Medication therapy management
Medication therapy management, generally called medicine use review in the United kingdom, is a service provided typically by pharmacists that aims to improve outcomes by helping people to better understand their health conditions and the medications used to manage them. This includes providing education on the disease state and medications used to treat the disease state, ensuring that medicines are taken correctly, reducing waste due to unused medicines, looking for any side effects, and providing education on how to manage any side effects. The process that can be broken down into five steps: medication therapy review, personal medication record, medication-related action plan, intervention and or referral, and documentation and follow-up.
The medication therapy review has the pharmacist review all of the prescribed medications, any over the counter medications, and all dietary supplements an individual is taking. This allows the pharmacist to look for any duplications or dangerous drug interactions. This service can be especially valuable for people who are older, have several chronic conditions, take multiple medications, or are seen by multiple doctors.
In 2014, the US Centers for Medicare and Medicaid Services required Part D plans to include these services, which led to an expansion of services offered. It is a free service for members enrolled in Part D who meet three eligibility criteria. Enrollees must have at least two chronic conditions, take multiple drugs covered by Part D, and are predicted to exceed a preset amount in annual out of pocket costs for their covered Part D drugs (set at $3,967 in 2018 and $4,044 in 2019).
A medicine use review (MUR) is an advanced service offered by pharmacies in the United Kingdom. It is part of the current contract pharmacies hold with the National Health Service (NHS). An MUR is an opportunity for patients to discuss their medicines with a qualified pharmacist. An MUR is a free NHS service that is held in a private consultation room at a local pharmacy. It is not meant to replace the role of the general practitioner but rather provide:
- A review of all medicines to see if there is any overlapping or interactions
- Give extra information on what medicines are for
- Discuss side effects of medicines
- Identify problems associated with medicines
Pharmacies in the United kingdom are paid £28 for each Medicines Use Review undertaken, up to a maximum of 400 per pharmacy, per year. At least 70% of patients must be in one of the four target groups:
- taking certain high risk medicines on the national list
- recently discharged from hospital with changes to their prescribed medicine
- with a respiratory condition such as asthma or chronic obstructive pulmonary disease
- with cardiovascular disease or risk factors, who are prescribed four or more regular medicines.
The introduction of pharmacists into GP surgeries means that the practice pharmacists can do more to ensure that reviews are carried out where necessary.
Abuse of system
There have been concerns over abuse of the system, whereby multiple pharmacies are using the system to charge the £28 fee for each 10- to 15-minute MUR, and pressuring pharmacists to meet targets for the number carried out, with the review more of a tick-box exercise than a benefit for the patient. There have also been cases of falsification of figures.
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