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What Is A Medication Review?

What Is A Medication Review
A medication review is a meeting about on your medicines, with an expert – a pharmacist, doctor or nurse. There may be changes you want to suggest, worries that are bothering you or questions that you want answered. And the person you meet with may also have changes or questions to raise with you.

What is the definition of medication review?

Background – In order to reduce the number of preventable adverse drug events and hospital admissions, medication review is often recommended, incorporated in several guidelines and also frequently reimbursed by health care insurers in various countries,

  • Medication review is defined by the Pharmaceutical Care Network Europe (PCNE) as “a structured evaluation of a patient‘s medicines with the aim of optimising medicines use and improving health outcomes.
  • This entails detecting drug related problems and recommending interventions”,
  • In clinical practice, for each individual patient, medication review is mostly operationalized as an isolated intervention during a short term intervention period,

Several systematic reviews and meta-analyses already examined the effectiveness of medication review and these did not unequivocally prove the effectiveness of medication review, However, these systematic reviews did not only include trials assessing the effect of medication review in terms of how it is mostly operationalized in practice: an isolated cross-sectional assessment of total medication use during a short term intervention period less than 3 months.

  1. Most trials in the systematic reviews assessed the effect of medication review as part of multi-faceted pharmaceutical care interventions, consisting of for instance transitional care, adherence counseling and education of patients and healthcare professionals, besides medication review.
  2. Such interventions also often last longer than 3 months.

Furthermore, most systematic reviews focus on specific patient groups (e.g. polypharmacy, elderly, hospitalized) and/or on specific outcome measures (e.g. hospital admissions and mortality). As a result, more insight is necessary in the effectiveness of medication review as an isolated short-term intervention on clinical outcomes, quality of life, drug-related and economical outcomes.

What is the medication review process?

Admission and discharge information transfer steps – In simplified terms, six steps—which are remarkably similar at all three IDSs studied—are used to gather, organize, and communicate clinical information at admission and discharge. At admission—

  1. the admitting physician writes admitting medication orders;
  2. nurses document the patient’s historical medications; and
  3. inpatient pharmacists create a medication administration record (MAR).

At discharge—

  1. the discharging physician develops discharge instructions for the patient;
  2. nurses educate the patient about the discharge instructions; and
  3. the new medication regimen is transmitted to the follow-up physician in a discharge summary.

Research evidence: Medication reconciliation studies have focused on the accuracy of the medication history during various transitions: ambulatory to an acute care inpatient setting, skilled nursing facility to an acute care inpatient setting, inpatient acute care setting to the skilled nursing facility, inpatient acute care setting to discharge, inpatient floor to the intensive care unit (ICU), and ICU to discharge.

Little research has focused on outcomes related to the prevalence of errors resulting from a lack of or incomplete patient medication lists. Medication reconciliation is the process of comparing a patient’s medication orders to all of the medications that the patient has been taking. This reconciliation is done to avoid medication errors such as omissions, duplications, dosing errors, or drug interactions.

It should be done at every transition of care in which new medications are ordered or existing orders are rewritten. Transitions in care include changes in setting, service, practitioner, or level of care. This process comprises five steps:

  • develop a list of current medications;
  • develop a list of medications to be prescribed; (3) compare the medications on the two lists; (4) make clinical decisions based on the comparison; and (5) communicate the new list to appropriate caregivers and the patient.

Errors prevented by medication reconciliation include inadvertent omission of therapy, prescribing a previously ceased medicine, the wrong drug, dose, or frequency, failure to recommence withheld medicines, and duplication of therapy after discharge.

What are the 4 types of medication review?

