Repeat prescribing: ways to improve this necessary
evil
During the primary care programme on 8 October, speakers
addressed the pharmacists role in medication review services and working
within the primary health care team to help coronary heart disease patients.
Opportunities in medicines management were also considered.
Providing a medication review service in primary
care is an opportunity for pharmacists to improve the way in which patients
use their medicines, according to Margaret Culshaw, pharmaceutical adviser,
South Huddersfield Primary Care Group.
However, to understand the need for medication review,
it is necessary to understand how medicines are prescribed in primary
care. Up to 75 per cent of prescriptions issued by general practitioners
are repeat prescriptions, and repeat prescribing is probably the main
reason for medication reviews. Repeat prescribing decreases consulation
time and is “a necessary evil without which primary care, as we know it,
would not exist,” Mrs Culshaw said. However, repeat prescribing systems
are far from perfect.
A recent audit of repeat prescribing systems in
South Huddersfield showed that when a repeat prescription was requested,
20 per cent of repeat items had a review date that had passed. Of more
concern was the fact that 60 per cent of items had no review date planned,
she said.
Mrs Culshaw said that the definition of medication
review is the process whereby a health care professional reviews patients,
their illnesses and drug treatments needs, therefore it would be a mistake
to consider pharmacists as the only professionals able to carry out medication
reviews. However, although medication reviews may be best done by a doctor,
this may not be possible and pharmacists are the best qualified alternative.
A medication review by a pharmacist can take a number
of forms and pharmacists have described and developed many different approaches,
including brown paper bag reviews in community pharmacies, pres-cription
record reviews, domiciliary visits and nursing home review schemes.
Other ways in which pharmacists provide medication
reviews are by targeting specific conditions and by carrying out reviews
by appointment. The latter, she said, involves patients attending a 20-
to 25-minute appointment with a pharmacist at a general practice surgery,
which has the added benefit of all the patients’ medical records being
available on site.
She added that now is a good time for pharmacists
to put forward their plans for providing a medication review service.
Coronary heart disease
Medication review services are one way in which
pharmacists can work in the primary health care team to help patients
with coronary heart disease, according to Rachel Ainger, pharmaceutical
adviser, Selby and York Primary Care Trust. There is a lot of work to
be done around coronary heart disease and pharmacists need to be formally
engaged in primary care trust business. “At the moment I do not think
we are fully utilising the resource that we have, which is community pharmacy,”
she said.
Mrs Ainger commented that coronary heart disease
is a priority area, both in terms of treatment and prevention. “We have
got to get the treatment right, but we have also got to make sure that
we are preventing further coronary events from occurring in patients and
prevent coronary heart disease in patients who are at high risk.”
There are lots of opportunites for pharmacy and
it is essential that integration into the health care team is achieved.
Pharmacists are already involved in health promotion aspects and this
needs to be tied in with other local initiatives. We also need to make
sure that whatever is happening in community pharmacy is fed into what
is happening across the rest of the primary care trust and therefore does
not happen in isolation, she said.
Pharmacists and primary care trusts must make use
of any available evidence so that systems can be developed which use pharmacy
skills appropriately. “On the back of that, we can remunerate appropriately,”
Mrs Ainger said.
Medicines management services
Richard Seal, project leader, national medicines
management project at the National Prescribing Centre, defined medicine
management services as “systems for designing, implementing, delivering
and monitoring accessible, appropriate and cost-effective pharmaceutical
care to patients based on need”, which can happen throughout the health
care system.
In his opinion, the scope of medicines management
is divided into five parts: clinical medicines management services; technical,
managerial and administrative aspects; health of the public; issues at
the interface between care agencies and care providers; and social care.
He felt most strongly about the health of the public aspect and said that
pharmacy has a crucial role to play in this area, for example in health
promotion. Smoking cessation is something that community pharmacists,
hospital pharmacists and even students can get involved in, he said.
Mr Seal commented that not all services will be
needed in all areas. However, where services are offered, they should
be provided to a consistent level of quality by people who are competent.
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