A pilot survey of junior doctors’ attitudes and awareness around medication review: time to change our educational approach?

Abstract

ObjectivesOur aim was to explore junior doctors’ attitudes and awareness around concepts related to medication review, in order to find ways to change the culture for reviewing, altering and stopping inappropriate or unnecessary medicines. Having already demonstrated the value of team working with senior doctors and pharmacists and the use of a medication review tool, we are now looking to engage first year clinicians and undergraduates in the process.MethodAn online survey about medication review was distributed among all 42 foundation year one (FY1) doctors at the Chelsea and Westminster Hospital NHS Foundation Trust in November 2014. Descriptive statistics were used for analysis.ResultsTwenty doctors completed the survey (48%). Of those, 17 believed that it was the pharmacist's duty to review medicines; and 15 of 20 stated the general practitioner (GP). Sixteen of 20 stated that they would consult a senior doctor first before stopping medication. Eighteen of 20 considered the GP and consultant to be responsible for alterations, rather than themselves. Sixteen of 20 respondents were not aware of the availability of a medication review tool. Seventeen of 20 felt that more support from senior staff would help them become involved with medication review.ConclusionsJunior doctors report feeling uncomfortable altering mediations without consulting a senior first. They appear to be building confidence with prescribing in their first year but not about the medication review process or questioning the drugs already prescribed. Consideration should be given to what we have termed a ‘bottom-up’ educational approach to provide early experience of and change the culture around medication review, to include the education of undergraduate and foundation doctors and pharmacists.

Patient-centred management of polypharmacy: a process for practice

“…With the increase in the number of medicines available for purchase without prescription and the poor co-ordination and communication of clinicians managing medicines, accurate medication review is often a challenge. Recent work12 has described the challenge to junior doctors, in both attitudes and awareness, of medication review in a hospital.…”

Deprescribing in older adults: a new concept for nurses in administering medicines and as prescribers of medicine

“…In addition, there is sometimes the need for consideration of the legal, cognitive, emotional and physical differences of prescribing in older adults. The complexities of prescribing in older adults illustrate the need for expanded competencies for prescribing and deprescribing in this population 21. Deprescribing should be part of the normal drug prescribing pathway, whereby any medication, including those for long-term conditions, have a therapeutic ‘end date’ 22…”

“…The unique challenges in prescribing in older adults can be underestimated by a nurse workforce who often lacks specific older person's competencies and skills 27. This is not a problem limited to nurse prescribers and mirrors the discourse for the development of expanded competencies for medical prescribers 21 28. Generic nurse prescribing courses provide the foundation for nurse prescribing; however, without specialist training nurses tend to limit their prescribing activity to specific conditions rather than across multiple conditions 24 29…”

Medi(c)ation Work in the Emergency Department: Making Standardized Practice Work

“…A large number of controlled clinical trials evaluating the effectiveness of medication review with respect to subsequent health care contacts, morbidity and mortality have been conducted (Christensen & Lundh, 2016) but left issues of implementation unresolved (Viswanathan et al, 2015). In addition, aspects relevant to the delivery of medication review, such as physician-pharmacist collaboration, task distribution, or physicians' perceived competence in performing medication review have been previously explored (Hatah, Braund, Duffull, & Tordoff, 2013;Jubraj et al, 2015). Nevertheless, these studies used interview or questionnaire methods and were directed at cognitive and attitudinal factors of individual practitioners only.…”