Reviewing medicines The considered that review of prescribed is most commonly undertaken in clinical settings as part of management of patients and their medical problems. In this setting it is seen as integral to continuing care and not separate from it. The GDG considered that all levels of as described in ‘Room for Review’ take place in this setting and have a role. Revisiting a decision to prescribe medicines and exploring patients medicine-taking behaviour was considered by the GDG to be part of the dynamic process that long-term medicine prescribing required. The research evidence primarily addresses medicine reviews that take place separate from the delivery of clinical care, often by practitioners who do not have access to clinical history and notes. These have been a recent development and have primarily involved pharmacists. Most of the evidence on reviews by pharmacists comes from studies that targeted older adults on multiple, Many studies include quite complex pharmaceutical care programmes where the interventions consists of a number of components including education and follow-up which the considered more intensive than is currently provided in any type of provided in the UK. can have benefits for the patient but evidence was conflicting whether this led to improvements in to prescribed medicine. The were particularly concerned that reviews of medicine carried out remote from the clinical settings needed to feed back to clinicians who were involved in prescribing and other aspects of care. Increasing the number of medicine reviews and the personnel involved in carrying them out might not be effective if communication and follow up is not achieved. The were clear that the lack of research on reviews conducted as part of clinical care should not indicate that these were not of value. Review of will continue to be part of delivery of health care. As responses to medicine can change over time, both in terms of patient behaviour () and clinical outcomes, a process of is likely to be necessary and be part of on-going processes of decision-making and medicine-taking. An informal review of medicine should continue as part of good clinical practice but it is not possible to recommend precise timings for formal medicine reviews outside the clinical setting. The titles and abstracts of studies retrieved by an electronic search for were scanned for relevance to the question of whether medicine review increases to, Any potentially relevant publications were obtained in full text. These were then reviewed to identify the most appropriate evidence to help answer the question and to ensure that the recommendations are based on the best available evidence. This process required four main tasks: selection of relevant studies; assessment of study quality; synthesis of the results; and grading of the evidence. This paper includes a narrative summary of the included evidence, following the agreed reviewing protocol: Types of studies – randomised controlled trials (RCTs) of interventions to increase, Types of participants – people prescribed medicine for a medical condition. performed by any healthcare professional or trained personnel. Setting – carried out in the community. Duration of studies – no time limit specified for this evidence review. Types of interventions – any (as implying face to face meeting between the patient and the doing the review) interventions intended to change to prescribed medicine. The content and delivery of interventions are not standardised in the literature. The term ‘pharmaceutical care programme’ is used and this applies to pharmacist led programmes which assess medicine use, develop an intervention and provide long term follow-up to patients including liaison with the prescriber. Some of these interventions provide intensive support. Some subjective assessment of studies was required as content is often not well defined. Many of studies on interventions to increase adherence used pharmacists to carry out the intervention but we have included here only studies that were carried out in the community and were providing general review rather than disease specific support. Types of outcome measures – any prescribed medicine outcomes which changed as a result of the, Outcomes relevant to patient involvement were reported as part of the evidence review. Of the RCTs found relating to, many had to be excluded as they did not have outcomes. Instead they focused on hospital readmissions, care home admissions, death and cost-effectiveness. One high quality RCT conducted by Zermansky (2002) for HTA could not be included as there were no specific adherence outcomes. studied whether a trained pharmacist could conduct effective clinical medicine reviews of elderly patients who were on repeat prescriptions from their GP. The participants were 65 years or over on repeat medicine, who were not resident in a nursing or residential home and were not terminally ill. The study lasted 12 months and the intervention involved the pharmacist assessing the patient, their illnesses and their medicine regimen and making recommendations. The primary outcome measure was the number of repeat medicine changes per patient, which was 2.2 in the intervention group and 1.9 in the control group (Difference of 0.31, 95% CI 0.06 to 0.57), p=0.02). The secondary outcome was the effect on cost of medicine. There was a rise in repeat medicine items for both groups, but this was statistically significantly less for the intervention group (intervention