I'm confused. I don't like being confused. I particularly don't like being confused by my own professional leaders about something I'm told will define my profession's contribution to healthcare, but which no-one I've asked can give me a clear definition for.
That something is Medicines Optimisation.
The term started being used a few months ago, but (until tonight) I've never clearly seen a definition of it, let alone an explanation of what the difference is between it and the two current concepts about pharmacist practice, those of Pharmaceutical Care and Medicines Management.
I do both daily, so I can define them off the top of my head. Pharmaceutical Care is the philosophy of practice by me as an individual practitioner dealing with the patient in front of me. It is the same philosophy used by community pharmacists doing Medicines Use Reviews and hospital pharmacists doing medicine reviews on wards. Medicines Management, on the other hand, is the collection of systems in place to ensure that medicines are handled to their best, safest, most cost-effective manner.
This has come to a head because of an article I saw earlier today which sought to explain what medicines optimisation was. However no easy answer was forthcoming:
"Chief pharmaceutical officer for England Keith Ridge is reluctant to offer a simple definition for medicines optimisation"
Okay then, so it defies easy definition - what does it involve? Improving quality and outcomes, value for patients, concordance/adherence, closer working with patients, better relationships with other health professionals, relating contract payments to clinical performance - all the things have been demanded by the grass-roots since the days of Pharmacy in a New Age. We want these, but how is this more than just a shopping list of applehood-and-mother-pie things that we'd all love to see.
We are told that medicines optimisation is more sophisticated than medicines management - but how? Let us remind ourselves of what medicines management is and was. The National Prescribing Centre defined medicines management as "Medicines management (MM) is a system of processes and behaviours that
determines how medicines are used by patients and by the NHS. Effective MM
will place the patient as the primary focus, thus delivering better targeted care and
better informed individuals.... (leading to) improve health, Improve patient care and satisfaction, Make better use of professional skills, Deliver effective clinical governance (and) Maximise the effective use of resources available"
The article ends with describing how the term is currently being "socialised" and a communication strategy to explain the term to patients. Perhaps the powers that be need do a better job of explaining it to medicines managing and pharmaceutically caring pharmacists like me?
We need a clear, universally accepted definition. I found one with this evening from UKMI.
"Medicines optimisation is an approach that seeks to maximise the beneficial clinical outcomes for patients from medicines with an emphasis on safety, governance, professional collaboration and
patient engagement"
However, this still needs work. How does this approach vary from the daily practice of any pharmacist who seeks to benefit patients through maintaining safe governance systems, and their work with other professionals? And this is before you start looking at whether you can determine patient engagement through 3 for 2 offers. Everything I have seen relates to Medicines Optimisation being the answer to all our problems, yet I struggle to see how it answers them.
I have no objection to the promised land that the prophets of Medicines Optimisation are portraying, I'm just remaining confused by what this new term means and how it will enable us to get to Pharmacy Paradise.
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