In-Depth Notes on Medication Review and Patient Profile

Medication Review and Patient Profile

Overview of Medication Review

  • Definition: "A structured critical examination of a patient’s medicines…"
    • Aim: Optimize medication efficacy, minimize related problems, and reduce waste.
    • Collaborative process between clinician and patient for shared decision-making based on patient needs and preferences.

Medication Review Process

  • Settings:
    • Community Pharmacy: Services include essential, advanced, and enhanced medication reviews.
    • Hospital Pharmacy: Focus on patient's journey from admission to discharge, including medicines reconciliation and therapeutic drug monitoring (TDM).

Structured Medication Reviews (SMRs)

  • Identification Criteria:
    • Patients in care homes
    • Complex polypharmacy (≥10 medications)
    • Severe frailty, isolation, or recent hospitalizations
    • Use of addictive pain medications

Types of Medication Reviews

  • By Type:
    • Type 1: Prescription review (no patient involvement)
    • Type 2: Concordance and compliance review (involves patient)
    • Type 3: Clinical medication review (comprehensive, includes patient condition)
  • By Levels:
    • Level 1: Technical prescription review
    • Level 2: Review with full patient notes
    • Level 3: In-depth clinical review with patient dialogue

Care Plan Development

  • Key Steps in Developing Care Plan:
    • Assessment:
    • Systematic evaluation of patient's health needs.
    • Objective Setting:
    • Establish clear goals based on patient issues.
    • Intervention Implementation:
    • Execute planned interventions.
    • Outcome Evaluation:
    • Measure results related to health goals.

Identifying Patients for Review

  • High-Risk Groups:
    • Individuals on >3 medications, complex regimens, or experiencing significant recent medical changes.
    • Elderly (>75 years), individuals with communication difficulties, mental health concerns, or living conditions impacting care support.

NHS Long Term Plan

  • Focus on reducing dependency-causing medications, addressing antimicrobial resistance (AMR), and ensuring safer prescribing practices for vulnerable populations.

Recognizing Drug Therapy Problems

  • Drug Therapy Problems Include:
    • Unnecessary therapy, needs additional therapy, ineffective or unsafe medication use, adherence issues, adverse drug reactions.
  • Involves continual assessment of indications, effectiveness, safety, and patient willingness to take medications.

Patient Profile

  • Purpose:
    • Structured record of relevant medication details.
    • Facilitates identification of pharmacist interventions and informs care plans.
  • What It Typically Contains:
    • Patient demographics, allergy status, clinical presentation, medication history, and compliance data.

Medicines Management

  • A systematic approach involving assessment, delivery service reviews, and risk management to optimize medicine use by patients in the NHS.
  • Increases necessity due to rising complexity of medication prescriptions and usage, aiming to reduce drug-related morbidity and mortality.

Resources

  • Useful Tools:
    • STOPP/START toolkit for identifying inappropriate prescribing practices.
    • ACB Score and NNT websites for clinical decision support.

Conclusion

  • Effective medication review and management are crucial for enhancing patient care, ensuring medication safety, and addressing the challenges of polypharmacy and complex health needs.