The Complete Structured Medication Review 

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The complete structured medication review comprises 10 parts :

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Part 1 : Meds used

- Gather details of all current medication used (from patient, carers, records)

Part 2 : Logistics

- Review procurement and distibution of each med used

Part 3 : Awareness and Concordance

- Review patient's understanding and use of each medication (from patient)

Part 4 : Indications 

- Review current indication for each medication used (MAI)

Part 5 : Appropriatenes and interactions

- Review  each medication used for appropriateness and interactions (STOPP-START and/or online drug

interaction checker)

​Part 6 : Revise medication use

- Compile revised list of medication to be used

Part 7 : Schedule implementation

- Schedule the implementation of the revised list of medication

Part 8 : Feedback and education

- Feedback and education of patient and carer regarding revised medication schedule (with patient and carers)

Part 9 : Records update

- Medical records update and distribution of updated medications list to other healthcare providers involved in

patient's care.

Part 10 : Progress reviews

- Schedule progress reviews during and after implementation

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Part 1 : Meds Used 

• Current medication used regularly (as prescribed by GP, specialist, pharmacist)

  • as per cardex in care setting

  • as per actual dispensing in home setting

• Medication used sporadically including :

  • Over The Counter (OTC) medication (obtained from friend, relatives, pharmacy or supermarket)

  • Other medications taken (e.g. leftover tablets, medicines prescribed for others)

  • Herbal supplements, vitamins etc

  • Illicit drugs

  • Other : cafeine, alcohol

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Part 2 : Logistics

• Ensure that there are no problems with the process of GP issuing repeat scripts, pharmacy processing scripts and issuing medications, approprite on-site storage of medications, and patient receiving medication with no interruption between cycles of supply.​

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Part 3 : Awareness and Concordance

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• In general: 

  • “Are you good at remembering your pills?”

    • Multi-compartment ‘compliance aids’ can be helpful for some patients and/or in some settings

    • Other simpler measures such as Medicines Reminder Charts are more helpful for many patients.

  • "Can you access your medication easily?

    • Patient packs of medicines are generally helpful but older people may have particular difficulties with blister packaging and, to a lesser extent, with foil packaging.

    • Large print labels can be used.

  • “Can you swallow them OK?”

    • Does the patient need soluble tablets or liquids?

  • "Do you have a card detailing all medications you use, to be carried by yourself at all times"

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• For each medication:

  • “What is this medicine for?”

    • Does the patient understand and accept the reasons for their medicines and the health consequences of not taking them?

  • “Do you think it works?”, “Does it have any side effects?”

    • Does the patient (or carer) have any concerns, questions or issues about the medication that they want to raise?

    • Side effects may be real or perceived

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Part 4 : Indications 

• Obtain sufficient medical history and current disease status to assess current indications for prescribing.

  • Utilise a systematic review tool for each medication, such as MAI

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Part 5 : Appropriatenes and interactions

• Review  each medication used for appropriateness and interactions

• use systematic review tool such as STOPP-START

• and/or use online drug interaction checker (e.g. Medscape Drug Interaction Checker)

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​Part 6 : Revise medication use

• Considering steps 1-5 above, compile a revised list of medication to be used

  • Any high-risk prescribing should be changed urgently

  • Unnecessary medications should be discontinued

  • New medications indicated should be introduced

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Part 7 : Schedule implementation

• Changes should generally be introduced progressively over time unless there is a significant, urgent problem

• New medications should also usually be introduced one-by-one (to avoid confusion if prescribing or de-prescribing causes new symptoms)

• Reduce old medications gradually if necessary to avoid rebound effects (physiological or psychological dependence) and introduce new medications gradually too – start low and go slow.

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Part 8 : Feedback and education

• Education and negotiated agreement pertinent to other drugs used identified in Part 1 (Meds Used)

• Correction of problems in practical aspect of medicines use identified in Part 2 (Logistics)

• Education pertinent to real and perceived problems and or side effects identifien in  Part 3 (Awareness and Concordance)

• Feedback and education of patient and carer regarding revised medication arising from Part 6 Update Medication Use)

• Feedback and education of patient and carer regarding schedule for implementation of revised medication arising from Part 7 (Schedule Implementation)

• Provision and/or update of card detailing all medications in use to be carried by patient at all times

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Part 9 : Records update

• Detail Meds Review process in patient record, including salient portions of discussions with patient and carers. It will make the next review easier and may be important medicolegally.

• Update prescriptions schedules (e.g. cardex)

• Distribute updated medications list to other healthcare providers involved in patient's care (e.g. pharmacist, specialists, etc.).

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Part 10 : Progress reviews

• Arrange to assess progress and, if necessary, make further changes in the future.