mean 0.2, s.d=1.55; control mean 0.4, s.d=1.53, difference −0.2, 95% CI, −0.4 to −0.1). The cost saving for the intervention group compared to the control group was £4.75 per 28-day month, a total of £61.75 per patient per year. A systematic review (Holland 2007) focusing specifically on pharmacist-led was found. However the primary outcome of interest was reduction of hospital admissions and deaths in older people and was a secondary outcome. The studies included all forms of medicine review for checking and optimising the patients’ medicine regimens apart from those with only knowledge and/or adherence outcomes. They reported that 14 of the trials included adherence, with 7 reporting a statistically significant effect and 7 reporting a statistically non-significant positive effect. The term ‘pharmaceutical care programme’ is also used in the literature and this generally applies to pharmacist-led programmes which assess medicine use, develop an intervention and provide long term follow up to patients. Although more intensive that any programmes currently delivered in the UK we included these studies as it was important to assess whether such structured and intensive support was either clinically or cost-effective. Some subjective assessment of the studies was necessary as the content of the reviews and pharmaceutical programmes is not always clearly defined. Sturgess (2003) measured a structured pharmaceutical care programme provided to elderly patients by community pharmacists 191 elderly patients with a mean age of 73.1 ± 5.0 for the intervention group and 74.2 ± 6.3 for the control group. This RCT was conducted in Northern Ireland. In the intervention pharmacists assessed patients to identify medicine-related problems. A number of information sources were used by intervention pharmacists during this assessment procedure including: the patient (via informal questioning), the patient’s GP, study questionnaires and computerised medicine records. During the assessment, pharmacists were asked to document any identified medicine-related problems and to form with the patient an intervention and monitoring plan e.g. education, implementation of improving strategies. Pharmacists visited patients at home to assess storage of where problems were identified. Self-reported : between-group analysis at each assessment point indicated that a statistically significantly higher proportion of intervention patients were compliant with their medicine at 12 (intervention group: 40.4%, control group: 24.4%) and 18 (intervention group: 47.3%, control group: 14.7%) months compared to control patients (p<0.05) (6 months: intervention group: 34.5%, control group: 29.4%). Analysis of change in compliance during the study (change in compliance status compared to that reported at baseline) showed that a statistically significantly higher proportion of intervention patients changed from non-compliant to compliant compared to control patients (intervention 13.4% vs. control 9.1%) and a statistically significantly higher proportion of control patients changed from compliant to non-compliant compared to intervention patients at 18 months (control 36.4% vs. intervention 4.5%). Lowe (2000) determined whether a and education programme influenced elderly patients' and knowledge compared to a control group in a RCT.161 participants, mean age 77.5 (sd=65–96) for the intervention group and 75 (sd=65–88) for the control group, mainly female (67%), living with spouse or relative 55% (intervention group) and 57% (control group) and prescribed an average of 4 (ranging from 1 to 8). The RCT was conducted in a GP practice in Leeds, UK. An investigator visited patients and filled in a structured questionnaire regarding their medicines, which medicine had been used and patients' understanding and ability to take medicines. The investigator then reported the findings to doctors where there was a need to reduce dosage and discontinue medicine, then liaised with the pharmacist for modifications to medicine containers. At the second visit after a month they delivered 1 months supply of medicine and removed any other prescribed medicines. They discussed the regimen, the purpose of the medicines and the correct way to take them, with the use of a reminder chart if needed. At 3 weeks follow-up participants were given a further months supply and assessed on their knowledge and compliance, by counting the medicines left from the last visit. The mean compliance score was 91.3% for the intervention group (95% CI, 89% to 94%) and 79.5% for the control group (75% to 84%), which was statistically significantly different (p<0.0001).N.B This study was under 6 month's duration but the patients were followed up twice at 3 week to monthly intervals and the study was of particular relevance. Begley (1997) assessed the influence of domiciliary pharmacy visits on medicine management in sample of elderly people recently discharged from hospital to their own homes. Patients were aged 75 years or older. The study included one intervention group receiving home visits and counselling, in which structured patient interviews were conducted during the domiciliary visits and consisted of six sections: patient information; medicine knowledge; Patient dexterity; abbreviated mental test; medicine management; and with medicine regimen. Patients were seen during 12 months. There were two control groups: one which was the control and received visits only (called V group), and other which was the control group that