Using tools to support medication review

Nina Barnett, Consultant Pharmacist, Medicines Use and Safety (SPS)Published Last updated See all updates
Topics: Polypharmacy

This page contains a selection of tools that health care professionals may find helpful when undertaking medication review

About the tools

The tools support medication review in the follow ways:

  • list of medication of concern
  • principles for medication review and deprescribing
  • symptoms which may be linked to medicines related problems

Anticholinergic Burden Scales

Medichec helps to identify medications potentially negatively affecting cognitive function, including those causing dizziness and drowsiness, using the Anticholinergic Effect on Cognition (AEC) scale, which also defines the extent of this effect.

http://www.medichec.com/assessment

Beers criteria (US)

The American Geriatric Society “Beers” criteria, first developed in 1992, provides a list of medications and types of medications that are either potentially inappropriate or should be used with caution in older people, including people with specific health conditions or poor kidney function.

https://www.healthinaging.org/medications-older-adults/medications-older-adults-should-avoid

Canadian Deprescribing Network

This website provides evidence-based  guidelines for deprescribing for five areas of medicines including proton pump inhibitors, antihyperglycaemics, antipsychotics, benzodiazepines and anticholinesterases/memantine.

https://deprescribing.org/resources/deprescribing-guidelines-algorithms/

Collation of articles on deprescribing

This themed collection gathers key articles which provide tools to help with decision-making and implementation of interventions to support a sustainable approach to deprescribing and better patient outcomes.

Age and ageing

https://academic.oup.com/ageing/pages/deprescribing-collection

European Journal of Hospital Pharmacy

This collection of articles provides a practical overview of tools and offers readers discussion of deprescribing, including a patient perspective.

https://ejhp.bmj.com/content/24/1/1

Medication appropriateness index

A method for assessing drug therapy appropriateness, which can support quality of care/outcome measurements in healthcare.

https://www.ncbi.nlm.nih.gov/pubmed/1474400

Medstopper tool (US)

An online tool where the user can enter a list of medication and the tool provides information about reducing/tapering or stopping medicines and ranks the medicines, rating potential of the medicine to reduce symptoms, risk of future illness and risk of causing harm.

http://medstopper.com/

NHS Scotland and The Scottish Government

This guidance offers a patient-centred structure for initiation of new medicines as well as review of existing treatments. It includes Number Needed to Treat (NNT) data of common interventions, and Cumulative Toxicity and Anticholinergic Burden tools. Case finding is supported by Polypharmacy Indicators and the guidance is also available as a smartphone application with a section for patients.

http://www.therapeutics.scot.nhs.uk/wp-content/uploads/2018/04/Polypharmacy-Guidance-2018.pdf

NICE multimorbidity guidance

This guideline focusses on medicines for people who have multiple long-term conditions to support reduction of treatment burden (including polypharmacy and multiple appointments) and unplanned care. It prioritises shared decision making in reviewing treatment together with the patient’s, health priorities, lifestyle and goals and identifies those who are most likely to benefit from this approach.

https://www.nice.org.uk/guidance/ng56

Database of treatment effects

This spreadsheet provides information on benefits of specific medicines in specific conditions, against specific outcomes. It is designed to be used in discussions about harms and benefits of medicines between clinicians and patients to support shared decisions.

https://www.nice.org.uk/guidance/ng56/resources/database-of-treatment-effects-excel-2610552205

STOPP/START tool

Based on a literature review and a consensus of European experts, this tool provides a list of medication which supports prescribers to reduce inappropriate prescribing in older people tool.

http://ageing.oxfordjournals.org/content/early/2014/10/16/ageing.afu145.full

STOPPFrail tool

This tool focusses on the Frail older population and identifies 27 medicines-related criteria that highlight potentially inappropriate medicines for people with a limited life expectancy. It supports prescribers by offering a structure to deprescribing and can be used in all healthcare settings.

https://academic.oup.com/ageing/article/46/4/600/2948308#.WdAS-u779FA.twitter

Further frailty information

Additional resources on frailty can be found at https://www.england.nhs.uk/ourwork/clinical-policy/older-people/frailty/frailty-resources/.

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