Medicines Use(less) Reviews

SRxA’s Word on Health brings you news of a great idea gone bad!  Six years ago the UK National Health Service (NHS) introduced Medicine Use Reviews (MURs). Run by community pharmacists, MURs were designed to help patients understand how their medicines should be used and why they have to take them, identify any problems and, if required, provide feedback to the prescriber.

In addition, they were supposed to improve patient compliance and the clinical and cost effectiveness of medicines by reducing medicine wastage which is estimated to cost the NHS £100 million a year. However a damning new study by pharmacy researchers at the University of Nottingham found that they’d failed to achieve either clinical or cost effective improvements. And this failure didn’t come cheap.  1.7 million MURs were conducted between 2009 and 2010 at a cost of £28 ($44.63) per review.  In that period, the total cost to the NHS was £47.6m ($76 million).  Multiply that by the six years the scheme has been running and you’re talking close to $300 million. As part of the review, researchers carried out five weeks of observation in two retail pharmacies, during which 54 MURs were observed and 34 patients were interviewed about their experience of the MUR. Patients with any condition were invited for MURs rather than those with complex conditions and medicine regimes who may benefit most, the study found. They also found that pharmacists responded to pressures to complete the MURs quickly so that they could return to “routine” duties by adopting a scripted, formulaic approach. Complex medicine-related issues that did arise were circumvented by the pharmacist and so the opportunity to improve the clinical management of the patients’ medicines was lost. Moreover, most patients revealed that they already felt adequately informed about their medicines, and there was no evidence of a reduction in the wastage of unused medicines. Asam Latif, a researcher in pharmacy practice at the University of Nottingham, concluded: “There was little evidence that MURs in practice demonstrated improvements in the clinical or cost-effectiveness of patients’ medicine use or reduced waste.”  Ouch!

Smoke Across the Water

While many people in the US are frustrated with healthcare reforms, SRxA’s Word on Health has learned that the grass isn’t always greener elsewhere.

This week, doctors in the UK have been told to stop referring smokers for any routine elective surgery unless their patients quit or complete a government run Stop Smoking course.

The controversial plans, which have already provoked anger among Family Practitioners, have been tabled as part of a draconian package of cost-cutting measures.

Other tactics include extending waiting times for surgery and a halt to all consultant-to-consultant referrals for the rest of the financial year unless clinically urgent.

Family doctors are also being asked to play a greater role in stopping their patients from going to the ER in order to drive down costs.

In a letter sent to all General Practitioners in the South West of England, the National Health Service (NHS) said: ‘There is good evidence to show that stopping smoking prior to surgery reduces length of stay and infection rates, and improves healing time; it is also a time when people are often highly motivated to give up. All patients who smoke and are booked for planned surgery will therefore be required to complete a NHS Stop Smoking course prior to surgery. Going forward, all patients requiring planned surgery should be referred to a NHS Stop Smoking Service before being added to the waiting list. A ‘Non Smoker’ status OR completion of the program is the threshold for surgical referral.’

Opponents of the scheme argue that this will only make waiting lists longer and denies smokers their basic human rights.

Word on Health would love to hear your views on this. Should patients be forced to give up smoking in order to have surgery?  Should smokers pay higher health insurance premiums because they consume higher amounts of healthcare costs?

Have your say now.