Percent of Population Aged 16 and Older Reporting Limitations in General Activities: 27.3%

Source: Statistics on Persons with Disabilities, Master tables concerning EU 2020: year 2018, Prepared for the European Disability Expertise (EDE) By Stefanos Grammenos (in collaboration with Mark Priestley), Sept. 11, 2020.

“Whilst it is assumed that health services are intended to support the most vulnerable patient groups, this study illustrates that access to services is complex and may not always be compatible with this aim. In the first dimension of Levesque’s framework, patients’ ability to perceive care was constrained by their levels of health literacy and beliefs related to health and illness. Even when an MUR [Medicines Use Review] was undertaken, they were unable to fully benefit because they were unaccustomed, and therefore unprepared, to receiving such a service. In effect, patients had low ability to frame MURs as a service that they could access for support and could personally benefit from. This is unsurprising given our previous work suggesting there is a general plurality and fragility of patients’ sense-making of new pharmacists’ roles and services [38]. Similar problems of low ability to perceive have been seen in other services such as smoking cessation. Whereas interventions combining pharmacotherapy and behavioral support have been shown to increase successful attempts to quit smoking [39], it is acknowledged that people from marginalized groups (who have high prevalence of smoking compared with the general population) have lower levels of risk perceptions, poorer awareness and uptake of cessation support and poorer experiences (i.e., feel judged) [40,41,42].

“In the second dimension, it was found that patients’ capacity to choose to seek care was constrained by their knowledge of the MUR service, but also wider perceptions and experiences of healthcare and interactions with health professionals. Our findings support evidence suggesting that patients’ experience of healthcare is poor and subject to implicit bias [7,8,9,10]. The third dimension illustrated the problems patients encountered accessing care largely due their circumstance. Patients were particularly disadvantaged where they were physically unable to reach the pharmacy and so had fewer opportunities to speak to the pharmacist. In the final dimension, ‘ability to engage’, the impact of receiving a single MUR on the patient’s care and wellbeing was difficult to assess. Nevertheless, where the pharmacist’s advice and support were in line with patient expectations, this was valued by patients and reportedly made a positive contribution to their care.”

“The repercussions on the provision of pharmacy service, management and delivery are unclear. Pharmacists are increasingly taking on enhanced medicine management and support roles to improve knowledge, understanding and adherence to medicines [16]. One example is of the UK National Health Service (NHS) community pharmacy funded medication review service known as ‘Medicines Use Reviews’ (MURs). Available since 2005, the service consists of an annual consultation with the pharmacist. The purpose being to resolve medicine related issues, concerns and to reduce avoidable waste [17]. Despite this service seeking to improve knowledge and use of medicines, significant variability in delivery has raised concerns, particularly that the service is not being targeted to patients who may benefit most from a review with a pharmacist [18]. There are low levels of evidence to support medication reviews for marginalized groups. However, this should not be interpreted as a lack of need, but rather a result of a general low level of representation of marginalized groups in research [19].”

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Page last updated Sept. 22, 2022 by Doug McVay, Editor.