received traditional pharmaceutical services with no visits except for the beginning and the end of the study (NV group). At each visit there were statistically significant differences between the groups in terms of distribution of patients at the various levels of (p<0.001). Compliance was higher at 3 months and 12 months for the intervention group compared to the other control groups (p<0.001), despite the low compliance value for the intervention group at the 12 month visit. Patients in the intervention group who increased their compliance rates between visits also increased their medicine knowledge scores (p<0.005). Mean scores for medicine knowledge did not differ significantly (statistically) between the groups at any of the visits, although the mean score for the intervention group increased significantly (statistically) between the initial and the two weeks visits (p=0.001). There were no changes for patient dexterity scores between groups at any point of the study. Contacts with GP and health workers was lower for the intervention group than for the control (V) in each of the four time periods (p<0.01). Bernsten (2001) conducted a multicentre RCT in seven European countries including the UK that evaluated a pharmaceutical care programme provided to elderly patients (aged 65 or older) taking 4 or more by community pharmacists. A total of 1290 intervention patients and 1164 control patients were recruited. The programme interventions included: 1) educating the patient about their medicine regimen and their condition; 2) implementing -improving interventions such as medicine reminder charts; 3) rationalising and simplifying medicine regimens in collaboration with the patients GP. This was a continuous process throughout the 18 months of the study. Generally, the programme had some positive effects on humanistic health outcomes such as satisfaction with treatment, and sign and symptom control, and on economic outcomes, but had less impact than anticipated on medicine therapy, medicine knowledge and with medicine. An analysis of changes in compliance during the study indicated that at 18 months a statistically significantly higher proportion of the intervention patients changed from being noncompliant to compliant compared with the control groups (p=0.028). Intervention patients rated the services provided higher that the control at 6 and 18 months (p<0.05). There was a small statistically significant increase in satisfaction in the intervention group over time (baseline vs.12 months p=0.039). Nazareth (2001) compared patients who had been discharged from hospital with a discharge plan with those who had a standard discharge letter. This RCT included 362 patients from four hospitals in central London. The participants had a mean age was 84 years in both groups (s.d=5.2 and 5.4 respectively), mainly female (62% and 66%), white (97%) with a mean of three chronic medical conditions and prescribed a mean of 6 (s.d=2). The discharge plan included assessing the prescribed medicine, rationalising the medicine and assessing patients' medicine management, knowledge and support. The participants were then followed up 7 to 14 days later at home by community pharmacists who compared medicine-taking with prescribed medicines and their understanding and to the medicine regimen. They intervened when necessary and provided medicine counselling, disposal of excess medicines and liaison with GPs. There was no statistically significant difference in adherence to medicines for either group at 3 months or at 6 months. Lipton (1994) assessed the impact of clinical pharmacists' consultations on medicine regimens,, and health service use of 706 geriatric hospitalized patients discharged on 3 or more, The RCT was conducted in the USA. Mean age was 74.6 in the experimental group and 74.4 in the control group. Pharmacists consulted with experimental patients at discharge and 3 months thereafter, and with physicians as needed. Controls received usual care. At 6–8 weeks after enrolment, experimental patients were more knowledgeable about regimens than controls. At 12–14 weeks, they were on fewer medicines and less complex regimens, and had better compliance scores p<0.001). There was no effect on service use or charges, perhaps due to inadequate sample size and lack of targeted medicine group's analysis. Hanlon (1996) was an RCT which compared the effects on elderly outpatients who had an additional pharmacist intervention with those who received usual care from their physician. Most of the patients were male (98% in the intervention and 100% in the control group), white (79% and 75% respectively), married (65.7% intervention, 85.4% control), with baseline rates of 73% and 74% respectively. The mean age of participants was 70 years old. The RCT was conducted in Durham, North Carolina. Before attending the physician the pharmacist reviewed their medical records and medicine lists to ascertain their current medicine use, medicine-related problems and to evaluate their needs by applying the Medicine Appropriateness Index. Their findings were then reported to the physician. The Pharmacist educated the patient on medicine-related problems and encouraged compliance through strategies such as medicine reminders and written patient materials. They reviewed safe medicine use and the importance of discussing with physicians. There were no statistically significant differences between the groups at the end of the follow-up period with regard to medicine compliance (77.4% of