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‘Little evidence’ for effectiveness of medicines use reviews

Medicines Use Reviews (MURs) have failed in their objectives to improve the effectiveness of medicines or reduce drug waste, a damning evaluation has concluded.

A study by pharmacy researchers at the University of Nottingham found there is ‘little evidence' that pharmacists' medicines use reviews achieve clinically or cost effective improvements in medicines usage.  

Medicines use reviews were introduced in 2005 to ‘improve the clinical and cost effectiveness of prescribed medicines and reduce medicine wastage', which is estimated to cost the NHS £100 million a year.

In England, 1.7 million MURs were conducted in 2009-10, and at a cost of £28 per review the total cost to the NHS was £47.6m.

The researchers recruited two pharmacies in Nottingham and carried out five weeks of observation, during which 54 MURs were observed and 34 patients were interviewed about their experience of the MUR. Pharmacists and support staff were also interviewed.

‘Pharmacists and support-staff were influenced by commercial pressure to meet a specified target number of MURs. Patients with any condition were invited for MURs rather than those with complex conditions and medicine regimes who may benefit most,' the study found.

‘Pharmacists responded to pressures to complete the MURs quickly so that they could return to "routine" duties by adopting a scripted, formulaic approach.'

‘Complex medicine-related issues that did arise were circumvented by the pharmacist and so the opportunity to improve the clinical management of the patients' medicines was lost.'

Most patients revealed that they already felt adequately informed about their medicines, and there was no evidence of a reduction in the wastage of unused medicines.

Mr Asam Latif, a community pharmacist and a researcher in pharmacy practice at the University of Nottingham, concluded: ‘There was little evidence that MURs in practice demonstrated improvements in the clinical or cost-effectiveness of patients' medicine use or reduced waste.'

'Pharmacists need to be clear about the purpose of MURs and organisations should make better provision for pharmacists to implement the service in a manner conducive to realising its intended aim.'

Prescribing and research in medicines management conference 2011, abstract #10.