Aim To evaluate Medicines Use Reviews (MURs) in community pharmacies, with a focus on MURs conducted with children alone and with their guardian(s).
Method A service evaluation of MURs was conducted using a questionnaire proforma. The questionnaire proforma design was informed by current literature and MUR guidance (PSNC)1 and included both quantitative and qualitative questions in order to understand how pharmacists approach and perceive conducting MURs, with a specific focus on those with children alone and with their guardian(s). Participants were community pharmacists holding an MUR accreditation by a Higher Education Institution, whom had already performed at least one MUR. Quantitative data formed descriptive statistics and this was supported by the qualitative data which was analysed using a thematic framework approach. Ethics was not required; this work was a service evaluation.
Results In total, 16 community pharmacists participated. The majority 81% (13/16) reported that they did not conduct any MURs in patients younger than 18 years. All participants reported feeling confident when conducting MURs in adults; whilst 56% (9/16) of participants reported feeling confident in conducting an MUR with a child with their parent/guardian present and only 25% (4/16) feeling confident with a child alone. Lack of confidence regarding child MURs was linked to paucity of opportunity, insufficient experience and training, and the need to amend question technique. Regarding consent, 75% (12/16) of participants reported that they were not confident in taking MUR consent from children, and 31% (5/16) from adolescents. Reasons for low confidence in gaining child/adolescent consent included never conducting MURs in children - so no experience in gaining consent, concern regarding child understanding, and always wanting a responsible adult present. Further barriers to MURs in children included: issues surrounding safeguarding, children possibly not having the necessary knowledge to participate if parents are responsible for medicines management, child ability to provide full consent and child anxiety, thus impact on aptitude to communicate effectively.
Conclusion This was a small-scale evaluation exploring MURs in children. Supporting anecdotal evidence prior to this study, study findings suggest that very few MURs are conducted in patients less than 18 years. Community pharmacists discussed poorer confidence in conducting MURs with children and adolescents compared to adults. Reports highlighted that the major barriers to conducting MURs in this patient cohort may be related to pharmacists’ concerns surrounding child consent and potential lack of experience and training. This study should be used to inform larger studies exploring barriers to gaining consent in children, and also conducting appropriate services with children. Analogous studies with other healthcare professional groups would be beneficial, and this data could be compared. Findings should also help to shape future education and training for pharmacists and allied healthcare professionals in order to optimise future patient services, thus patient care.
PSNC. 2018. MURs: the basics. [online] Available at: https://psnc.org.uk/servicescommissioning/advanced-services/murs/murs-the-basics/ [Accessed 19 Nov. 2018]
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