intervention group and 76.1% of control group complied, p=0.88). Chisholm (2001) studied the rates of patients who received a clinical pharmacist intervention in addition to usual care compared to control patients after a renal transplant. The RCT included 24 participants, 75% male with a mean of 49 years (s.d=10 years) and 58.3% Caucasian, 37.5% African-American and 1 Hispanic. The RCT was conducted in Augusta, Georgia, USA. The Pharmacist obtained medicine histories and reviewed monthly. They made recommendations to the nephrologists and counselled the patients on their medicine, including instructing how to use the medicine. Patients were encouraged to call them with any questions. The patients were assessed on their understanding of their medicine and advised on how to enhance compliance. At 12 months the rate was statistically significant for the intervention group 96.1% (s.d=4.7%) compared to the control group 81.6% (s.d=11.5%), p<0.001. For 6 of the 12 months there were differences in compliance rates (64 to 100% for control group and 89 to 100% for the intervention group) with the intervention group always at a higher rate (p<0.05). The duration that patients complied for also differed with the intervention group remaining 75% compliant each month compared to only 33.3% of the control group (p<0.05). Taylor (2003) conducted an RCT of patients attending a community-based physician and compared those who additionally received a Pharmacist intervention to a control group. The majority of participants were women (63.6% in the intervention group vs 72.2% in the control group, p=0.445), most were white (60.6% vs 61.1%, p=.966) with a mean age of 64.4 and 66.7 years respectively (p=0.467), the majority were married 75.8% vs 72.2 (p=0.935) with 12 years mean education. They were taking on average six each. The RCT was set in medicine clinics in Alabama, USA. The pharmacists evaluated the patients' medicine, reviewed medical records and examined medicine history to determine and complications with medicine. Therapeutic recommendations were made to the physicians and the pharmacists made follow-up visits to patients, gave individualised education and were available to answer questions. Patients' responses to were monitored and their medicine regimens consolidated, dosage frequency was reduced and medicine reminders and techniques for using certain devices were taught. The number within the intervention group to have scores of 80–100% increased by 15% but there was no change for the control group (time period not stated). By 12 months this difference was not statistically significant, 100% of patients in the intervention group versus 88.9% (s.d=6.3) of the control group had compliance scores of 80–100%, p=0.115). At baseline this was 84.9% (s.d=6.7) and 88.9% respectively (s.d=5.8, p=0.728). The most frequently sited reasons for not complying with medicine were forgetting to take the (n=10), having too many to take (n=9), finding it hard to read or understand the directions (n=4) and too much trouble to take (n=4). Grymonpre (2001) compared the impact on geriatric patients who received pharmaceutical care compared to those patients who did not in a RCT. Most of the patients were female (75% intervention vs 83% control, p=0.254), aged 77 (s.d=8.0 to 9.0), Caucasian (100%) and lived alone 61% vs 77% respectively, p=0.018. The RCT was conducted in a community-based health clinic in Manitoba, Winnipeg, Canada. Volunteers and staff were trained to conduct a comprehensive which was utilised by the pharmacist to identify and document potential and actual medicine-related issues and to address these with the patient and they physician. Their use of prescribed and non-prescribed, social medicines, home remedies, regimen, and communication with GPs, problems or side effects with medicines were all assessed. The recommendations were given in a letter to physicians and the patients were followed up by the pharmacist when required to monitor therapeutic endpoints and sort out any problems that had arisen. The mean number of mediations adhered to at follow-up was 87 ± 46 for the intervention and 85 ± 41 for the control group, p=0.895, showing no statistically significant difference in, Sookaneknun (2004) compared hypertensive patients assigned to a pharmacist-involved group with those who had no pharmacist involvement, with the objective of stabilising blood pressure. The participants of the RCT included 235 patients, mean age 63 years old and mainly female (64% in intervention and 71% in control group). The RCT was conducted in Thailand. The intervention group's blood pressure was measured every month by the pharmacist and they assessed the patients understanding of, and reviewed adverse effects from the medicines. Medicine counselling was given and medicine-related problems were identified, resolved and prevented. The recommendations for change of medicine regimen were given to the physicians. The adherence at pre-test was not statistically significantly different but at post-test the treatment group had statistically significantly increased adherence compared to the control group, Pre-test adherence of 80% or more was found in 51% of the treatment group and 56% of the control group. At post-test this had increased to 63% for the treatment group and had remained constant (55%) for the control group (p=0.014). The quality of many of the RCTs was low. This was mainly due to the possibility of bias occurring within the methodology. : Reviewing medicines

