What are medication reviews?
A medication review is defined by Pharmaceutical Care Network Europe (PCNE) as:
“an evaluation of a patient’s medicines with the aim of optimizing the outcomes of medicine therapy. This entails identifying the risks, detecting medication-related problems and suggesting solutions” [1].
What this means is that a pharmacist will review the patient’s medication regimen to ensure that medications are still needed, appropriate, not causing any side effects, and not interacting with any other medications or food. Therefore, if a problem is discovered, the pharmacist will work with the patient to find a solution.
Why are medication reviews necessary?
The role of medication reviews can sometimes be overlooked in clinical practice. In some cases, medication use can continue being used even if they were meant for short-term use. The use of multiple medication can lead to polypharmacy with inappropriate medications interacting with other medications, which can cause side effects. Sometimes, medication doses have to be accommodated as our body’s physiology changes with age. Therefore, it is necessary to do medication reviews regularly.
For example, let us look at the case of Dave. Dave is a 72-year-old male who has been having some symptoms of constipation over the past month. He is attributing it to his diet and lack of physical exercise. He then visits his pharmacy to pick up his prescription medications, and while there asks for a medication that can help with his constipation. While reviewing his medications, the pharmacist asks Dave “Do you only take prescription medications?”. Dave replies, “No, I picked up an over-the-counter medication a month ago because I have trouble going to sleep after I wake up to go to the bathroom, and I wanted to fix that problem”. The pharmacist realizes that his constipation is actually an adverse effect from the OTC medication he picked up to help him sleep. The pharmacist helps him figure out which medication he could use to help him sleep, but one that does not cause constipation. Imagine if a medication review was not done in this situation? A side effect would have been missed, and a new medication would have been started, possibly causing an increased negative interaction between the medications, and causing more adverse effects.
Medication reviews are crucial in care settings and can help prevent adverse reactions from medications, reduce usage of inappropriate medications, increase the use of appropriate medications, and improve the patient’s overall health. These reviews are even more important where there is frequent use of multiple medications for chronic conditions, such as by older adults. Furthermore, in person with cognitive impairment and/or dementia, it is important to do medication reviews to determine if there are medication related problems like medication adherence, drugs that can cause symptoms of cognitive impairments, amongst others. Although all pharmacists conduct their own medication reviews, currently there is not one tool that focuses on key components of medication reviews in individuals with cognitive impairment and/or dementia. With her clinician colleagues, Dr. Tejal Patel constructed a standardized medication review specifically for older adults with cognitive impairment and dementia. This tool is called the MedRevCiD checklist and has been validated through a modified Delphi study. You can check out this link for more information.
PCNE. Pharmaceutical Care Network Europe. Statement on medication review 2011–2012. http://www.pcne.org. Accessed 23 Nov 2015.
Reflection question: Have you personally had a medication review, and/or have conducted a medication review? Give us an example of how medication reviews have been beneficial to you, let us know in the comments below!