MURs and prescription interventions – what is the difference?

MURs and prescription interventions – what is the difference?

A frequently asked question is about the differentiation between Medicines Use Reviews (MURs) and prescription intervention MURs. There is only one service; it is what prompts the review that is the differentiating factor.

Regular MURs can be prompted pro-actively by identification of a certain group of patients (for example, those in the national target groups) that subsequently lead to an invitation for an MUR.

A prescription intervention MUR is more reactive, in the sense that it is the response to a significant adherence problem with a person’s medication that subsequently leads to an MUR being conducted. The issue or issues that prompt the pharmacist to offer an MUR in this circumstance are likely to be highlighted as part of the dispensing process. Commonly the issues will highlight the need for the patient to develop their understanding of their medicines in order to improve their own use of the medicines.

The same consultation occurs for MURs and prescription intervention MURs, i.e. establishing the patient’s actual use, understanding and experience of taking all their medicines; identifying, discussing and assisting in the resolution of poor or ineffective use of drugs by the patient; identifying side-effects and drug interactions that may affect the patient’s compliance with instructions given to him/her; and improving the clinical and cost-effectiveness of drugs prescribed to patients thereby reducing the wastage of such drugs.


Click on a heading below for more information. 

Are dose optimisation and dose synchronisation prescription interventions?

It would not be sufficient for a pharmacist to simply complete an MUR form solely relating to a proposed dose optimisation or synchronisation as an MUR. However, dose optimisation and synchronisation could clearly be included as part of a regular or prescription intervention MUR.

Examples

The following examples are provided to assist pharmacists in determining what may and may not be considered a prescription intervention MUR:

Scenario 1. A prescription requests 56 Lisinopril 10mg tablets TWO to be taken daily. You recommend to the GP that the patient could be changed to 28 Lisinopril 20mg tablets ONE to be taken daily.

This intervention alone would not lead to a prescription intervention MUR, but could be included as a recommendation if an MUR was initiated for another reason.

Scenario 2. A patient presents at the pharmacy with a prescription for 28 days of Aspirin and you know that they came to the pharmacy last week for a 28 day prescription of Simvastatin. When you look at the patient’s PMR you realise that their medicines need to be synchronised and contact the surgery to ask them to amend the quantities on the next prescription.

This intervention alone would not lead to a prescription intervention MUR, but could be included as a recommendation if a MUR was initiated for another reason.

Scenario 3. A Fluticasone inhaler has been added to a patient’s inhaler regimen; when you dispense the prescription you check that the patient understands when to use the new medication. Whilst talking to the patient, it transpires that they have not been using their medication as they needed to do to obtain the most benefit. You decide that the patient needs more advice than the brief counselling that you are able to provide at the time of dispensing and invite the patient for an MUR.

This intervention could lead to a prescription intervention MUR. 

FAQs

Q. Is it necessary to make the same records for both?
A. Yes.

Q. Can you perform a prescription intervention MUR by talking to a patient in the pharmacy, without conducting a patient interview in a consultation area?
A. No. A prescription intervention MUR is a full MUR which must be conducted following the requirements laid down in the Directions.

Q. When you perform a prescription intervention MUR do you only have to review the medicines that have highlighted the need for the intervention?
A. No. A prescription intervention MUR requires a full MUR to be conducted on all the patient’s medicines, following the requirements laid down in the Directions.

Q. Can you perform a prescription intervention MUR for a patient who has not received their prescribed medication from your pharmacy for the last three months?
A. Yes you can, as the three month rule does not apply to prescription interventions. 



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