Unintended consequences
Medication reviews were given a bad press last week. A paper in the BMJ suggested that, if anything, pharmacist interventions caused more problems than they solved and patients were more likely to find themselves in hospital after a review than if they had been left in peace and quiet.
However, before pharmacists start tearing their hair out and wondering
why on earth medicines use reviews have been given such an important
role to play in the new community pharmacy contracts, they should read
the News feature on p106. This puts the findings in context. The researchers
acknowledge, for example, that, in the particular patient group studied
(people who had recently been discharged from hospital), pharmacist intervention
might have improved patients’ adherence to their medicines and,
as a result, the patients, who were old, tended to suffer more side effects.
That, in turn, could have led to their readmission to hospital. This
may be a case of unintended consequences rather than any real shortcomings
with the overall concept of medication reviews.
There is a huge body of research that indicates that patients tend not
to take their medicines appropriately for maximum clinical benefit. In
younger patients who are chronically ill and older patients who have
not been admitted to hospital, it is not yet fully known what the impact
of pharmacist-led medicines use review might be on targeted groups of
people. So the BMJ paper should be seen as an invitation to carry out
more research to determine where exactly the benefits of MUR lie and
what its limitations are. This is likely to strengthen the case for MURs
which, at the moment, may seem little more than common sense.
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Focus on Iraq
Readers might wonder why The Journal has chosen to focus on Iraq, although the first national election planned for this weekend provides a timely hook for an Article on the current pharmaceutical chaos in that country (p115). After all, it does not have anything to do with pharmacy practice in Britain and many people may be beginning to feel compassion fatigue after being bombarded with images from the fringes of the Indian Ocean over the past few weeks.
However, we decided that the article, based on e-mails from an academic pharmacist
at the University of Tikrit, paints such a bleak but moving picture of pharmacy
in a country where the UK Government, for better or worse, has decided to play
a significant role that pharmacists here might like to be aware of the privations
suffered on a daily basis. The tragedy is that people are powerless to do anything
much to help and there does not seem to be any glimmer of hope.
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