McCormick, Patricia;
(2022)
What is the value of domiciliary medication review services? A mixed-method exploration and analysis of medicines optimisation in domiciliary settings.
Doctoral thesis (Ph.D), UCL (University College London).
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Abstract
Medication reviews are recognised as essential to identifying and optimising problematic polypharmacy. Domiciliary medication reviews (DMRs) which have become more prevalent in recent years, are identified as comprehensive and patient-centric medication reviews. Despite their popularity, there is little evidence on where the value of DMRs lies. This research aimed to understand the value of domiciliary medication reviews using mixed methods. The research was underpinned by a systematic review of the literature to understand the existing landscape around DMRs. Correlational techniques were used to explore the relationships between demographics and intervention variables. The deeper service-based perceptions and views of both patients and DMR pharmacists were sought using semi-structured interviews and focus groups. The systematic review revealed a very profession-centric view of DMRs that suggested the impact of these services could be measured using traditional clinical outcomes. The literature rarely went beyond describing clinical process measures. The quantitative analysis revealed that individuals have differing needs that go beyond the scope of the medications they take. Results suggested that a ‘one size fits all’ approach to service delivery will not work optimally, and instead a holistic and more comprehensive approach is needed. The qualitative analysis suggested that conducting medication reviews in the domiciliary setting afforded advantages over traditional healthcare settings. For individuals the medicines expertise of professionals is important but so too is the socialisation aspect of the review. The time spent conducting a review was essential for a comprehensive review and ensuring individuals felt heard. This multi-method and multi-perspective study enabled a richer understanding of where the added value of DMRs services might lie. It is suggested that the value lies in a well thought out service, delivered by knowledgeable medicines experts (pharmacists), who are able to connect with patients and understand their needs, even when they are not medication related.
| Type: | Thesis (Doctoral) |
|---|---|
| Qualification: | Ph.D |
| Title: | What is the value of domiciliary medication review services? A mixed-method exploration and analysis of medicines optimisation in domiciliary settings |
| Open access status: | An open access version is available from UCL Discovery |
| Language: | English |
| Additional information: | Copyright © The Author 2022. Original content in this thesis is licensed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) Licence (https://creativecommons.org/licenses/by-nc/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request. |
| UCL classification: | UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Life Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Life Sciences > UCL School of Pharmacy UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL |
| URI: | https://discovery-pp.ucl.ac.uk/id/eprint/10147357 |
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