Michael Bronlund Health Science Centre, University of Canterbury (Friday, 10.00, General 2)

1. The Medication Use Review service
(MUR)
A case study for identifying e-
learning opportunities in
pharmacists’ on-going training.
By Michael Bronlund

2. Master Thesis
Health Science Centre
University of Canterbury
Acknowledgements:
Assoc. Prof. Ray Kirk
Dr. Arindam Basu
Pharmacy Guild of New Zealand
(Canterbury)

3. The Model of a Healthcare
Training Environment
Funder: DHB
Programme Planning
Business Environment
Environment or PHO
Employer:
Pharmacy Course Provider:
NZ College of
Service Possible
Pharmacy
contract funding
Work Relationship
Registration Training
Environment of contract
Employee: professional
Pharmacist standards
Pharmacy Council of NZ
KEY
Stakeholder
An Environment

4. Why will e-learning be used?
The need for vocational training from one
centralised location creates a demand for course
delivery to be flexible and localised.
An example - ADHB staff training
‘The advantages of staff, as learners being able to access
course material at different times and places, is being
acknowledged by both funders and employers.'
(Paterson, 2010)

5. The Research Results
Faxed out invitations to over 640 dispensaries in over 11
DHBs and had 5 DHB pharmacy coordinators forward
emails to their networks as an invitation and reminder.
Questionnaire Received
Dispensary 51 responses with 45 completed.
Service
19 responses of which 14 were deemed to be
Course
completed.
Total 250 free text comments

6. The Model of a Healthcare Training
Environment
Funder: DHB
Programme Planning
Business Environment
Environment or PHO
Employer:
Pharmacy Course Provider:
NZ College of
Service Possible
Pharmacy
contract funding
Work Relationship
Registration Training
Environment of contract
Employee: professional
Pharmacist standards
Pharmacy Council of NZ
KEY
Stakeholder
An Environment

7. The Medication Use Review
http://www.skillsformurs.co.uk/com/aboutTheCourse.action
A pharmacist -
● interviews patient about medications they are taking
● can offer advice on how to make this more effective
● can liaise with other healthcare professionals to change
medications
● In New Zealand this service can be arranged in
different ways.

8. The Model of a Healthcare Training
Environment
Funder: DHB
Programme Planning
Business Environment
Environment or PHO
Employer:
Pharmacy Course Provider:
NZ College of
Service Possible
Pharmacy
contract funding
Work Relationship
Registration Training
Environment of contract
Employee: professional
Pharmacist standards
Pharmacy Council of NZ
KEY
Stakeholder
An Environment

9. The pharmacy
as a business
A pharmacist is employed in a community
pharmacy
● needs to maintain registration and seeks
accreditation to provide services.
● when in charge of dispensary
– has input into decisions to offer services
– supports staff training

10. The Model of a Healthcare Training
Environment
Funder: DHB
Programme Planning
Business Environment
Environment or PHO
Employer:
Pharmacy Course Provider:
NZ College of
Service Possible
Pharmacy
contract funding
Work Relationship
Registration Training
Environment of contract
Employee: professional
Pharmacist standards
Pharmacy Council of NZ
KEY
Stakeholder
An Environment

11. Who pays for the MUR service?
Publically funded through -
One of the 20 District Health Boards (DHB)
or a Primary Healthcare Organisation (PHO) which
● sets health goals for region
● prioritizes spending
● negotiates, monitors and evaluates services
● funds training

12. The Model of a Healthcare
Training Environment
Funder: DHB Programme Planning
Business
or PHO Environment
Environment
Employer:
Course Provider:
Pharmacy
NZ College of
Service Possible
Pharmacy
contract funding
Work Relationship
Registration Training
Environment of contract
Employee: professional
Pharmacist standards
Pharmacy Council of NZ
KEY
Stakeholder
An Environment

13. Who provides the MUR training?
●New Zealand College of Pharmacists (NZCP) is
the only provider of training.
●Weekend seminar based course in regional
centres.
● A case study completed before accreditation.
●Still offering MUR course and additional focus
courses.

