Medicines use review service in community pharmacies in Spain: REVISA project

Abstract

Background: Community pharmacy services play an important role in controlling some factors related to medicine use, and pharmaceutical services integrated with primary healthcare services are critical to achieve the desired outcomes and to significantly reduce harms that can otherwise arise from multiple medicine use, such as non-adherence or medicine-related problems. The aim of the REVISA project is to carry out a study on preliminary implementation of the medicines use review (MUR) service in Spanish pharmacies through pharmacist-led initiatives to obtain a better understanding of patients’ medication adherence and medicine-related problems, together with satisfaction and acceptability of the service and whether patients might be willing to pay for it in the future. Methods: A preliminary implementation, cross-sectional multicentre study was conducted using a convenience sample of voluntary community pharmacies from all regions of Spain. Descriptive and logistic regression analyses were undertaken. Results: Sixty-four community pharmacies participated and a total of 495 patients were enrolled. A slight predominance of women (56%) was noted, with a mean age of 66.09±14.71 years and a mean consumption of 5.68±2.97 medicines. As results of MUR, a total 550 referrals were made. Non-adherence with the medication (OR=1.74; 95% CI: 1.17 to 2.58), polypharmacy (OR=1.50; 95% CI: 1.02 to 2.20) and help with medication (OR=3.03; 95% CI: 1.45 to 6.34) were associated with referrals. Patients were adherent for 68.3% of their medicines. However, at the patient level, only 31.5% were adherent. Polypharmacy patients older than 65 years increased the risk of non-adherence (OR=1.56; 95% CI: 1.06 to 2.30).The mean time employed by the pharmacists in the MUR was 52.80±31.52 minutes (MUR-related cost of €17.27). Most patients expressed a high level of satisfaction with the MUR service (98.5%) and a willingness to pay for it (84%). Conclusions: The MUR service in community pharmacies in Spain can be delivered, that it appears to be acceptable to patients and that most patients said they would be willing to pay for it. Pharmacists self-reported the length of time taken to deliver a MUR although the feasibility of incorporating into everyday practice would need to be assessed.