Medication reviews in primary care

Abstract

Medication reviews are becoming increasingly important in primary care, as the need to reduce the wastage of medications in order to save money increases. It is estimated that 50% of drugs are not taken as prescribed, and 5–17% of hospital admissions are a consequence of adverse reaction to medication ( Department of Health (DH), 2001 ). A medication review may be conducted by a nurse, doctor or pharmacist, provided they have the appropriate therapeutic knowledge and clinical experience. There are three levels of medication review. Level 1 is a prescription review. Level 2 involves a review of medicines using the patient's notes. Level 2 enhanced also includes a telephone discussion with the patient. Level 3 is a clinical medication review, involving face-to-face contact with the patient. Medication reviews are important for concordance, as they enable a patient to understand why they are taking a particular medication. Given the pressure on appointments in primary care, level 3 reviews may not always be feasible and indeed in many cases would be inappropriate and could annoy patients. Medication reviews should target those most likely to benefit. This would include the frail elderly with multiple co-morbidity and polypharmacy and those with frequent hospital admissions.