Van Den Berg, Melandi (2014) Investigating the value of the community pharmacy medicines use review (MUR) service. (PhD thesis), Kingston University, .
Abstract
The Medicines Use Review (MUR) service was introduced in the UK in 2005 to improve patients' knowledge and use of medicines. The service, in essence, engages the patient and the pharmacist in a structured, private conversation about the patient's medicines. Pharmacies are permitted to deliver a limited number of annual MURs yet for a number of years service provision remained low. During the period of this investigation, the service attracted substantial controversy. In 2008 the UK Government called for improvements to be made to the 'quality' of service provision, with measurement of tangible patient outcomes a key concern. This thesis set out to investigate the potential value of the MUR service. First, using discourse analysis, this thesis considered the social construction of the MUR through written marketing material and its potential impact on uptake of the service, making suggestions for future situations. Next, based on a retrospective cross-sectional audit of MUR records, a practical tool for selecting patients who might benefit from an MUR consultation was developed and explained. Auditing MUR records was suggested by others as one way of tackling questions around service 'quality'. However, the cross-sectional audit suggested that such records were inadequate for assessing service quality and it is argued that quality measures should be based on the achievement of intended service outcomes. Finally, and relating to patient outcomes, this thesis includes a qualitative investigation of patients' MUR experiences, particularly patient satisfaction, as a measure of quality. In the absence of existing patient satisfaction questionnaires measuring the true dynamics of the MUR interaction, a novel conceptual framework for measuring patient satisfaction with this service was developed and is put forward. The results contained herein can contribute to the development of an intervention for measuring the benefits of the MUR versus usual care in terms of patient outcomes.
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