Medication Review: What’s in a Name and What Is It about?

Robberechts, Anneleen; Brumer, Maja; Garcia-Cardenas, Victoria; Dupotey, Niurka M.; Steurbaut, Stephane; De Meyer, Guido R. Y.; De Loof, Hans

doi:10.3390/pharmacy12010039

Cited by 3 publications

(3 citation statements)

References 61 publications

(120 reference statements)

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“…Our study further shows that an MR in Aruba can generate cost savings as well. This is in line with findings in the literature [ 1 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 ], although there are also sources that mention a finding of no significant cost savings [ 8 , 45 ]. This demonstrates that uncertainties remain about the cost-effectiveness of MR interventions in general.…”

Section: Discussionsupporting

confidence: 90%

“…In several other countries, including Australia, Canada, Chile, Germany, the United Kingdom (UK), and the United States (US), MRs are performed as well—mostly under different names, such as ‘clinical medication review’ and ‘medication assessment’ [ 2 , 8 ]. In each country, MRs are set up differently, with, e.g., different inclusion criteria, different divisions of labour and communication between healthcare providers, the inclusion (or not) of patient interviews, and different locations—e.g., in a community pharmacy or general practice, or at the patient’s home [ 1 , 2 , 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

“…As to effects on mortality and morbidity, or in terms of the patient’s quality of life, findings are limited and conflicting, but there are some positive results addressing a decrease in the number of fall incidents among patients, and improvement of laboratory values such as HbA1c, blood pressure, and low-density lipoproteins (LDL). In line with this, studies on the cost-effectiveness of MRs can also be considered to be ambiguous and scarce [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

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Developing Medication Reviews to Improve the Aruban Healthcare System: A Mixed-Methods Pilot Study

Copinga,

Kok,

van Dam

et al. 2024

Pharmacy

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This study investigated whether and how medication reviews (MRs) conducted by pharmacists and general practitioners (GPs) with patient involvement can be performed on the island of Aruba (Dutch Caribbean). In this mixed-methods pilot study (both qualitative and quantitative), constructive and observational methodologies were combined. Healthcare providers’ and patients’ views on MRs and aspects of Aruban healthcare and culture relevant to MRs were examined. These insights were used to develop a protocol for conducting and implementing MRs in Aruba. Surveys were distributed and semi-structured interviews were held among Aruban community pharmacists and GPs, and a pilot program was created in which MRs were carried out with four Aruban patients and their GPs. According to the included healthcare providers, the main purpose of MRs is to optimize the patient experience and achieve concordance. Even though pharmacists and GPs consider their partnership equal, they have different views as to who should bear which responsibility in the MR process in matters regarding patient selection and follow-up. Common Aruban themes that were mentioned by the healthcare providers and deemed relevant for conducting MRs included behaviour/culture, healthcare, lifestyle, and therapy compliance. Anamnesis should be concise during the MR, and questions about medication storage, concerns, beliefs, and practical problems, as well as checks for limited health literacy, were considered important. In the pilot, at least three to, maximally, eight pharmacotherapy-related problems (PRPs) were detected per MR consultation, such as an incorrect dosage of acetylsalicylic acid, an inappropriate combination tablet for blood pressure regulation, and the absence of important laboratory values. All patients considered their consultation to be positive and of added value. In addition, it was observed that an MR can potentially generate cost savings. The information obtained from the healthcare providers and patients, together with the basic principles for MRs, as applied in the Netherlands, led to a definitive and promising MR format with practical recommendations for community pharmacists in Aruba: in comparison with the Dutch MR approach, GPs and pharmacists in Aruba could collaborate more on patient selection for MRs and their follow-up, because of their specific knowledge regarding the medications patients are taking chronically (pharmacists), and possible low levels of health literacy (GPs). Taking into account the Aruban culture, pharmacists could ask extra questions during MRs, referring to lifestyle (high prevalence of obesity), readability of medication labels (limited literacy), and herbal product use (Latin American culture). GPs and medical specialists sometimes experience miscommunication regarding the prescription of medication, which means that pharmacists must carefully take into account possible duplicate medications or interactions.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Developing Medication Reviews to Improve the Aruban Healthcare System: A Mixed-Methods Pilot Study

Copinga,

Kok,

van Dam

et al. 2024

Pharmacy

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Use of the BRANT-MERQS scoring table for the quality assessment of type 3 medication review in patients with rheumatoid arthritis and those with type 2 diabetes mellitus

Robberechts,

Stas,

Puttemans

et al. 2024

Front. Pharmacol.

