Tools to support medication review

Using tools to support medication reviews

In this article we highlight tools to help you with your structured medication reviews (SMRs) around managing problematic polypharmacy, and to support shared decision making. This is a large collection of resources, with summaries to help you find the right tools for you and your patients.

Our article Resources to support medication review (SPS page) also contains useful resources to support you with your SMRs, and provides information and guidance that reflects the growing understanding of problematic polypharmacy and overprescribing.

Identifying inappropriate medicines

Anticholinergic Burden (ACB) Calculator

The ACB calculator calculates the anticholinergic cognitive effect burden score and suggests alternative options with a lower burden.

Medichec

Medichec is a free app that identifies medicines with anticholinergic cognitive effects, highlighting their extent and the cumulative impact of multiple medications.

Medichec also identifies medicines that are reported to cause QTc prolongation, hyponatraemia, bleeding risk, dizziness, drowsiness, and constipation. It then ranks them according to the frequency of reported adverse effects.

Medicines and Falls

The National Falls Prevention Coordination Group’s medicines and falls guide (pdf) offers guidance on medication reviews for people at risk of falls. It highlights falls risk increasing drugs (FRIDs) and medicines linked to fractures.

Medstopper tool

The Medstopper tool is a US online deprescribing tool which ranks medicines based on their potential to improve symptoms, reduce the risk of future illness and likelihood of causing harm. It also provides information about reducing and tapering or stopping medicines.

STOPPFrail tool (v2)

The STOPPFrail tool (version 2, available from Age and Ageing) highlights potentially inappropriate medicines in patients aged 65 years and older, living with frailty and with a limited life expectancy. It supports prescribers by offering a structure to deprescribing and can be used in all healthcare settings.

STOPP/START tool (v3)

The STOPP/START tool (version 3, available from European Geriatric Medicine) provides a list of potentially inappropriate medicines in patients aged 65 years and older based on specific criteria. It supports prescribers to identify and reduce inappropriate prescribing.

STOPPFall tool

The STOPPFall tool (available from deprescribing.org) aids deprescribing of falls-risk-increasing-drugs (FRIDs). An online digital deprescribing decision tool has also been developed.

ThinkCascades tool

Prescribing cascades occur when a medicine is prescribed to manage the side effects of another medicine, typically when a side effect is misinterpreted as a new condition.

The ThinkCascades tool (available from Drugs and Aging) outlines nine clinically important prescribing cascades consistent with potentially inappropriate prescribing in older people.

Deprescribing guidance and tools

Deprescribing network

Deprescribing.org’s guidance and algorithms, developed by international deprescribing networks, offer evidence-based guidelines for deprescribing across five medication categories:

• proton pump inhibitors
• antihyperglycaemics
• antipsychotics
• benzodiazepines
• anticholinesterases/memantine

Health Improvement Scotland Right Decision Service

The Health Improvement Scotland’s Right Decision Service is Scotland’s national decision support system for health and social care. It offers digital tools to help staff and patients make quick, evidence-based decisions safely.

Health Improvement Scotland’s guidance on polypharmacy offers tools that support quality prescribing and polypharmacy in its:

• antidepressants quality prescribing guide
• respiratory quality prescribing strategy
• type 2 diabetes quality prescribing strategy.

Health Improvement Scotland’s Manage my meds tool provides information and tools to help patients and carers understand and manage their medicines and prepare for a medicines review with a healthcare professional.

PrescQIPP Improving Medicines and Polypharmacy Appropriateness Clinical Tool (IMPACT)

The PrescQIPP Improving Medicines and Polypharmacy Appropriateness Clinical Tool (IMPACT) helps identify clinical and deprescribing priorities. It provides practical recommendations for appropriately continuing or stopping medicines and highlights key issues to consider.

Conversational tools

Ask 3 Questions

The Advancing Quality Alliance Ask 3 Questions leaflet helps patients prepare for shared decision-making by considering:

• What are my choices?
• What are the pros and cons of each option for me?
• How do I get support to help me make a decision that is right for me?

BRAN

Choosing Wisely UK promotes shared decision making conversations between clinicians and patients using BRAN questions:

• What are the Benefits?
• What are the Risks?
• What are the Alternatives?
• What if I do Nothing?

It is a collaborative process to select tests, treatments and care management or support packages, based on clinical evidence and patients’ informed preferences and values.

Three-talk model

The three-talk model (available from BMJ) guides shared decision-making through three steps:

• introducing choice
• describing options using patient decision support
• helping patients explore their preferences and make decisions

GROW model

The GROW model is a framework to facilitate a collaborative approach to a discussion, such as during a structured medication review. It is a tool commonly used in coaching. Many resources for this model exist, including this Health Education England Resource.

Health Innovation Network resources

The Health Innovation Network has developed patient information materials in multiple community languages to help patients prepare for and understand structured medication review consultations.

Patient decision aids

I Manage My Meds

I Manage My Meds is a set of resources to support people in managing their medicines more safely and confidently. It is aimed at older adults taking five or more medicines to provide better support for polypharmacy management.

GP Evidence

The GP Evidence website is aimed at clinicians and includes clinical research evidence for 11 common long-term conditions, helping you to explain the information and personalise it for your patients.

NHS England Decision Support Tools

NHS England have decision support tools for many conditions, designed to support shared decision making between patients and a clinician.

NICE patient decision aids

The NICE library of patient decision aids to help people decide on healthcare options by providing evidence-based information.

Healthcare Improvement Scotland shared decision aids

Hosted by Healthcare Improvement Scotland, the Right Decision Service website hosts a list of shared decision aids from external providers.

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