Resources for the Comprehensive Geriatric Assessment based
Proactive and Personalised Primary Care of the Elderly

Medication Review

Medication Review Process

In the primary care setting, the medication review is best conducted in 4 parts :

Part 1 : Information gathering from patient records and from patient and carer

Part 2 : review of medication :

Using STOPP-START and/or MAI

with reference to Beer's criteria and/or MIMS

Part 3 : Feedback and education of patient and carer regarding revised medication schedule

Part 4 : Medical records update, and distribution of updated medications list to other healthcare providers involved in

patient's care.

Ideally part 1 may be conducted by the practice nurse (patient and carer attendance required)

part 2 may be conducted by the GP (patient and carer attendance NOT required)

part 3 may be conducted by the pharmacist or by the GP (patient and carer attendance required)

Part 4 may be conducted by the practice manager or practice nurse (patient and carer attendance NOT required)

 

Part 1 should cover :

  • Practical aspects of medicine use

  • Details of all medication use

  • Concordance aspects of medicine use

 

Practical aspects of medicine use :

 

  • Problems ordering and receiving repeat medicines

    • There should be no problems with the process of GP issuing repeat scripts, pharmacy processing scripts and issuing medications, patient receiving medication with no interruption between cycles of supply.

  • Problems removing medicines from containers

    • 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.

  • Problems swallowing tablets

    • Does the patient need soluble tablets or liquids?

  • Difficulties in reading labels

    • Large print labels can be used.

  • Problems remebering to take medicines

    • 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.

Details of all medication use :

  • Side effects from the medication

    • side effects may be real or perceived

  • Other non-prescription medicines

    • obtained from friend, relatives, pharmacy or supermarket

    • including vitamins, supplements, herbal, homeopathic or othe non-prescription substance

  • Other prescription medication

    • obtained from other primary carer, specialist or institution

  • Other drugs

    • including street drugs, caffeine, alcohol

​​​Concordance aspects of medicine use :

 

  • How is the patient actually taking the medicines?

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

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

Part 2 should cover :

Review of medication in use and determination of new medication to be introduced, taking into account information gathered in Part 1 of the review, and utilising either (or both) :

  • Explicit criteria-based tools that acilitate medication review in multi-morbid older people in most clinical settings

    • e.g. STOPP-START and/or Beers Criteria

  • Implicit criteria based tools that use patient-specific information in order to judge whether a specific medicine is appropriate

    • e.g.MAI.

Part 3 should cover :

  • Feedback and education of patient and carer regarding revised medication schedule arising from Part 2

  • Correction of problems in practical aspect if medicines use identified in Part 1

  • Education pertinent to real and perceived side effects identifien in  Part 1

  • Education and negotiated agreement pertinent to other drugs used identified in Part 1

  • Agreement on expectations and timing of next medicines review

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

Part 4 should cover :

  • Update of patient's medical records

 

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

medication tablets capsules

This Read More page is an extension of Medication Review

Back To : Medication Review

The Medication Review is one of 5 sub-domains of the

Medical Assessment

Back To : Medical Assessment

The Medical Assessment is one of 8 domains of the

Comprehensive Geriatric Assessment (CGA)

Back To : Comprehensive Geriatric Assessment