Medicines Optimisation from different perspectives

The annual Prescribing Research in Medicines Management (PRIMM) meeting (www.primm.eu.com) brings together a range of disciplines to discuss research in the use of medicines. Doctors, pharmacists, nurses and social scientists were among the 62 delegates at the 2015 conference held in London in January. They were treated to an enlightening series of talks on medicines management from the perspectives of an academic GP (Prof Tony Avery), an academic pharmacist (Dr David Alldred), an academic nurse (Prof Sue Latter) and a patient advocate (Margaret Murphy). Being able to showcase work from different perspectives and different countries is one of the unique features of PRIMM. Our organising committee currently includes doctors, pharmacists and nurses and representatives from UK and the Republic of Ireland.

Tony Avery described some of his work on prescribing errors in primary care, including the PRACtICe study, which found a prevalence of prescribing or monitoring errors of 4.9%, and the PINCER trial, which demonstrated the effectiveness of a pharmacist-led IT-based intervention in reducing these in general practice. The RCGP has recognised the need for greater emphasis on therapeutics and prescribing skills and developed an educational initiative, which has been used by over 1000 GPs to date. Tony also graphically illustrated the current pressure which GPs in England face in making decisions about the management of individual patients from his personal experience, and talked about the need for greater collaboration with pharmacists in primary care.

  Tony Avery

Medicines Optimisation – A GP’s perspective

David Alldred described his work on medication review and medication errors in care homes, (including the CHUMS study), which found that 70% of care home residents had at least one medication error. David’s work also clearly showed the need for more collaborative working between pharmacists and GPs plus care home staff for this population of patients.

  David Alldred

Medicines optimisation – A research Pharmacist’s perspective

Sue Latter described some of her work on nurse and pharmacist prescribing, which suggested that perhaps not all those qualified to prescribe in these professions are using their abilities to the full. Her research has shown that 66.4% of nurse prescribers and 42.7% of pharmacist prescribers report they prescribe instead of a doctor and the average consultation time reported was 21 minutes for nurses and 18 minutes for pharmacists, so longer than the average GP consultation. Studies show that prescribing by nurses is mostly appropriate, safe and also acceptable to patients. However over half of nurses in a survey and a quarter of pharmacists had concerns about prescribing for patients with multi-morbidity. Small-scale developments suggest that, yet again, joint working between the professions is desirable for this increasing sector of the population.

   Sue Latter

What is the contribution of nurse presecribers to medicines optimisation?

Margaret Murphy is the external lead advisor to the WHO Patients for Patient Safety programme: http://www.who.int/patientsafety/patients_for_patient/en/

Her belief is that adverse events can be catalysts for change and her talk was truly inspiring. She reminded us of an important quote by Sir Liam Donaldson, who chairs this group: “To err is human, to cover up is unforgivable, but to fail to learn is inexcusable.”  She described an initiative in Ireland “Let’s talk medication safety” http://www.isqsh.ie/index.php/lets-talk-safety which has developed booklets for patients and the public, provides a ‘medication tracker’ and lots of other ways in which patients can help themselves to ensure they optimise their medicines use. Patient empowerment is key, but again joined up working between the health professions can improve patients’ experience.

  Margaret Murphy

The patient experince as a catalyst for medication optimisation

The morning session was followed by reporting of submitted work. There were a total of 31 posters displayed, 12 of which were also presented in more detail during two poster walks, plus five oral presentations of submitted work. The Hugh McGavock prize of £200 was won by Dr Lucy Moore for her work on “How patients optimise medicines in daily life”. Best poster prize of £50 was awarded to Sarah Thomas for her study on “Investigating medication prescribing accuracy for critical error types: the IMPACT tool”.

 Lucy Moore – Winner of the Hugh McGavock prize

 Best Poster winner – Sarah Thomas