Medication Review Process

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

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

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Part 2 : review of medication :

Using STOPP-START and/or MAI

with reference to Beer's criteria and/or MIMS

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

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

patient's care.

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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)

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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.

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• 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.

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• Problems swallowing tablets

  • Does the patient need soluble tablets or liquids?

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• Difficulties in reading labels

  • Large print labels can be used.

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• 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.

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Details of all medication use :

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• Side effects from the medication

  • side effects may be real or perceived

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• Other non-prescription medicines

  • obtained from friend, relatives, pharmacy or supermarket

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

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• Other prescription medication

  • obtained from other primary carer, specialist or institution

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• Other drugs

  • including street drugs, caffeine, alcohol

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​​​Concordance aspects of medicine use :

 

• How is the patient actually taking the medicines?

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

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

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Part 2 should cover :

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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) :

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• 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

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

  • e.g.MAI.

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Part 3 should cover :

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

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

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

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

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• Agreement on expectations and timing of next medicines review

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

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Part 4 should cover :

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• 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.).