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Letters to the Editor
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Medication review
Pharmacists well placed to provide training
From Dr J. Krska, MRPharmS, and others
In the light of the recent concerns over whether there are benefits for
patients in pharmacists providing medication
review services, Petty et
al (PJ, 21 May, p618) suggest that there are questions about who should
perform reviews. Although we would agree there are no published randomised
controlled trials of reviews performed by GPs or nurses, we would draw
your readers’ attention to the extensive training programme we have
undertaken in Angus Local Health Care Co-operative.
Following a pilot study in one practice in which five GPs and six nurses
were trained to carry out reviews,1 all GPs and primary care nurses in
the LHCC have been offered training. Initially 45 GPs took up this offer,
which they perceived to be beneficial2 and others have since received the
training. A total of 49 nurses have also received basic training in adding
aspects of medication review to their routine practice.
Training enhanced the quality of GP reviews in the pilot practice1 and
the outputs from GP reviews suggest that, given the same time and systematic
approach used by clinical pharmacists, GP reviews are likely to be as effective
as pharmacist reviews (data in preparation). The nurses’ reviews
are still being evaluated, although we believe nurses are capable of identifying
many common issues, addressing some themselves and referring onwards, most
likely to pharmacists, for further advice.
Initial data suggest that more patients appear to prefer that a review
be carried out by their GP than by a pharmacist.3 However, far from suggesting
that pharmacists should abandon the concept of a medication review service,
we believe our data support the idea that scarce pharmacist resource should
be targeted to patients least likely to receive a review from a nurse or
GP. This could include patients on large numbers of medicines, for whom
a review will be time-consuming, and those in care homes or the housebound
who are less likely to have a domiciliary review by a GP.
For the last year practices throughout the UK have been working towards
targets set by the general medical services contract which includes a medication
review, carried out by a doctor, nurse or pharmacist. Therefore it would
seem appropriate to ensure that these other professionals receive some
training in the process, so that all patients can benefit. Pharmacists
are well placed to provide such training, as well as carrying out reviews
themselves and perhaps supporting pharmacy technicians to contribute to
review services in the future.
Janet Krska
David Gill
Angus LHCC
Denise Hansford
School of Pharmacy,
The Robert Gordon University, Aberdeen
References
1. Krska J, Ross SM, Watts M. Medication reviews provided by GPs and
nurses: an evaluation of their quality. International Journal of Pharmacy
Practice
2005;13:77–84.
2. Hansford D, Krska J, Gill D. General practitioners’ views of pharmacist-supported
training in medication review. International Journal of Pharmacy Practice
2004;12(Suppl):R79.
3. Krska J, Ross SM. Medication review — whose job it is? International
Journal of Pharmacy Practice 2002;10(Suppl):R86. |
The
Pharmaceutical Journal