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Models of Review

Levels of Medication Review

There are several distinct approaches to medication review being followed in practice.
By no means all reviews are conducted with the patient present. Some involve professionals scrutinising a patient's list of medications to identify anomalies and problems. Others would include looking at the patient's full record so that appropriateness of medication can be assessed in relation to their condition and history. Both of these activities have value, but neither is as effective as face-to-face discussion with the patient. A medication review that does not take account of what the patient actually takes rather than what is on the prescription or in the record is incomplete. It is important to know what the patient is actually taking, the response to medication, whether the condition is worsening or improving, and if there are any unrecognised medical needs. Face-to-face review provides the opportunity to discuss the patient's values and beliefs, and how medicine-taking fits in with the patient's daily life.
People also use the term "medication review" to cover related activities such as a data analyst interrogating a GP computer system to identify all patients taking a particular medication, to highlight opportunities for substituting a therapeutically equivalent product on the basis of cost. While cost effectiveness is a legitimate objective of medication review, it should always be subordinate to improved care and safety. Blanket adjustments for cost reasons alone, in our view, do not constitute medication review.
In effect, the general umbrella of medication review covers a whole spectrum of activity, which is more or less systematic and involves patients to a greater or lesser degree. Within that broad spectrum we have identified four types or levels of review, reflecting common approaches used around the country. The value of defining these different levels is to:
  • Illustrate a range of possible approaches
  • Encourage clarity and consistency
  • Provide a basis for systematic recording and comparison
  • Support professionals as they seek to improve quality
  • Encourage a move towards reviews which involve patients as partners.
Whatever the type of review, it is essential that the patient is informed and involved in the decision making around changes and is provided with opportunity to discuss and feed back how they feel about their medication. It is unacceptable not to discuss with a patient or carer any aspect of a review leading to a change in their medicines. Although there may be workload implications for primary care staff, this need not be unduly onerous. Guidance and tools for communicating with patients in relation to medication review are detailed in section 5: Putting medication review into practice.

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