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

Different types of Medication Review

Level 0 - Ad-hoc Review
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Unplanned, opportunistic, unstructured review
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Patient may or may not be present
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May or may not involve a health professional
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Example: may be a single question about a medicine
Level 1 – Prescription Review
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Review of medicines without the patient's full medical notes; may not include a review of the full repeat prescription
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Patient may or may not be present
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Usually involves a single health professional
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Example: a medicines use review
Level 2 – Treatment Review
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Review of medicines with the patient's full medical notes
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Patient often not present
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Usually involves a single health professional
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Example: review of medicines for a particular condition such as asthma
Level 3 – Complete Clinical Medication Review
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Full structured, medication review with the patient's full medical notes
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Patient present
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Can be a single health professional or multidisciplinary
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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
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Current medication used regularly (as prescribed by GP, specialist, pharmacist)
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as per cardex in care setting
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as per actual dispensing in home setting
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Medication used sporadically including :
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Over The Counter (OTC) medication (obtained from friend, relatives, pharmacy or supermarket)
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Other medications taken (e.g. leftover tablets, medicines prescribed for others)
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Herbal supplements, vitamins etc
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Illicit drugs
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Other : cafeine, alcohol
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Part 2 : Logistics
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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
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In general:
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“Are you good at remembering your pills?”
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Multi-compartment ‘compliance aids’ can be helpful for some patients and/or in some settings
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Other simpler measures such as Medicines Reminder Charts are more helpful for many patients.
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"Can you access your medication easily?
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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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Large print labels can be used.
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“Can you swallow them OK?”
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Does the patient need soluble tablets or liquids?
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"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:
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“What is this medicine for?”
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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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“Do you think it works?”, “Does it have any side effects?”
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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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Side effects may be real or perceived
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Part 4 : Indications
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Obtain sufficient medical history and current disease status to assess current indications for prescribing.
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Utilise a systematic review tool for each medication, such as MAI
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Part 5 : Appropriatenes and interactions
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Review each medication used for appropriateness and interactions
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use systematic review tool such as STOPP-START
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and/or use online drug interaction checker (e.g. Medscape Drug Interaction Checker)
Part 6 : Revise medication use
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Considering steps 1-5 above, compile a revised list of medication to be used
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Any high-risk prescribing should be changed urgently
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Unnecessary medications should be discontinued
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New medications indicated should be introduced
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Part 7 : Schedule implementation
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Changes should generally be introduced progressively over time unless there is a significant, urgent problem
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New medications should also usually be introduced one-by-one (to avoid confusion if prescribing or de-prescribing causes new symptoms)
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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
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Education and negotiated agreement pertinent to other drugs used identified in Part 1 (Meds Used)
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Correction of problems in practical aspect of medicines use identified in Part 2 (Logistics)
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Education pertinent to real and perceived problems and or side effects identifien in Part 3 (Awareness and Concordance)
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Feedback and education of patient and carer regarding revised medication arising from Part 6 Update Medication Use)
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Feedback and education of patient and carer regarding schedule for implementation of revised medication arising from Part 7 (Schedule Implementation)
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Provision and/or update of card detailing all medications in use to be carried by patient at all times
Part 9 : Records update
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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.
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Update prescriptions schedules (e.g. cardex)
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Distribute updated medications list to other healthcare providers involved in patient's care (e.g. pharmacist, specialists, etc.).
Part 10 : Progress reviews
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Arrange to assess progress and, if necessary, make further changes in the future.

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