Services Database Medicines Optimisation Support for Patients

The aims and objectives of this enhanced service are to:

• support independent living and assist patients, living in their own homes, who need assistance to take their medicines, and for whom failure to comply with their prescribed medicines could have serious implications on their health status;
• ensure that all such patients have their needs assessed to identify the most appropriate mechanism for assisting their medicines taking;
• improve patient compliance with therapy by:
  • improving the patient’s understanding of their medicines;
  • where possible, simplifying the medicines regimen and ordering process where appropriate;
  • identifying practical problems in taking their medicines and where appropriate providing compliance aids; and
  • providing advice and support to the patient and/or carer, including referral to other health and social care professionals where appropriate.
• Reduce wastage of medicines.
• Ensure that all patients receiving assistance through the service have their needs reviewed on a regular basis.

This service is not aimed specifically at older people and is open to patients of all ages who experience difficulties taking their medicines as prescribed.

Patients should be referred to the service from their GP (other healthcare professionals, for example, community nursing teams or primary care visitors can refer patients back to the GP for a patient to be referred for this service).

The pharmacist will complete an assessment on the patient to decide what level of support should be offered. All of the below options must be considered with the supply of a monitored dosage system (MDS) being the last resort. The options include:

• review and rationalisation of medication regimen with GP, for example, formulation change (solid-dose to liquid or soluble formulations, use of modified release preparations, etc);
• clarification of medication regimen, for example, post hospital discharge;
• patient/carer counselling - verbal and written explanation;
• labelling modifications, for example, larger type if software/printer allows this, or additional labelling;
• container modification, for example, blisters transferred to bottles, plain caps;
• more informal involvement of relatives/friends;
• medicines reminder chart;
• advice for carers (informal, or social services carers) on how to improve patient compliance; and/or
• provision of MDS.

Any proposed action will be discussed with the healthcare professionals and, where appropriate, social services professionals involved in the patient's care.

Pharmacists providing this service must:

• be MUR accredited;
• attend educational/briefing meetings as required;
• agree to continually update their knowledge in the care of patients and demonstrate competence in this area. This should preferably be recorded in a CPD portfolio.

Pharmacists can also access CPPE training which may support this service:

• Domiciliary visiting workshop
• Concordance open learning and workshop