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Wiki_Medication Review (redirected from Medication Review)

Medication Review

 

Medication review is a trendy topic, and in many countries some form of medication review is performed in community pharmacy or hospital. Medication review is an essential element of pharmaceutical care. It also is part of seamless care, just the transfer of information is not enough. To have a correct picture of the medication that a patient uses (and should use) before a review, medication reconciliation should be performed. The Pharmaceutical Care Network Europe has a working group on medication review. This working group has made a definition, and formulated three levels of Medication Review.

Additional information and detailed documentation about Medication Review can be found on the PCNE website.

 

Types of medication review

 

PCNE Type 1: Simple MR: A simple medication review is based on the available medication history in the pharmacy.

  • ·         Reveals: drug interactions, some side-effects, unusual dosages and some adherence issues

 

PCNE Type 2A: Intermediate MR: An intermediate medication review can be performed when the patient can be approached for information. Such a review is based on medication history and patient information.

  • ·         Reveals: drug interactions, some side-effects, unusual dosages, adherence issues, drug-food interactions, effectiveness issues, side effects, and problems with OTC

PCNE Type 2B: Intermediate MR: An intermediate medication review can be performed if GP information is also available. Such a review is based on medication history and medical information.

                  Reveals: drug interactions, some side-effects, unusual dosages, adherence issues, drug-food interactions, effectiveness issues, indication without a drug and drugs without indication

 

PCNE Type 3: Advanced MR: An advanced medication review is based on medication history, patient information and clinical information.

  • ·         Reveals: drug interactions, some side-effects, unusual dosages adherence issues, drug-food interactions, effectiveness issues, side effects, problems with OTC, indication without a drug and drugs without indication, dosage issues

 

The PCNE definition reads:  Medication review is a structured evaluation of patients’ medicines with the aim of optimizing medicine use and improving health outcomes. This entails detecting drug-related problems and recommending interventions.’ This definition was accepted unanimously by the PCNE General Assembly in 2016 as the official PCNE definition of Medication Review. A position paper that supports this definition can be found here. An article on the process of the creation of the definition will be published.

 

Studies about medication review

 

Medication review is performed in most developed countries. In Europe Bulajeva et al. (not free) described the situation in 2014. They concluded that a full clinical medication review (Type 3) was not yet done in so many European countries. An increasing number of papers describe the findings of medication review in terms of problems detected, but studies about the impact on real patient outcomes, however, are still scarce. A systematic review by Hohl et al. in 2015 in the British Journal of Clinical Pharmacology (not free) found that wide confidence intervals suggested that additional research is likely to influence the effect size estimates and clarify the effect of medication review on patient-oriented outcomes. That review failed to identify an effect of pharmacist-led medication review on health outcomes. Another review by Wallerstedt et al in 2014 in the same journal also did not find that medication reviews for nursing home residents reduced mortality or hospitalization. However, publications about medication review performed by other professionals such as nurses, doctors or clinical pharmacologists are unknown to date, and there are reports on beneficial effects on intermediate outcomes such as the number of drug-related problems.Doing a reproducible structured medication review proves to be a big challenge in most papers.

 

Tools for medication review

 

During medication review, the pharmacist is looking for drug related problems, that may influence the quality of the pharmacotherapy. Apart from his skills and expertise, the pharmacist can also use one or several tools. Such tools usually are made for assessing the medication of patients that are 65 and older, and use several medicines ('polypharmacy in the elderly'). In the American setting, the Beers criteria are well known and used often. The 2015 revised version of the Beers Criteria (free) is freely available from the website of the Journal of the American Geriatric Society.  In the European setting the Stopp-Start criteria currently are the most well-known. An updated version was published in 2014, and an amended version of that publication was made accessible in 2015 as

STOPP/START criteria for potentially inappropriate prescribing in older people: version 2.  (free)

In the Dutch multidisciplinary Guideline 'Polypharmacy in the Elderly', (in Dutch, free), the STOPP-START criteria are specifically mentioned as a tool that can detect potential drug-related problems (DRPs). In practice, both the Beers criteria and the STOPP-Start criteria are being adapted to specific settings, countries and languages.

 

Drug related problems

 

A drug-related problem (DRP) is an event or circumstance involving drug therapy that actually or potentially interferes with desired health outcomes. (PCNE 2001). DRPs can be potential (in future possibly leading to real problems for the patient) or manifest (the problem already impacts on the patient and his therapy).  The term ‘Drug Related Problem’ is not unique for a problem with pharmacotherapy. Other terms have been proposed. See the Wiki on Drug-related problems.

 


 

 

 

 

 

 

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