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Pharmaceutical Services Negotiating Committee

General News

NMS and MUR: Maximising patient value from consultations

The analysis of NMS data from PharmOutcomes has demonstrated a positive impact on patient adherence, which of course is a key aim of the service. Improving patient adherence is also at the heart of the MUR service, but as all pharmacists know, there are a great many factors that impact an individual’s decision on whether or not to use medicines as prescribed.

The complexity of adherence

Adherence is a complex behavioural process strongly influenced by the environments in which people live, healthcare provider’s practice and how healthcare systems deliver care.

Every person’s decision will be influenced by a range of factors, which may include their knowledge and beliefs about their illness, their motivation to manage it and their confidence in their own ability to engage in management of the illness. Often the balance between the person’s perceived necessity for the treatment and their concerns about using the medicine will have an influence on their decision to adhere to a regimen or not.

As a consequence of the existence of this complicated picture for each individual patient, if community pharmacy services such as MURs and NMS are to provide the best possible support to patients to help them optimise their use of medicines, the quality of the consultation between the patient and pharmacist has to be high. A quality conversation between the patient and the pharmacist is the most important element of the consultation in order to ensure the patient is able to share their concerns about their medicines and ask any questions they may need answering. This requires a two way discussion between the patient and the pharmacist, rather than the pharmacist delivering information in a didactic manner to a passive patient.

Optimising consultations

When the NMS was developed, a set of carefully worded questions - the NMS interview schedule - were developed by experts in pharmacy practice and psychology for use by pharmacists providing the NMS. Subsequently a similar MUR interview schedule was developed for use in MURs. The questions in the interview schedules were constructed, and carefully ordered, to help shape the conversation between the patient and the pharmacist so that the patient’s concerns or problems with their medicines or their need for more information about their medicines are determined and addressed.

The importance of the order the questions appear in the schedules is demonstrated by the first two questions in the NMS schedule:

                1. Have you had the chance to start taking your new medicine yet?

                2. How are you getting on with it?

The temptation may be to start the discussion with the patient by asking question two, but that question asked in isolation pre-supposes the patient has started to take the new medicine; if that is not the case the patient may feel obliged to ‘play along’ with the implicit presumption, thus missing the opportunity for the patient and pharmacist to discuss the reasons why the medicine has not been taken.

The importance of the interview schedules

Recent feedback received by PSNC has suggested that not all pharmacists are using the interview schedules during NMS and MUR consultations. This is a cause for concern, as it may mean that the services will not be maximising the help provided to the patient to optimise their use of medicines.

If you are not using the interview schedules to shape your NMS and MUR consultations please give them a try next time you sit down with a patient; many pharmacists have found they can really help improve the quality of the discussion with the patient – may be you will too.

Posted 19 March 2013

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