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Medication review

Holistic approach needed in primary care

From Ms V. Burgess MRPharmS, and Dr A. Rogers, MB BS

Bryony Dean and Ann Jacklin suggest a solution to medication review in primary care involving letters from hospital pharmacists to general practitioners in an attempt to resolve potential medication-related problems that have been identified in secondary care (PJ, March 3, p282). Any attempt to improve medication review would be welcomed, but there are several issues not addressed by the system proposed.

The amount of paperwork GP practices currently receive is a real issue of concern and we suspect that most GPs would prefer a more complete discharge summary taking a holistic approach to medication review rather than another set of paperwork. Additionally, in most practices the repeat prescribing system for a patient discharged from hospital would be updated from the discharge summary and to add further paperwork would add an element of risk to this.

Achieving effective medication review as part of repeat prescribing systems in primary care is a huge issue involving many steps. The source of most confusion for patients discharged from hospital is a lack of complete information in discharge summaries regarding actual medication changes in secondary care, changes in brand name or formulary switches and incomplete drug histories on admission.

Prescribing priorities and pressures are different in primary and secondary care. Although all are guided by national objectives, such as national service frameworks, it is essential that secondary care pharmacists providing the advice fully appreciate these differences, and that key prescribing messages are agreed across the interface in a meaningful way.

If consistent prescribing patterns which cause particular concern are identified by secondary care pharmacists in hospital inpatients, it may be more effective to discuss these concerns at primary and secondary care prescribing committees or at interface prescribing meetings. This would facilitate a mutual understanding of the prescribing behaviour and a meaningful intervention for all patients can be devised.

A focus on joint educational events for primary care prescribers and community pharmacists involving primary care group and trust prescribing advisers is more likely to improve practice and promote understanding in both primary and secondary care .

We believe that huge benefits would be realised in primary care if the above issues were addressed and although the system proposed has commendable aims, it might not be the holistic approach we are all looking for.

Vanessa Burgess
Prescribing Adviser

Alan Rogers
Chairman, South Southwark PCG

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