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Why do you need a medication review?

Why are medication reviews so important? – Medication reviews identify opportunities to help you get the best out of the medicines you’re taking, to help you understand what they do and why you’re taking them, to switch you to different medicines – or sometimes to stop medicines that are no longer right for you.

forgetfulness, a patient may involuntarily fail to remember taking their medication a patient may consciously decide to stop taking their medicine as prescribed without consulting their GP due to distressing side effects or uncertainty about the actual need for the medicine the challenge of managing multiple prescriptions cultural issues forgetfulness worsening health

During a medication review, a patient can discuss any concerns they might have about what they’re taking and hopefully avoid the failure of a treatment. If you’re experiencing side effects, it’s also worth reporting them to the Yellow Card Scheme, The Yellow Card Scheme helps the Government monitor medicines to ensure any safety concerns are collated and addressed.

What is the aim of medication review?

Structured Medicine Reviews (SMRs) are an evidence-based and comprehensive review of a patient’s medication, taking into consideration all aspects of their health. In a structured medication review clinicians and patients work as equal partners to understand the balance between the benefits and risks of and alternatives of taking medicines.

The shared decision-making conversation being led by the patient’s individual needs, preferences and circumstances. Problematic polypharmacy is where, for an individual taking multiple medicines, the potential for harm outweighs any benefits from the medicines and/or they do not fully understand the implications of the medication regime they are taking.

This includes:

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medicines that are no longer clinically indicated or appropriate or optimised for that person combination of multiple medicines has the potential to, or is actually causing harm to the person practicalities of using the medicines become unmanageable or are causing harm or distress.

SMRs have benefits to people taking multiple medicines:

improved experience and quality of care through being involved in the decision-making process and having a better understanding of the medicines they take less risk of harm from medicines (e.g. adverse drug events, side effects, hospitalisation or addiction) better value for local health systems (e.g. reduced medicine waste).

Who can perform a medication review?

Quick reference guide – Conducting a medication review is a key role for pharmacists in all settings as part of the multidisciplinary approach to care. Pharmacists can address practical medicines optimisation and medicines adherence issues thereby improving the clinical effectiveness of medicines taken by patients.

Many problems with medicines usage can be avoided by monitoring the effects of therapy, making recommendations to change therapy and modifying medication where necessary. This guidance is for all pharmacists who monitor and review patient medicines. Medication reviews can be conducted in different healthcare service settings such as community pharmacies, primary and secondary care, care homes, etc.

This guidance provides a basic understanding of what a medication review is and describes the aims of conducting one. It outlines factors you may need or feel appropriate to consider when providing a medication review and after completion of the review.

What is the difference between medication reconciliation and review?

What is the difference between medication reconciliation and medication Medication reconciliation is conducted to ensure that the provider has a complete record and understanding of the prescription and non-prescription medications a patient has been taking (including doses and frequencies) when prescribing medications after transition points in care (e.g.

  • Admission, discharge).
  • In cases where there is previous medication information (e.g.
  • From PharmaNet, a nursing home’s medication administration record), a provider will review the record with the patient and other sources (e.g., the family physician) to create the ‘best possible medication history’.
  • Medication reconciliation – also called MedRec – is an Required Organizational Practice.

A medication review starts with establishing a best-possible medication history, and includes a critical evaluation of the patient’s medications for any potential drug-related issues (e.g. medications that may be necessary or unnecessary, drug interactions, ADRs, inappropriate dosing).

What should be included in medication review?

Medication review – Health and social care practitioners should discuss and review the following during a medication review:

the purpose of the medication review what the resident (and/or their family members or carers, as appropriate, and in line with the resident’s wishes) thinks about the medicines and how much they understand the resident’s (and/or their family member or carer’s, as appropriate, and in line with the resident’s wishes) concerns, questions or problems with the medicines all prescribed, over‑the‑counter and complementary medicines that the resident is taking or using, and what these are for how safe the medicines are, how well they work, how appropriate they are, and whether their use is in line with national guidance any monitoring tests that are needed any problems the resident has with the medicines, such as side effects or reactions, taking the medicines themselves (for example, using an inhaler) and difficulty swallowing helping the resident to take or use their medicines as prescribed (medicines adherence) any more information or support that the resident (and/or their family members or carers) may need.

How long is a medication review?

