| · New contract
· Medicines management
· Registration examination
· Levothyroxine
· Hiccups
· Prescription pricing
· IT
· Personal control
· Control of entry
· Supermarket pharmacies
· Retention fees
· The Society
· The Journal
Letters to the Editor
|
Medicines management
Numbers do not add up
From Mrs P. K. Sandhu, MRPharmS
I refer to the news
item “Trigger questions useful to identify
medicines support need” (PJ, 16 October, p549). First, I commend
the attempt to develop a single assessment process (SAP) with only four
questions because this has the potential to simplify the process enough
to be used in wider practice.
Would the project managers please clarify a few issues on the methodology
and results stated in the article since I have been left a little perplexed.
Question 3: “Can you swallow and use all of your medicines and
get all of your medicines out of their containers?” contains three
questions. Does the patient have to say “yes” to all three
parts to qualify? If all three parts are relevant and important, which
they seem to be, then surely it should be split into three questions
producing an SAP that consists of six questions.
The inclusion criteria of responding “yes” to any of the
questions is also puzzling. Surely, saying “yes” to “Do
you always take all of your medicines the way the doctor wants you to?” seems
to be the perfect response. Am I to understand that by saying “yes” a
patient is actually demonstrating non-compliance as, after all, none
of us is perfect so he or she must be lying?
Finally, with regards to the results, could you please explain where
the 88 per cent of older people needing an alteration to their medicines
was derived from. I understand we have limited data in the story but
the figures just do not add up (or divide).
Since supporting older people is such a key area in medicines management,
an initiative such as this has great potential value. It would help if
we could be assured of the robustness of the methodology before it receives
wider adoption.
Pam Sandhu
Southall
| |
LELLY OBOH, project co-ordinator, replies:
First, I must correct
the statement in the press release: “A
response of ‘yes’ to any of the four questions indicates a potential
pharmaceutical care need.” It should state: “A response that indicates
a problem in any of these areas shows that the older person may have a potential
pharmaceutical care need.” The confusion is because the four trigger
questions were originally statements where a “yes” response would
indicate a need. However they were rephrased as questions in the final report,
which changes
this. I hope this clarifies Pam Sandhu’s next two questions.
One of the eight objectives of the project was to test the four trigger questions
to determine if they can identify older people with a potential pharmaceutical
care need within the single assessment process. They were asked as part of
the overview assessments (or case finding process) along with other non-pharmacy
questions (with or without prompts) to trigger a referral for further assessment
for support. All of those, for whom the trigger questions highlighted a need,
were subsequently found to have a pharmaceutical care need in the in-depth
assessment.
The project was not geared to validate the questions and further work will
be needed to do this.
In 88 per cent of the older people who were part of the evaluation, there
was an alteration made to at least one medication, and in many cases, more
than one.
Although the sample size is relatively small (n=32) we feel this observed
outcome remains important and representative of reality. The reported proportion
refers
to the number of cases (patients) not the number of medicines observed.
The three pilot sites employed different methods to case find their project
population. However each site was limited to 17 patients for the in-depth
medication assessment
irrespective of the numbers found. For the explanation about the numbers
see Table D-1 and footnote on p26 of the final report (www.london.nhs.uk). |
|
The
Pharmaceutical Journal