Medication Reviews: Define a medication review A medication review is defined as: - "a structured, critical examination of a patient's medicines with the objective of reaching an agreement with the patient about - treatment, - optimising the impact of medicines, - minimising the number of medication related problems and - reducing waste". What are the types of medication reviews? Medication reviews can be conducted in different healthcare service settings: Community pharmacies Hospital GP practice Care homes - Sitting w/ a patient and discussing different aspects What are the aims of medication review? - aim : to have a partnership between the patient and the pharmacist - Improve knowledge - Identify reasons for non-adherence - Side effects, interactions, therapeutic duplication - 2 types of medication for the same condition ?- and inappropriate doses - Lifestyle advice - Medicines wastage - Monitoring requirements - e.g checking liver function - Clinical assessment - BP, peak flow measurement - if they have asthma - Update PMR/patient medical notes - Discuss any issues raised in the review with the prescriber - Evidence based - OTC medicines or supplements What are the 3 types of reviews? 1. Prescription Review 2. Concordance/Compliance Review - behaviour of the patient, are they taking are they happy taking the medication, need to have patient 3. Clinical Review - is this the right dose, checking lab results, is it having a result and desired outcome, very in depth, reviewing their condition as well not just medications
Characteristics of types of medication review - remember, the different types of review are not hierarchical but each has a distinct purpose Purpose of the review Requires patient to be present Access to patient's notes Includes al prescription medicines Indudes prescription, complementary and over-the- counter medicines Type 1 Prescription review Address technical issues relating to the prescription eg, anomalies, changed items. cost effectiveness No (any resulting changes to prescribed medicines must involve the patient/corer) Possibly (medicines use review by community pharmacist may not Include access to patient's dinicol notes) Possibly (a prescription review may relate to one therapeutic area only rather thon all prescribed medicines) Type 2 Concordance and compliance review Address issues relating to the patient's medicine- taking behaviour Usadily (any resulting changes to prescribed medicines must involve the patient/carer) Possibly (medicines use review by community pharmacist may not Include access to patient's clinical notes) Yes Type 3 Clinical medication review Address issues relating to the patient's use of medicines in the context of their clinical condition Yes Yes Yes Who is involved? No Yes Yes Review of medicines and/or condition Mapping to professional activities Medicines # QOF # MUR (prescription intervention) # Basic medicines reconcoation in hospitals Medicines use # QOF # MUR # DRUM # Single assessment process # Basic medicines reconciliation in hospitals Medicines and condition # QOF # Enhanced service In community pharmacies - MUR (target and non-target) - NMS - Domiciliary visits- schemes employing pharmacists to go to patients home to discuss medications -Home Optimisation of Medicine Service (HOME