North West which have still to find contractors to implement them.¹³⁹ They related to Salford PCT, Central Manchester, and North and South Manchester PCTs, and Ashton, Leigh and Wigan PCT. The fourth, In Northumberland, has a service provider. Further information is available at www.doh.gov.uk/local pharmaceutical services/index.htm. The development of the North West proposals was supported by the North West Medicines Management PCT Network.

ABPI Conference Focuses on Medicines Management

16-July-2002 - "Making the Most of Medicines Management" was the theme of a meeting organised in April by the Association of the British Pharmaceutical Industry as part of its series of conferences for professional advisers. Free copies of the report of the meeting are now available from the ABPI (contact Margaret Fleming).

The meeting focussed on medicines management and how it was likely to influence the provision of health care. The chairman was Jeremy Hallett (assistant director, National Primary Care Development Team). Speakers were Adrian Towse (director, Office of Health Economics), who gave preliminary details of an OHE/University of York survey of medicines management across 329 primary care organisations and 275 NHS hospital trusts [report to be published in August], Clive Jackson (director of the National Prescribing Centre, Darrin Baines (director medM), Paul Streets (chief executive, Diabetes UK), Peter Jackson (commercial development manager, Leo Pharmaceuticals), Ian Greaves (GP, Gnossal Surgery, Staffordshire), Stephen Collins (assistant director, Commission for Health Improvement), and Ian Small (head of prescribing, Norwich PCT).

Disease State Management Pilots in Portugal

11-July-2002 - Disease state management programmes are being piloted by Portugal's National Association of Pharmacies (Associação Nacional das Farmácias, ANF).

The programmes are pharmacist managed. They follow disease state management and pharmaceutical care principles, ANF says. Portuguese community pharmacists are being supported in implementing the programmes, the impact of which will be assessed.

The time-table is: Development stage, September, 1999, to July, 2001; implementation (pilot), September, 2001, to July, 2002 (expected); evaluation, September to December 2002. The pilot is taking place in six geographical regions throughout Portugal. Therapeutic areas covered are asthma, diabetes and hypertension.

Approximately 90 pharmacies (30 per programme) and 120 community pharmacists are involved. Patients number 352. Initial visits have been performed and follow up visits are taking place according to intervention protocols. Patient data and care provided is being documented. Main parameters being documented are: patient data, drug use profile, drug-related problems, clinical measurements performed (eg, blood pressure, blood glucose, cholesterol), use of health care resources, pharmacist intervention, and time spent.

Suzete Costa of the ANF says: "Our main goal is to test the methodology we have designed and some process and outcome indicators. After the pilot, we expect to refine the methodology and expand the programmes to other pharmacies so that we can change practice in a sustainable manner and obtain data that demonstrates the added value of pharmacists."

The development of strategy and materials and the training of pharmacists by the programme manager are supported by the ANF through its Pharmacy Based Disease Management Department. Follow up for patients is at present performed on a voluntary basis at no cost to patients. The programmes have been developed through collaboration with Professor Dennis Helling (pharmacy operations director, Kaiser Permanente Colorado, USA).

A poster on the project was presented at the European Society of Clinical Pharmacy Spring Conference in Slovenia in May 2002. Copies of the poster can be obtained from Ms Suzete Costa.

DRP Classification Proposal

27-June-2002 - A proposal that "drug related problem" (DRP) should have its own chapter in the International Classification of Primary Care (ICPC) produced by WONCA (World Organisation of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians) has come from Spain. The proposal is made by pharmacists associated with the research group on pharmaceutical care at the University of Granada and the research group on applied pharmacology and pharmacotherapy at the University of Seville. The ICPC is a standard reference used by doctors to classify health problems - Espejo J, Fernández-Llimós F, Machucha M, Faus MJ. Problemas relacionados con medicamentos: dedinición y propuesta de inclusión en la Clasificatión International de Atención Primaria (CIAP) de la Wonca. [Drug related problems: definition and proposal for its inclusion in the International Classification of Primary Care (ICPC) from WONCA] Pharmaceutical Care Espana 2002;4:122-7.