Structured medication reviews should last at least 30 minutes, confirms NHS lead – The Pharmaceutical Journal.

What is the value of medication review?

Patient education is the key – Prevention begins with a detailed medication therapy review and patient education. During a review, pharmacists can help identify potential adverse drug reactions and make recommendations for alternate therapies. They can detect errors or discrepancies in labeling, dosage or treatment, and address any adherence issues that the patient may have.

  • Adherence rates are as low as 50% for the average chronic disease patient.
  • Pharmacists can be particularly effective at addressing this issue alone.
  • Improving adherence rates to recommended treatments helps prevent risk factors for complications and improves health outcomes.
  • Through one-on-one consultation and education during the medication review, pharmacists provide patients with essential coaching.
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Patients gain a better understanding of their medication treatment and learn how to more effectively manage their health. Outcomes include reduced absenteeism and presenteeism, reduced incidences of short-and long-term disability, and ultimately reduced health care costs.

What happens with a medication review?

A medication review is a meeting about on your medicines, with an expert – a pharmacist, doctor or nurse. There may be changes you want to suggest, worries that are bothering you or questions that you want answered. And the person you meet with may also have changes or questions to raise with you. The meeting is free.

Do you need blood test with a medication review?

Why do I need a medication review?

Many people think that healthcare is something that happens when they visit their GP, hospital, dentist, pharmacy or local clinic. What the illustration opposite shows is that the time you spend in these healthcare settings is a tiny percentage of a patient’s daily life.

  • Click to enlarge.) has Parkinson’s disease and her illustrations shows how much care is in a patient’s own control.
  • The red dot is the time she spends with her doctor and the rest of the time, she’s on her own.
  • Unfortunately, you can’t take your GP home to look after you but what you can do is take your medication as prescribed to make sure it has the desired effect,

Research has shown that patients fully intend to take their medication as prescribed but within just two weeks, 50% of patients are no longer doing so! The review will be undertaken by a trained pharmacist, nurse or GP and it’s an opportunity to fully review all the medication you take, both on prescription and bought over the counter and includes vitamins, minerals and herbal products. It’s an ideal opportunity for you to ask any questions you may have about your medication so if you have any ideas, concerns or expectations please ask away.

  1. Is the medication still needed? Some medications are needed to be taken for the rest of your life but some are for a short period of time e.g. pain killers before an operation, indigestion remedies and laxatives.
  2. Tests and monitoring. Before you come in for your review you may be asked to come to practice for a blood test. This can be for a number of reasons including to make sure the medication is having the desired effect or to check that your internal organs are functioning properly.E.g. some medications are not safe if your kidneys or liver are not functioning properly.
  3. Does the medications prescribed follow best evidence? Research is always being performed to make sure we understand what treatments are best for patients. This is assessed by NICE (National Institute for Health and Care Excellence) who send recommendations to GPs. Part of the review is to make sure your medications follow current best practice
  4. Side effects. One of the main reason patients don’t take side medicines is due to concern about side effects. You medication review is a brilliant opportunity to discuss your concerns about potential side effects.
  5. Risk reduction. Most medications are perfectly safe is taken as prescribed. However we know that patients don’t always remember all of the conversation with their GP so we check to make sure patients take steps to minimise potential risks e.g. taking aspirin after food.
  6. Simplification. If taking your medication becomes too complicated, there’s a chance you’ll forget to take them as prescribed. So at your review, we’ll take every opportunity to simplify your medication regime if required.

After your review we want you to:

  • understand what medicines you are taking for which condition
  • understand how you need to take your medicines to get maximum benefit
  • understand how to avoid unwanted effects
  • be confident to take your medication as prescribed and understand that you have a key person within your surgery who you can contact with any medication related queries.

Why do I need a blood test for a medication review?

Medication Safety This may include a blood test or other physical check such as a blood pressure or discussing your symptoms or side effects. These checks are imperative to ensure the medication is not causing any adverse effects.

What is the importance of medication review and reconciliation?

