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Patients unaware of Wales discharge service

The DMR service for recently discharged patients prevents unecessary A&E admissions, hospital admissions and drug wastage, researchers say

Wales' DMR service, for patients recently discharged from hospital, is beneficial but there is a lack of awareness for it among GPs and patients

Wales' discharge medicines review (DMR) service benefits patients and the NHS but suffers from a lack of awareness, an evaluation commissioned by Community Pharmacy Wales has found.

The pharmacy service for patients recently discharged from hospital offered a three-fold return on investment by preventing unnecessary A&E attendances, hospital admissions and drug wastage, found the academic evaluation, given to C+D on August 13.

But there was a lack of awareness of the DMR among patients and GPs, found the study, carried out by researchers from the Universities of Cardiff, South Wales and Bradford between 2013 and March 2014.

Patients said they valued the input of a pharmacist but only two out of the six patients who received a DMR and were interviewed in the study said they had heard of the service. There was also "little to no knowledge" of the DMR among the five GPs interviewed for the research and few hospital referrals. 

As a result, community pharmacists said they had problems identifying eligible patients and they also complained of a lack of discharge information and excessive paperwork.

Despite these pitfalls, the Welsh government had decided to continue funding the service due to the positive findings, the evaluation's authors said. The DMR had cost just over £1million to implement between October 2011 and December 2013 and freed up resources amounting to around £3m, the study found.

The evaluation showed that 81 per cent of the 14,649 DMRs conducted in this period had identified inaccuracies in prescriptions, with over half of these being medicines mistakenly discontinued or restarted after the patient's discharge.

The figures showed that 70 per cent of Welsh pharmacies had made DMR claims in that timeframe, but revealed varying levels of engagement with the service.

Discharge medicines review: the figures

-          Each DMR costs roughly £68.50

-          14,649 DMRs were completed

-          The service saved £3m in resources

-          31% of DMRs were conducted with carers

-          70% of Welsh pharmacies performed at least

one DMR

-          5% of Welsh pharmacies completed more than 100 DMRs

-          The average pharmacy conducted 17 DMRs

Source: Evaluation of DMRs conducted between October 2011 and December 2013, commissioned by Community Pharmacy Wales 

Multiples with over 25 branches had taken a "strategic" decision to become involved in the service and had completed 56 per cent of the total DMRs, while independent pharmacies had made up less than a third of the claims, the evaluation found.

The study recommended that uptake of the DMR should be increased across Wales and the service promoted to all stakeholders.

The two-part DMR service is designed to help improve the transfer of medicines information between secondary and primary care and improve medicines adherence. Consultations are carried out face-to-face or over the phone and relatives or carers can also hand over discharge letters to pharmacists on the patient's behalf.

Related stories
• Future of discharge medicine reviews secured in Wales 
 PNAs the way forward for Wales, government proposes 

What do you think should be done to raise awareness of the DMR service?   

We want to hear your views, but please express them in the spirit of a constructive, professional debate. For more information about what this means, please click here to see our community principles and information

Leon The Apothecary, Student

This isn't news, it's the result of a lack of advertisement.

Gerry Diamond, Primary care pharmacist

As I said before get appropriate collective lobbying and advertising on behalf of community pharmacy. I don't care where we get the money but we need an alliance of independent and corporate pharmacy to blow our trumpet as a great profession!

Meera Sharma, Community pharmacist

This is not a surprise! Any piecemeal service that is funded on it's own without any engagement with the rest of the care pathway or healthcare agenda will produce exactly the same. I agree with the other comment, the role of pharmacy should fundamentally be built into the 5-year plan to avoid this postcode based service provision. Pharmacies are business, there needs to be a viable, long-term strategic business plan not this kind of one-off opportunities. Does not make financial sense for the long-term.

N O, Pharmaceutical Adviser

For the nth time, whether it is England or Wales, unless the service is advertised/ communicated by the NHS/ DoH at the point of discharge for DMRs and through other professionals for all enhanced and advanced services. Till such time any kind of a survey will yield the same result (including the Census)

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