Medication Review Process Overview

Data Access and Information

• Medication history should include: medicine names, formulations, doses, regimens, route(s) of administration, duration of treatment (with start and end dates), name and specialisation of prescriber.
• Clinical Data includes information on: current investigations, past medical and surgical history, family history, current health conditions, recent hospital admissions.
• Patient interview can provide information not routinely documented, such as: side effects, medication adherence, medication preferences, lifestyle habits, use of non-prescription, traditional, complementary and integrative medicines

The MR Process

• The MR process is a patient care program conducted by pharmacists.

Patient Care Process

• This process is conducted in three steps: assessment, care plan development, and follow-up evaluations.
  • Assessment
    • Designed to understand the patient and their medication experience for rational drug therapy decisions.
    • Determine if the patient's drug therapy is appropriate, effective, and safe, and if the patient is compliant with their medications.
    • Identify drug therapy problems.
  • Essential clinical skills for assessment include: inquiry, listening, and observational skills.
  • Patient perception of professional experience is based on: dress and demeanor, quality and relevance of comments, ability to elicit relevant information, willingness to listen, ability to provide meaningful information, feedback, and explanations, attitude and confidence.
  • Assessment should take place in a clean and organized area, providing privacy for the patient.
  • Notes should be taken during the assessment to document the patient's experience, and this should be explained to the patient, emphasizing the importance of confidentiality.
  • The purpose of the encounter should guide the practitioner's assessment process.
  • The care plan includes activities such as establishing goals of therapy, selecting appropriate interventions, and scheduling follow-up evaluations.
  • Care plan responsibilities include: negotiating and agreeing upon endpoints and time frame for pharmacotherapies with the patient and other providers, considering therapeutic alternatives, selecting patient-specific pharmacotherapies, considering non-drug interventions, and educating the patient.
    • There are three steps in constructing a care plan:
      • Establishing goals of therapy
      • Selecting appropriate individualized interventions
      • Scheduling the next follow-up evaluation
  • Establishing goals of therapy involves defining a parameter, a value, and a time frame to describe desired endpoints.
  • Goals of therapy should be explicitly stated, consistent with patient preferences, clinically sound, and observable or measurable within a specified time frame.
  • The goals of drug therapy may include:
    • Curing a disease
    • Reducing or eliminating signs and/or symptoms
  • Selecting appropriate individualized interventions
    • Interventions should achieve the stated goals of therapy.
    • Possible interventions include:
      • New drug regimens
      • Drug therapy changes
      • Patient-specific education or information
      • Referrals to specialists
      • Instructions on using prescription and non-prescription drugs, other remedies, products, and devices
    • Selecting interventions that prevent new drug therapy problems from developing is crucial for patients at higher risk for such problems.
  • Scheduling the next follow-up evaluation is important for determining the outcomes of drug therapy.
    • The follow-up evaluation assesses the positive or negative impact of care plan actions on the patient.
    • The timing of the next follow-up evaluation should factor in the timing of positive outcomes, goal achievement, and potential negative outcomes, including side effects and adverse reactions to medications.

Test your knowledge on the Medication Review (MR) process and understand the critical components involved in patient care, including medication history, clinical data, and patient interviews. This quiz covers the importance of assessment, care plan development, and follow-up evaluations conducted by pharmacists.