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The increasing number of treatment options and an ageing population has meant that anecdotally more patients are seen with co-morbidities. The multiple specialisms involved in cancer patient care can lead to no one taking responsibility for the patient as a whole potentially resulting in poorer therapeutic outcomes and in-appropriate medicines continued.  

 The Medicines Use Review (MUR) service was introduced in April 2005 as the first advanced service for community pharmacy within England and Wales.  The current model of an MUR is a planned face-to-face, structured adherence-centred,consultation between an accredited pharmacist and a patient to discuss the multiple medicines they are taking, both prescribed and non-prescribed.   The MUR aims to help increase patients’ knowledge and understanding of their medicines, including how and why they should be taken. It also provides an opportunity to highlight any adherence issues, side effects or other medicine-related problems from the patient’s perspective and propose solutions if appropriate.

 

Between August 2016 and June 2017, at UCLH, patients receiving treatment for prostate cancer were invited to receive a full review of their medicines.  The review was undertaken by a specialist Oncology pharmacist.   23 patients were seen in the polypharmacy clinic. Each consultation took approximately 20 minutes, either in person or over the telephone (telephone consultation was equally effective). Each consultation was completed using a specialist medicines optimisation framework that was developed (and validated by the project board).  The framework included tools to measure adherence and health state as well as deprescribing criteria which was outlined in the STOPP/START toolkit. 

At follow up, 23/23 patients (100%) found the clinic beneficial, 11/23 patients (48%) had an improvement in health state (average improvement in patients’ health state was 16%) and 7/23 (30%) had an improvement in their adherence (15/23, 65% had no change in their adherence). The average number of medicines stopped per person ranged from 0-2; overall 14 medicines were stopped in the population seen. Of the interventions made (total of 20) by the Oncology Pharmacist at the time of consultation, 80% were clinical, 25% were economical and 20% were general advice.

The project highlighted the importance for long term pharmacy input to: keep ensuring access to lifelong personalised care, manage chronic diseases and reduce in-appropriate poly-pharmacy among cancer patients despite there being no direct savings on wasted medications.   During the pilot we developed tools to enable an effective MUR and questionnaires to assess satisfaction.

We would like to carry on this work and enable generalist community pharmacists to conduct a similar review with patients.  As a group of cancer specialists we would like to make sure that community pharmacists are trained to be able to understand enough about cancer to be able to give appropriate advice to cancer patients about non-cancer medicines.

We plan to do this in a number of ways

  • Hosting of a series of webinars aimed at community pharmacists through the British Oncology Pharmacists Association
  • 1:1 peer training from Cancer Pharmacist “Champions” within the community pharmacist setting.
  • E-learning and allocation of mentors and support.
  • Testing of tools developed in the pilot on a wider scale.  

We plan to use the Plan -do- Study Act methodology and apply iterative changes our improvement plan.  We will start by supporting the Greenlight Pharmacy chain based in Islington to develop the confidence to conduct an MUR in Cancer Patients.  Stage 2 will be to involve South West London and Manchester (Wells Pharmacy)

 

Measures of success will be numbers of MURS conducted in each Pharmacy and process measures will be assessed by level of confidence by the community pharmacist.  We have support from a national network of oncology Pharmacists (The British Oncology Pharmacists Asssociation), a network of approximately 1000 members.  

How you can contribute

  • Ideas from other members based in primary care to help develop the proposal further.

Comments

  1. Guest

    Jen Cockerell 3 years ago

    This is a really valuable project. I've lost count of the number of diabetic patients I've met who've struggled to control their glucose levels whilst on steroids prescribed with their chemotherapy. That's just one of the many co-morbidities. Keep up the good work!

    1. Guest

      Joseph Williams 2 years, 12 months ago

      Thank you for your comment Jen.  Cancer patients who are on long/short term steroids and diabetes is a huge issue; we came across this issue many times during our initial study!  Managing this at a community pharmacy level too would be great for our patients.

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