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BackgroundA type 3 medication review (MR3) is a patient-centred medication service primarily provided by pharmacists and is presently employed routinely in several countries. In this process, pharmacists interview patients and collaborate with the treating physician to optimize the patient’s pharmacotherapy, taking into account the patient’s medication history and other medical data including laboratory values. The need to maintain the quality of such interventions during and after their initial implementation cannot be overstated.AimThe objective of this study was to refine and assess a scoring table to evaluate the quality of MR3 conducted in Belgian community pharmacies.MethodsThe comprehensive quality of MR3s was assessed by scoring its various components using a previously developed scoring table, called BRANT-MERQS, Brussels Antwerp Medication Review Quality Score. MR3s were analysed from an implementation study with patients suffering from rheumatoid arthritis (RA, subproject 1) and type 2 diabetes mellitus (T2DM, subproject 2). Additional information was obtained during a telephone call with a subset of participating pharmacists of subproject 1 who finalized their first MR3.ResultsIn subproject 1, a total of 21 MR3s of patients with RA were examined. The assessment showed favourable scores for elements such as a well-organized medication schedule, treatment adherence, and the elaboration of specific interventions. However, certain other quality criteria posed challenges in the evaluation, for example, the use of simple and understandable language. Pharmacists faced time constraints, and elderly general practitioners (GPs) displayed limited enthusiasm, which were notable barriers observed for this subproject. In the context of subproject 2 that investigated 41 MR3s in patients with T2DM, the quality criteria of interaction between pharmacist and GP, and used sources and tools received high scores. However, there was still room for improvement, especially in areas such as accurate dosing, handling kidney function, QT prolongation, correctly associating laboratory values with relevant drugs and medical conditions, and optimisation of medication schedules for patients.ConclusionThis study demonstrated the feasibility of MR3 quality assessment through a scoring system. However, it also unveiled the tool’s current imperfections and highlighted the ongoing need for refinement, something expected of a new service in an implementation phase.

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Screening for Hypoglycaemia Risk and Medication Changes in Diabetes Patients Using Pharmacy Dispensing Data

Cahyaningsih,

Asiri,

de Vos

et al. 2024

JCM

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Background: To improve hypoglycaemia management in primary care, more insight is needed into the opportunities to screen for hypoglycaemia risk and subsequent treatment modification using routinely available data. Our primary aim was to assess the number of diabetes patients with an estimated high risk of hypoglycaemia and describe the treatment changes in these patients using pharmacy dispensing data. Additionally, our aim was to investigate patient characteristics associated with such treatment changes. Methods: A drug utilisation cohort study with a 1-year follow-up using the IADB.nl pharmacy database was conducted. Patients aged 35 years or older who received at least two glucose-lowering medication dispensings in 2019 were included. Hypoglycaemia risk was determined using a validated algorithm based on patient demographics and dispensing data. The hypoglycaemia risk score ranged between 0 and 1. The anniversary method was used to evaluate treatment changes after 1 year. Factors associated with treatment changes were assessed by multinomial logistic regression. Results: Around one-quarter (26.9%) of the 36,628 included patients had a hypoglycaemia score of 0.6 or more. After a 1-year follow-up, the majority of these patients (88.9%) experienced no diabetes treatment changes. De-intensification was observed for 8.8% and intensification for 2.3%. Having a high-risk score, being female, and being younger in age were associated with de-intensification. Conclusions: A substantial number of primary care patients using glucose-lowering medications appear at risk of hypoglycaemia, whereas few of them undergo medication de-intensification. Pharmacy dispensing data can be helpful in screening for diabetes patients in whom a review of treatment is indicated.

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Medication Review: What’s in a Name and What Is It about?

Cited by 3 publications

References 61 publications

Developing Medication Reviews to Improve the Aruban Healthcare System: A Mixed-Methods Pilot Study

Developing Medication Reviews to Improve the Aruban Healthcare System: A Mixed-Methods Pilot Study

Use of the BRANT-MERQS scoring table for the quality assessment of type 3 medication review in patients with rheumatoid arthritis and those with type 2 diabetes mellitus

Screening for Hypoglycaemia Risk and Medication Changes in Diabetes Patients Using Pharmacy Dispensing Data

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