Structured medication reviews for patients with multimorbidity and polypharmacy

Polypharmacy, or the use of multiple medications simultaneously, is a growing concern, especially among older people. Nearly one-third of people aged over 65 years of age in the UK take five or more medications daily. This is because people are living longer and often have multiple chronic illnesses that require medication.

The Risks of Polypharmacy

When people take many medications, there's a risk that some may not be necessary or might even be harmful. This can lead to:

• A heavy burden of managing multiple medications daily, which is time-consuming and stressful for patients.
• Difficulty in sticking to complex medication routines, especially for people with low health literacy or poor English language skills.
• Increased chances of adverse drug reactions and interactions, leading to potential harm and is severe cases to hospital admission.

Given these risks, optimizing medication use is crucial, especially for those with multiple health issues.

Medication Reviews (MRs)

One way to address the problems of polypharmacy is through medication reviews. This process involves a detailed assessment of a patient's medications to ensure they are appropriate, safe, and effective. However, studies show mixed results on their effectiveness. While they may improve medication-related outcomes, they don't always significantly impact overall health or quality of life.

The Rise of Structured Medication Reviews (SMRs)

Recognising the limitations of traditional medication reviews, structured medication reviews (SMRs) have been introduced. SMRs offer a more comprehensive approach, focusing on:

• Tailoring medication plans to the individual needs, preferences, and circumstances of the patient.
• Including patients and their families in decision-making about their medications.
• Often involving a multidisciplinary team for complex cases to ensure a thorough review.

Structured Medication Reviews (SMRs) are comprehensive, patient-centered assessments of an individual's medication regimen, designed to optimize medication use and improve health outcomes.  Here are the some of the key elements:

1. Shared Decision-Making: SMRs prioritise shared decision-making, where patients and healthcare professionals collaborate to make informed choices about medications. Patients are encouraged to actively participate in discussions about their treatment options, preferences, and concerns.

2. Personalised Approach: SMRs are tailored to each patient's unique needs, considering their medical history, current health conditions, lifestyle, and preferences. The goal is to develop a medication plan that aligns with the patient's individual circumstances and goals.

3. Comprehensive Review: SMRs involve a thorough evaluation of all medications a patient is taking, including prescription drugs, over-the-counter medications, herbal remedies, and supplements. This ensures that all potential interactions and risks are considered.

4. Safety Assessment: A critical component of SMRs is assessing the safety of each medication, including evaluating the risk of adverse drug reactions, drug-drug interactions, and the appropriateness of dosages. The aim is to minimise potential harm and ensure that the benefits of medications outweigh the risks.

5. Effectiveness Evaluation: SMRs also assess the effectiveness of each medication in managing the patient's health conditions. This may involve reviewing clinical guidelines, monitoring lab results, and discussing the patient's experiences with the medication.

6. Medication Optimisation: Based on the comprehensive review and assessments, SMRs aim to optimize the patient's medication regimen. This could involve adjusting dosages, discontinuing unnecessary medications, or suggesting alternative therapies.

7. Patient Education: SMRs provide an opportunity for patient education, ensuring that patients understand their medications, how to take them correctly, and the potential side effects. This empowers patients to take an active role in managing their health.

8. Documentation: All aspects of the SMR, including the patient's medication history, assessment findings, recommendations, and the agreed-upon medication plan, are documented in the patient's medical record. This ensures continuity of care and facilitates communication among healthcare providers.

9. Follow-Up: SMRs often include a follow-up plan to monitor the patient's response to any changes made to their medication regimen and to address any new concerns or issues that may arise.

By incorporating these key elements, Structured Medication Reviews can help reduce medication-related problems, improve medication adherence, and enhance patient safety and overall health outcomes.

The Impact of COVID-19 and Technology

The COVID-19 pandemic accelerated the use of technology in healthcare, including remote care options like phone, video, or online consultations. This shift aims to provide convenient, rapid access to healthcare and could improve the delivery of medication reviews. However, it’s still unclear how effective remote SMRs are compared to in-person reviews.

The Need for Further Research

While SMRs show promise, more research is needed to understand:

• How well SMRs work for different patient populations, especially those in primary care.
• The impact of remote delivery of SMRs on patient outcomes.
• How SMRs can best be implemented to improve health outcomes for those with complex medical needs.

Conclusion

Structured Medication Reviews represent a significant advance in managing polypharmacy, aiming to tailor medication plans to individual needs and involving patients in the process. However, ongoing research and adaptation, especially with the rise of remote healthcare, are necessary to maximise their benefits and ensure they meet the needs of diverse patient populations in the UK and elsewhere.

Structured medication reviews for adults with multimorbidity and polypharmacy in primary care: a systematic review protocol. https://bmjopen.bmj.com/content/14/5/e082825.full