14. The Model of a Healthcare Training
Environment
Funder: DHB
Programme Planning
Business Environment
Environment or PHO
Employer:
Pharmacy Course Provider:
NZ College of
Service Possible
Pharmacy
contract funding
Work Relationship
Registration Training
Environment of contract
Employee: professional
Pharmacist standards
Pharmacy Council of NZ
KEY
Stakeholder
An Environment

15. Why the MUR as a Case-study?
● Not all regions had funding for the service.
● Some pharmacists completed the training but
were left with no opportunity to practise.
By early 2010 :
● eight regions had a form of the service in
operation.
● 746 completed the course. 239 had been
accredited through a competency process.

16. The Research Tool
Two on-line questionnaires using Qualtrics
● Outcomes and principles of service.
● Reasons for the decision not to offer the MUR service.
● Descriptions of how the service is organised if provided.
● Obstacle to putting the MUR service into practice.
● Internal and External support for MUR training.
● Skills needed for an MUR case.
● Training method preferences.

17. The Model of a Healthcare Training
Environment
Funder: DHB Programme Planning
Business
or PHO Environment
Environment
Employer:
Course Provider:
Pharmacy
NZ College of
Service Possible
Pharmacy
contract funding
Work Relationship
Registration Training
Environment of contract
Employee: professional
Pharmacist standards
Pharmacy Council of NZ
KEY
Stakeholder
An Environment

18. Environmental Factors
driving e-learning
● Stakeholders in a pharmacy healthcare service –
promoting convergence of technology
• Health IT Board – 'build information management skills
into training programmes.' http://www.ithealthboard.health.nz/
• Focus on the Future: Ten Year Vision for Pharmacists in
New Zealand – Use of technology in service delivery
and the need to support pharmacist education
● Availability of on-line tools and Reusable Learning
Objects (RLO)

19. E-learning – an easy option?
The need for input from educators.
‘Developing effective instructional
materials depends on a great deal of
planning and collaboration, and concerted
efforts from many people skilled at using
the rights tools. These requirements are
even more crucial in online multimedia
and course development, which is highly
dependent on ever-changing computer
technologies.’ Caplan from Anderson 2008

20. Examples of Applications of
Model
Environmental factors identified for -
● MUR training providers
– funding changes – e.g. a more prescriptive service
– Primary healthcare team - e.g. training to encourage
collaboration
● MUR potential course participants and funders
– need for pharmacists to be strategic in acquiring support for
value added services
– supporting Continuing Professional Development, either for
registration issues or for quality of service delivered

21. Recommendations
What support can be offered for pharmacists’ for
potential e-learning?
● identify how to access and evaluate e-courses before
being used in training.
● standards of courses set and communicated.
● survey of skills and equipment.
● sharing what has worked via peer support.
● real case studies as a basis of course content.

22. Summary
Funder: DHB Programme Planning
Business
or PHO Environment
Environment
Employer:
Course Provider:
Pharmacy
NZ College of
Service Possible
Pharmacy
contract funding
Work Relationship
Registration Training
Environment of contract
Employee: professional
Pharmacist standards
Pharmacy Council of NZ
KEY
Stakeholder
An Environment

23. Examples of comments
supporting the Model
● ‘It is an important service for our largely elderly customer base. It also
utilizes our professional skills, rather than just counting tablets. It is also the
way of the future with technicians taking over more of the dispensing
functions and pharmacists doing more counseling , problem solving and
medicine management’
● ‘Until general practice understands and collaborates with this service
provision it is never going to reach its full potential. I don't need training in
this area (I already work in a practice and for a GP organisation). General
practice teams however need to be sold the benefit’
● when the MUR process is about communication I STRONGLY believe that
moving aspects of the course or training follow ups/support to an on-line
environment will NOT benefit the need for continuing communication
development.

24. Reference List
References
Anderson, T. (2008). Theory and practice of online learning. AU Press
Lee, E., Braund, R., & Tordoff, J. (2009). Examining the first year of Medicines Use Review
services provided by pharmacists in New Zealand: 2008. The New Zealand Medical Journal,
122(1293), 3566.
Paterson, C, Implementing Online Learning: Use of a ‘Shared Service’ Model , Health Care and
Informatics Review Online, 2010, 14(4), pg 26-33, Published online at www.hinz.org.nz
Wise, G (2009) The Continuous Learning Environment: Surviving Learning Solution Discovery,
Education & Training - Learning Architecture,
http://www.ithealthboard.health.nz/content/national-health-it-plan (p. 31)
http://psnz.org.nz/public/home/documents/10_year_plan.pdf