Medicines Management
Issue no 4, p1
July/August 2002

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Focus on outcomes in medication reviews

PCTs are beginning their work on medication reviews for older people, but are questioning what an effective review should cover, according to the author of the original NSF guidance.

Professor Alison Blenkinsopp, director, pharmacy department at Keele University, told Medicines Management that PCTs should not get too bogged down in the detail, but focus on outcomes instead.

"There's a lot of debate about what medication review should comprise in response to genuine questions from PCTs about what they should be including," said Professor Blenkinsopp, also professor of pharmacy practice, department of medicines management, Keele University.

"It is about trying to prevent adverse effects, and it may help PCTs to focus on outcomes rather than the process."

Professor Blenkinsopp said PCTs could narrow the focus by asking three simple questions.

"Does the patient still need this medicine, are they having any intolerable side-effects from the medicine, and is the patient still getting benefit from it," she said.

If these three questions could be ans-wered, then the actual process of medication review would not matter so much said Professor Blenkinsopp.

Professor Blenkinsopp said that PCTs should perhaps focus their efforts on older patients most at risk of adverse events, and spend more time on their medication reviews rather than reviewing patients less at risk. She added that a toolkit aimed at helping PCTs with medication review was currently being produced by the National Prescribing Centre. "This should help PCTs in a practical way and should be ready by the autumn." She added that being aware of certain drug classes would also help identify patients more at risk of problems.

"If you look at the research evidence it is essentially the same drugs that are responsible for older people being admitted to hospital with ADRs," said Professor Blenkinsopp.

This approach is being adopted by pharmacists at East Elmbridge and mid-Surrey PCT, which is in the process of rolling out a practice-based medication review service for older people.

Pharmacy adviser Gabrielle Clezy said prioritising higher risk patients was essential. "Just to do the annual review for everyone over 75 years would require a full time pharmacist, so we identify higher risk patients such as those in nursing homes, or recently discharged from hospital."

The PCT's scheme involves paying pharmacists on a sessional basis to train GPs and practice nurses to carry out medication reviews.

She added that the PCT hoped to find a budget to pilot an education module specifically developed to help pharmacists deliver training packages to care home staff to make them more aware of possible problems with medication.

The PCT is also in the process of inviting bids from community pharmacists under the LPS pilot scheme that focus on medication review for the elderly and access to phar-macy services out-of-hours.

Vanessa Lane, chief pharmacist, Elmbridge and Mid-Surrey PCT, said: "We're inviting pharmacists to apply for wave 1b in November, and prioritising proposals around medication review for older people."