Indicators in Drug-Related Morbidity

27-June-2002 - A key paper on the development of indicators for drug related morbidity has just been published in the UK. The indicators take the form of an adverse therapeutic outcome and an associated pattern of care that led to the event. An example is concurrent use of two or more oral or topical NSAIDs for two weeks or more leading to dyspepsia, upper gastrointestinal bleed, GI perforation, GI ulcer or anaemia.

The indicators have been developed by Hepler and other workers in North America as a means of preventing drug-related morbidity. Their acceptability for use in the UK has been tested by researchers from the school of pharmacy in Manchester with the involvement of Hepler (who is a visiting professor at the school).

Using the Delphi technique, consensus was reached for 20 indicators (19 of the 57 US generated indicators and 10 generated during the exercise) in a panel of six general practitioners with responsibility for prescribing issues and 10 pharmacists involved in medication review in primary care. Further work is in progress on refining and operationalising the indicators. They could be incorporated into computerised prescribing systems used in general practice.

The agreed indices are listed in the paper. Morris CJ, Cantrill JA, Hepler CD, Noyce PR. Preventing drug-related morbidity-determining valid indicators. International Journal for Quality in Health Care 2002;14(No3):183-98. An abstract can be found in the Research Database on this site. Reprints of the full paper are available from Caroline J. Morris, Drug Usage and Pharmacy Practice Group, School of Pharmacy and Pharmaceutical Sciences, University of Manchester, Oxford Road, Manchester M13 9PL. E-mail caroline.j.morris@man.ac.uk.

Third Wave of Medicines Management Pilots

27-June-2002 - The third wave of medicines management pilot projects under the National Medicines Management Services Collaborative Programme is due to start in October. Primary care trusts have now been invited by the project team, which is based at the National Prescribing Centre in Liverpool, to apply to be a third wave site. There will be up to 40 sites in the third wave, following on from 26 in the first and 40 in the second.

The project team is writing to all PCT chief executives in England giving details. This letter, further guidance on the MMS programme and an application form can be found on the NPC website. Those interested in applying are asked to inform the project team of this by July 26. Completed applications should be sent to Richard Seal (Medicines Management Project Team Leader) by noon on August 28.

MeRec Bulletin Focuses on Medicines Management

29-May-2002 - The latest edition of MeRec Bulletin (Vol 12, No 6) focuses on medicines management services. It reviews current policy and reports progress to date. It lists useful information resources. The bulletin introduces a classification of medicines management services into five main types:

• Clinical Medicines Management - This involves assessment, monitoring and review of prescriptions for individuals. Examples given include disease management clinics for patients taking anticoagulants, patient medication reviews and clinical pharmacy interventions
• Systems and Processes - Repeat prescribing and audit are mentioned here
• Health of the Public - These services, the bulletin says, address public health issues and provide education about medicines. Examples given are services for smokers or the elderly or for a disease area that may be high on the local public health agenda, such as, cardiovascular disease. Risk management (aimed at reducing errors) and disease prevention strategies are also mentioned.
• Medicines Management at the Interface - Examples given under this heading include formularies and guidelines, discharge planning and use of patients' own drugs in hospital.
• Patients and their Medicines - Services under this heading help bring together health and social care and allow patients to remain safe and independent in their own homes. Examples of such services include patient education, provision of support for carers, domiciliary medication review, and delivery of medication.

The bulletin concludes: Medicines management is an essential part of a safe, effective health care system and its development is now a major policy priority for the NHS.

Pharmaceutical care research conference in Denmark

16-May-2002 - The Third International Working Conference "Pharmaceutical Care Research - the Next Generation" will take place in Hillerød, Denmark, from 12-16 February 2003. The conference is being organised by the Pharmaceutical Care Network Europe in co-operation with the Pharmakon, the Danish College of Pharmacy Practice. There will be workshops, lectures, a debate and a poster discussion forum. Workshops will focus on study design, implementation of research findings in practice, patient adherence, economic aspects of pharmaceutical care provision and measuring outcomes. Lecture topics will include "the way forward for pharmaceutical care". A debate will take place on the motion "high quality pharmaceutical care research cannot be performed in the community pharmacy setting."

Details from Bente Frøkjær, professional secretary, PCNE. Download an application form (PDF)

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