The Pharmaceutical Journal
Vol 278 No 7449 p486-487
28 April 2007

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Letters to the Editor

Medicines use reviews (MURs)

Right to try to help resolve clinical issues

From Dr D. J. Jenkins, MRPharmS

With reference to the debate about the balance of medicines use review content, I agree entirely with Angela Alexander’s assessment that it is impossible to divorce drug usage issues from clinical issues (PJ, 21 April, p451). The following example, concerning two patients with whom I conducted MURs in the same week, illustrates the point:

• Patient A was prescribed clopidogrel, was unsure why, and also took OTC aspirin 75mg because “it seemed like a good idea”.

• Patient B had been prescribed both clopidogrel and aspirin by her GP for three years. The patient did not remember ever discussing the combination with her GP.

Intervention in the case of patient A is clearly appropriate and is part of the point of an MUR. But what about patient B? The duration of combination therapy is well outside the local guidelines, and the risks to the patient are identical to the previous example, but a comment about it would strictly be a clinical recommendation outside the scope of an MUR.

Pharmacists conducting MURs will encounter many such examples because prescribing for patients with several co-existing morbidities is difficult. We are right to try to help resolve clinical issues because our primary concern is the wellbeing of the patient.

David J. Jenkins
St Ives, Cornwall

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