Background – According to the Institute of Medicine’s Preventing Medication Errors report, 1 the average hospitalized patient is subject to at least one medication error per day. This confirms previous research findings that medication errors represent the most common patient safety error.2 More than 40 percent of medication errors are believed to result from inadequate reconciliation in handoffs during admission, transfer, and discharge of patients.3 Of these errors, about 20 percent are believed to result in harm.3, 4 Many of these errors would be averted if medication reconciliation processes were in place.

  1. Medication reconciliation is a formal process for creating the most complete and accurate list possible of a patient’s current medications and comparing the list to those in the patient record or medication orders.
  2. According to the Joint Commission 5 (p.1), Medication reconciliation is the process of comparing a patient’s medication orders to all of the medications that the patient has been taking.

This reconciliation is done to avoid medication errors such as omissions, duplications, dosing errors, or drug interactions. It should be done at every transition of care in which new medications are ordered or existing orders are rewritten. Transitions in care include changes in setting, service, practitioner, or level of care.

This process comprises five steps: (1) develop a list of current medications; (2) develop a list of medications to be prescribed; (3) compare the medications on the two lists; (4) make clinical decisions based on the comparison; and (5) communicate the new list to appropriate caregivers and to the patient.

Recognizing vulnerabilities for medication errors, numerous efforts are underway to encourage all health care providers and organizations to perform a medication reconciliation process at various patient care transitions. The intent is to avoid errors of omission, duplication, incorrect doses or timing, and adverse drug-drug or drug-disease interactions.

Why it is important to have a medication review for patients taking multiple drugs?

A medicines review can improve your treatment and prevent problems, especially for elderly patients taking multiple drugs. A regular check of the medications you take when you are elderly can benefit your health and well being and prevent problems like side effects.

What are the 4 stages of the medication process?

Definition/Introduction – Pharmacokinetics (PK) is the study of how the body interacts with administered substances for the entire duration of exposure (medications for the sake of this article). This is closely related to but distinctly different from pharmacodynamics, which examines the drug’s effect on the body more closely.

What is medication review in pharmacy?

Medication review is a systematic assessment of a patient’s medication management with the aim of optimising the quality use of medicines and minimising medication-related problems. It is a multidisciplinary responsibility that ensures the ongoing safe and effective use of medicines at all stages of the medication management pathway.1,2 Medication Order Review A review of individual medication orders and / or prescription validity.

  • It may take place without the patient present.
  • Medication Adherence Review A review of a patient’s medicine taking behaviour (how they actually take their medicines and what their beliefs about medicines are).
  • Clinical Medication Review A comprehensive review of a patient’s medicines in the context of their clinical conditions.

It considers the management of the conditions being treated and the appropriateness and continuing need of each medication, as well as potential gaps in therapy. Partnering with the patient/carer is essential when undertaking a clinical medication review.

Medication Review and Medication Reconciliation are distinct but interrelated processes. Medication review involves an evaluation of a patient’s medicines with the aim of optimising the quality use of medicines. A medication review will often result in the identification of actual or potential medication-related problems and recommendations to optimise medicines use.

Medication Reconciliation involves ensuring accurate and complete medicines information is communicated at all transfers of care. Medication reconciliation will often result in identification of medication discrepancies (e.g. differences between the documented medication history and the admission medication orders) which may be intentional or unintentional.

What is the difference between medication review and medication reconciliation?

What is the difference between medication reconciliation and medication Medication reconciliation is conducted to ensure that the provider has a complete record and understanding of the prescription and non-prescription medications a patient has been taking (including doses and frequencies) when prescribing medications after transition points in care (e.g.

admission, discharge). In cases where there is previous medication information (e.g. from PharmaNet, a nursing home’s medication administration record), a provider will review the record with the patient and other sources (e.g., the family physician) to create the ‘best possible medication history’. Medication reconciliation – also called MedRec – is an Required Organizational Practice.

A medication review starts with establishing a best-possible medication history, and includes a critical evaluation of the patient’s medications for any potential drug-related issues (e.g. medications that may be necessary or unnecessary, drug interactions, ADRs, inappropriate dosing).

What is a medication review mental health?

What happens during a medication review? – During a medication review, a psychiatrist will revisit all the medications you are taking including the dose and when you take them. A medication review is also an opportunity to ask any questions or voice any concerns you have about your medications so that you feel comfortable with your treatment plan.