Medicine Usage Review - MUR

The aim of an MUR is to help people to use their medicines more effectively. Specifically, the aims are to improve patient knowledge, concordance and use of medicines. This will be achieved through:

• Establishing the patient's actual use, understanding about and experience of taking his or her medicines
• dentifying, discussing and resolving poor or ineffective use of medicines
• Identifying side effects and drug interactions that may affect compliance
• Improving the clinical and cost-effectiveness of prescribed medicines
• Reducing medicine wastage

The second tier of the 2005 NHS Community Pharmacy Contract is formed of advanced services. These are part of the core national contract, although not all contractors will provide them from day one since accreditation of both the pharmacist and the premises will be required before they can be offered. It is hoped that eventually all pharmacists will offer advanced services.

MUR accreditation requirements

In order to provide advanced services, both the pharmacy premises and the pharmacist will have to meet certain accreditation requirements.

The premises must have a designated consultation area in which both the patient and pharmacist can sit down together. The area should be clearly signposted and be distinct from the general public areas of the pharmacy. Within the consultation area, the patient and pharmacist should be able to talk at normal speaking volume without being overheard either by people in the pharmacy or by members of pharmacy staff. Initially, contractors will be asked to self-assess their consultation area for compliance with the criteria. Primary care trusts will check this compliance during their monitoring of the contract.

Every pharmacist who provides the service will have to be accredited. This accreditation will be based on nationally agreed competencies. These competencies are currently being finalised but responsibility for accreditation will fall to higher education institutes.

How the MUR service works

Medicines use reviews will be aimed at people who are taking multiple medicines on an ongoing basis. This service will be increasingly important with the Government's current focus on improving the management of long-term conditions. Medicines use reviews should ideally be carried out every 12 months and the idea is that pharmacists will see patients regularly.

It is likely that PCTs will identify specific groups of patients that pharmacists could target for medicines use review. This will depend on the local population's needs and what other medication review services are being carried out locally. Other health professionals may also refer patients to pharmacists for review.

The prescription intervention service will be initiated when, during the dispensing of a prescription, the pharmacist identifies a need for an intervention to be made. The intervention will have to be over and above a basic intervention that a pharmacist would be expected to make as part of the essential dispensing service. To trigger the prescription intervention service, a problem will have to be sufficiently complex that a detailed examination of the patient's entire medication regimen is needed to solve it, rather than a basic intervention that could be dealt with in isolation.

All reviews will normally be carried out face to face with the patient. Reviews conducted by telephone will be permitted, but only when it is not practical for the patient to visit the pharmacy.

The review itself will involve identifying problems with a patient's medicines, providing advice to the patient and suggesting changes to the regimen to the patient's GP.

Pharmacists should offer advice on both prescribed and over-the-counter medicines to introduce concordance and to develop compliance, including ensuring that patients know how and when to use "when required" medicines. Advice should also be given on tolerability and side effects of medicines, and on use of different dosage forms. If practical problems with ordering, obtaining, taking or using medicines are identified, pharmacists should try to find solutions.

Pharmacists will not be able to change a patient's prescription. Instead, changes should be suggested to the prescriber. The following issues should be considered:

• Lack of adequate dosage instructions
• Unwanted medicines
• Changes to dosage form
• Generic substitutions for branded items
• Dose optimisation (ie, a higher strength instead of multiple doses of a lower strength)
• Improvements to clinical effectiveness. These could include interventions agreed between the PCT, pharmacist and prescriber. For example, highlighting patients on a treatment rather than maintenance dose of a proton pump inhibitor

Recommendations to the GP will be made using a nationally agreed reporting template. A record of the review should be made on the patient's record at the pharmacy and a summary sent to the GP. A copy of both the summary of the review and the recommendations should be given to the patient.

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