Elements of medication review
Medication reviews are most often undertaken by doctors, pharmacists and nurses, and may occur during outpatient clinics, home visits, exercise rehabilitation programs, or via the telephone. GPs are often central in coordinating medication management.
The process involves ensuring patients receive the most appropriate treatments for their condition at a safe and appropriate dose, while minimising the risks associated with medication use. The review should also aim to improve patient and carer understanding about their medicines to facilitate informed, shared decision-making regarding treatment.
Once a medication history has been taken and medication lists reconciled, the following elements should be identified:
- Any drug allergies or intolerances
- The suitability of each medicine, using available evidence to guide treatment choice and dose
- The need for additional therapy for untreated conditions
- Potential unwarranted therapy: e.g., medication where there is no current medical indication, or with an unnecessary duration of treatment
- Medicines that may be contraindicated or require precautions (for reasons such as renal or hepatic impairment) or that should be avoided
- Tests required for therapeutic efficacy or to detect adverse effects and toxicity
- Duplication of medicines (e.g,. multiple brands of the same medicine)
- The patient’s understanding of the medicines
- Safe storage and disposal of medicines
- Patient adherence with medications, including assessing the need for dose administration aids
- Non-pharmacological management and lifestyle factors
- Potential impact of Cardiac medications on exercise
- Vaccination status for influenza and pneumococcus
- Need for medical alert bracelet for e.g., anticoagulants or allergies
Engagement of the patient may be aided by explaining the purpose, process and possible outcomes of the review prior to the consultation, asking the patient to bring their medicines (or a list of their medicines) and encouraging the patient to ask questions and actively involve themselves in the discussion.
A medication review process should give the patient an opportunity to raise any concerns and ask questions about their medications. Given the large number of generic medicines for CVD, dedicate some time to discuss potential confusion over brands. Many countries provide a funded medication review service.