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

Medication Review

Different types of Medication Review 

meds review types 2.png

Level 0 - Ad-hoc Review

  • Unplanned, opportunistic, unstructured review

  • Patient may or may not be present

  • May or may not involve a health professional

  • Example: may be a single question about a medicine

 

Level 1 – Prescription Review

  • Review of medicines without the patient's full medical notes; may not include a review of the full repeat prescription

  • Patient may or may not be present

  • Usually involves a single health professional

  • Example: a medicines use review

 

Level 2 – Treatment Review

  • Review of medicines with the patient's full medical notes

  • Patient often not present

  • Usually involves a single health professional

  • Example: review of medicines for a particular condition such as asthma

 

Level 3 – Complete Clinical Medication Review

  • Full structured, medication review with the patient's full medical notes

  • Patient present

  • Can be a single health professional or multidisciplinary

  • Example: review of all medicines prescribed

The Complete Structured Medication Review 

The complete structured medication review comprises 10 parts :

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

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

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.

Part 3 : Awareness and Concordance

  • 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"

  • 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

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

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)

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

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.

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

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.).

Part 10 : Progress reviews

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

 

 

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

bottom of page