The United Kingdom (UK)2
The Australian Model2
The UK Model2
The Proposed Model for Ireland2
The aim of this dissertation is to investigate Medication Reviews being carried out by Pharmacists and to determine whether Medication Review could be conducted by Pharmacists in Ireland today, and if it would improve patient adherence and outcomes. Various studies and journals were researched so as to identify the different models of Medication review in action today in different countries. The Australian and UK models were both investigated as they provide dramatically contrasting evidence around the relative success of medication review. My dissertation describes the infrastructure in place in respect of medication review in each country and surveys the key studies which have been undertaken in relation to its relative success. I then consider whether medication review would be a suitable activity for Pharmacists in Ireland and, finally, propose a model which I believe would offer the optimum positive outcome both in relation to positive patient care and enhancing the position and reputation of Pharmacists in the community today.
Medication review, variously known as medication use review (UK), medication therapy management (USA) and home medication review (Australia) is a key issue for the practice of Pharmacy today. Indeed a recent symposium of the Pharmaceutical Care Network Europe (PCNE) held last November in Geneva, Switzerland was entirely dedicated to the topic of “Drug Related Problems and Medication Review”. J. W. Foppe van Mil’s intervention during this symposium provides an excellent overview of the topic and gives this definition: “Medication review may be defined as a structured evaluation of a patient's medicines, aimed at reaching agreement with the patient about drug therapy, optimizing the impact of medicines, and minimizing the number of medication-related problems”. Kos Sclavos, the National President of the Pharmacy Guild of Australia in his annual letter in 2005 stressed the crucial importance of the home medication review programme. He identified benefits not only for patients in improving adherence and outcomes but also for pharmacists underlining how medication review provides opportunities for pharmacists to broaden their horizons, utilise their expertise and demonstrate their value as an important member of the primary health care providers beyond traditional dispensing and OTC medication supply. Thus medication review has implications in relation to patient care but also in terms of defining new roles for Pharmacists. However, evidence of the positive impact of medication review is far from conclusive. Studies conducted in the UK and the USA indicate little or no improvement in the area of patient care in terms of patient adherence and outcomes, although it might be argued that this is due to the particular way that medication review is conducted there. Both the USA and the UK version of medication review pivots on the “brown bag” model where patients bring their entire medication supply to the Pharmacy and a consultation lasting 15 – 45 minutes is conducted there. The successful Australian model, instead, is patient centred and involves a visit from the Pharmacist to the private home of the patient offering access to the wider sociological and familial context of the patient. In addressing this topic I have elected to concentrate on two countries, England and Australia, as they provide dramatically contrasting evidence around the relative success of medication review. My dissertation describes the infrastructure in place in respect of medication review in each country and surveys the key studies which have been undertaken in relation to its relative success. I then consider whether medication review would be a...