The overall aim of the MUR service is to improve patient knowledge of medication via a consultation, resulting in more effective use of medicines. Some 50 per cent of MURs are required to fall into certain categories, as specified in the Pharmaceutical Services (Advanced and Enhanced Services) (England) Directions 2011. These categories now include patients:

• Taking a high risk medicine (NSAIDs, anticoagulants, antiplatelets, respiratory medicines)
• Recently discharged from hospital who had changes made to the drugs they were taking while they were in hospital
• Prescribed certain respiratory drugs
• Diagnosed with or at risk of cardiovascular disease and regularly being prescribed at least four medicines.

In the context of discharge MURs, the aims of the MUR service are as follows:

• Establishing patients’ actual use of medicines, including their understanding and experience of the medicines
• Identifying, discussing in a concordant manner and working towards medicines solutions in situations where there is deemed to be poor or ineffective use of medicines
• Identifying side effects and potential interactions
• Improving the cost effective use of medicines, with a view to reducing waste.

The MUR is not a clinical medication review. In the primary care environment, community pharmacists are allowed access to patients’ summary care records, but very few have this set up yet. Therefore, most will have limited information on diagnosis, condition management (including rationale for choice of medicines and any tests done and their results) and may have difficulty influencing, instigating and following up changes in medication. These are issues that would be covered in a clinical medication review rather than a MUR.