Establishing an evidence base for medicines use review: the development and evaluation of methodologies to assess the impact of medicines use review in practice

Mohammad, Abdul-Wahid (2008) Establishing an evidence base for medicines use review: the development and evaluation of methodologies to assess the impact of medicines use review in practice. PhD thesis, University of Greenwich.

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Abstract

The aim of this thesis was to develop and evaluate methodologies to assess the impact of medicines use review (MUR), a new service introduced under the new Community
Pharmacy Contract in April 2005.

A cohort study utilised a prospective active group of 120 patients recruited from 7 pharmacies across Kent with a retrospective control cohort matched for age, sex, GP practice and number of medicines. The primary outcome measure was a reduction in drug therapy problems (DTPs) with a 64% resolution observed in the active group compared to only 3% in the control group over the six month period of the study. The effect size was significant (p<0.0001) with an absolute risk reduction of 61% and a number needed to treat of 1.6. This means for every 16 DTPs receiving an intervention, 10 DTPs would be resolved over and above standard care at 6 months. There were no significant differences in secondary outcome measures (number of repeat medicines and use of health services) between the two groups.

A focus group of 6 patients not involved in the main study confirmed that MUR was well received by patients with overarching themes of awareness and trust. In addition a semi-structured questionnaire completed by 72 study participants confirmed that MUR was well received by patients.

Two further focus groups of 6 pharmacists (providers and non-providers of MUR) were also conducted which raised contrasting views regarding the New Pharmacy Contract but showed an overwhelming consensus between both groups that MUR was a beneficial service.

On the basis of these results, one can conclude that the hypothesis 'MUR will reduce drug therapy problems and will be well accepted by both patients and pharmacists' can be accepted. These findings make an original contribution to the literature and represent a significant contribution to the evidence base in support of MUR services.

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