What is a medication review?

As part of the multidisciplinary approach to care, conducting an evidence-based structured medication review is a crucial role for community pharmacists in all healthcare settings. Effective medication review is essential to efficient medicine management, medicine optimisation and the best possible outcome for the patient. Monitoring the effects of therapy, making recommendations for therapy changes, and modifying medications when necessary can prevent many problems associated with medication usage.

What is a Medication Review?

A medicine review is a comprehensive assessment of a patient’s medications, taking into consideration all aspects of their health. It involves a collaborative effort between clinicians and patients to understand the balance between the benefits and risks of taking medications, as well as exploring alternatives. The patient’s individual needs, preferences, and circumstances guide the shared decision-making conversation during the review.

At the review, a clinical pharmacist, who is working in the GP practice but as part of the wider Primary Care Network, will check the safe and effective use of medicines. All prescribed, over-the-counter and complementary medicines that the person is taking or using will be included in the review.

Problematic polypharmacy is a common issue for older people taking multiple medications, where the potential for harm outweighs the benefits or where the practicalities of managing the medications become unmanageable or raise the issue of patient safety. This may include medications that are no longer clinically indicated or appropriate, combinations of medications that cause harm, or difficulties in using the medications.

The Aims of a Medication Review

A medication review aims to provide several benefits to individuals taking multiple medications. By actively involving patients in the decision-making process and improving their understanding of their medications, medication reviews can enhance the overall experience and quality of care. Additionally, medication reviews can reduce the risks of harm from medications, such as adverse drug events, side effects, hospitalisation, or addiction. Furthermore, medication reviews contribute to better value for local health systems by reducing medicine waste.

When should a Medication Review be conducted?

Medication reviews should be conducted at various points in a patient’s healthcare journey. It is recommended to perform a medication review when:

• Patients reside in care homes
• Patients have complex and problematic polypharmacy, specifically those on 10 or more medications
• Patients are on repeat prescriptions
• Patients on medications commonly associated with medication errors
• Patients have severe frailty, are isolated or housebound, or have had recent hospital admissions and/or falls
• Patients are using potentially addictive pain management medication

The number of patients offered a medication review will depend on the clinical pharmacist capacity of the primary care network (PCN). PCNs are groups of general practices working together with community, mental health, social care, pharmacy, hospital, and voluntary services to support patients and improve healthcare outcomes.

The patient should be offered the option of meeting, either face-to-face in person or face-to-face virtually. Also, a patient who has started a new medicine may be encouraged to have a new medicine review.

Preparing for a Medication Review

Before conducting a medication review, it is essential to gather relevant information about the patient and their medications. This includes obtaining their medical history, current medication list, and any specific concerns or issues they may have. It is also important to consider any cultural or personal factors that may influence the patient’s medication use.

Collaboration with other health professionals, such as GPs, social prescribing link workers, consultant geriatricians, behavioural therapists, and specialist pharmacists, is crucial for the success of medication reviews. By working in partnership across a PCN, clinical pharmacists can leverage the expertise and support of a multidisciplinary team to address complex cases effectively.

Conducting a Medication Review

The medication review process involves several key components:

Shared decision-making principles

Shared decision-making principles should underpin the conversation between the clinician and the patient during the medication review. This collaborative approach ensures that the patient’s individual needs, preferences, and circumstances are taken into account, allowing them to play an active role in decisions about their medications.

Personalised approach

A personalised approach is essential in medication reviews to tailor the process to the individual patient. This includes considering the patient’s medical history, current health status, lifestyle factors, and any specific medication-related problems.

Safety considerations

During a medication review, the clinician should carefully evaluate the balance of benefits and risks of the patient’s current treatment. This involves assessing the effectiveness of all medications and considering any NHS guidance on exceptions to items that should not routinely be prescribed in primary care.

Effectiveness of medications

All medications prescribed during a medication review should be evaluated for their effectiveness. Tests may be made to determine whether the medicine is working (e.g. blood pressure checks, blood tests or checking inhaler technique). This includes assessing whether the medications are achieving the desired therapeutic outcomes and if any alternative medications or treatment options may better suit the patient’s needs.

Documentation and follow-up

Throughout the medication review process, it is crucial to document all findings, recommendations, and decisions made. This ensures continuity of care and provides a reference for future medication reviews. Additionally, appropriate follow-up actions should be taken to monitor the patient’s progress and address any ongoing concerns or issues.

Other points to consider

In addition to the primary components of a medication review, there are several other factors that pharmacists should consider:

• Medication Adherence: Assessing a patient’s adherence to their prescribed medications is an integral part of the medication review process. Identifying barriers to adherence and providing appropriate support can significantly improve patient outcomes
• Medication Optimization: Pharmacists should evaluate whether a patient’s medications are optimized for their specific health condition. This includes assessing the appropriateness of each medication, potential drug interactions, and potential improvements in medication regimens
• Medication History: Understanding a patient’s medication history is crucial for conducting a comprehensive medication review. This includes reviewing past medication use, medication allergies, and any adverse drug reactions previously experienced by the patient
• Medication Education: Providing patients with education and information about their medications is an essential aspect of the medication review process. This empowers patients to make informed decisions about their healthcare and promotes medication adherence

Community Pharmacy Contractual Framework Medication Review Services

In England, Scotland, and Wales, medication review services are part of the community pharmacy contractual framework. These services aim to support patients by optimizing their medication regimens and promoting safe and effective medication use. Pharmacists play a vital role in delivering these services and ensuring that patients receive the necessary care and support.

Conclusion

In conclusion, conducting a medication review is a critical responsibility for pharmacists in all healthcare settings. By actively involving patients in the decision-making process, addressing practical medicines optimisation and adherence issues, and collaborating with other healthcare professionals, pharmacists can enhance the overall quality of care and improve patient outcomes. Through continuous education and keeping up-to-date with the latest guidelines and resources, pharmacists can ensure the effective delivery of medication review services and contribute to the optimisation of medication therapy for individuals.

Further information on medication reviews is available on the Royal Pharmaceutical Society website.

Sources

• NHS England – Structured medication reviews and medicines optimisation
• Medication Review – RPS