Development of a model of clinical medication review for use in clinical practice

Problem

NICE define medication review 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”. Within NICE guidance for medicines optimisation, regular medication review is recommended as a key priority for implementation and a mechanism for making medicines optimisation part of routine practice. Despite the guidance, there is still a lack of understanding about what constitutes a clinical medication review. Practical and detailed descriptions for what a clinical medication review should involve and how it should be delivered in clinical practice are lacking. The aim of this study was to; i) identify the ‘active ingredients’ of a medication review described in trials aimed at improving medication safety and efficacy when compared with usual care; and ii) develop a model of medication review for use in clinical practice.

Approach

The starting point was a systematic review published in 2017 (Huiskes VJ. BMC Fam Pract) summarising the evidence for medication review as an isolated short-term intervention (as performed in clinical practice). An updated literature search, using the same search data sources and strategy was performed. Selection criteria included RCTs with adult participants (≥18 years), involving a medication review intervention operationalised as a single, short-term intervention, delivered by a healthcare professional and involving the patient, within which all medicines used by the patient were considered. Trials in a palliative care setting were excluded.

Titles and abstracts were screened, and full-text articles were considered by two reviewers independently. Data related to the characteristics of the intervention were extracted and analysed thematically to develop a framework to classify the components and functions (i.e. the ingredients) of the medication review strategies used. Outcomes investigated in each trial were also extracted.

Findings

Overall, 1498 papers were identified and 31 were included. The ingredients of the medication review strategies of included trials have been classified. Outcomes have been organised into the six categories (drug efficacy, treatment safety, service use, cost, patient experience, mortality). Cross tabulation analysis of ingredients per trial according to each outcome is being conducted.

A development group comprising the investigators and external advisers representing a range of stakeholder perspectives will be convened in January 2020 to review and synthesise the findings of the systematic review and develop a comprehensive and systematic approach to medication review.

Consequences

A medication review model for use in a routine clinical practice setting will be of use to healthcare professionals who have roles in medicines optimisation; help to improve the consistency, transparency and quality of the medication review process; and encourage routine and improved dialogue between patients and prescribers around the use of medicines.