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- Page navigation anchor for Targeted holistic review of people’s medicines is well overdueTargeted holistic review of people’s medicines is well overdue
The authors are right that the evidence base for the long-term benefits of structured medication reviews (SMRs) is not particularly strong. However, with the publication of the Dept for Health/Social Care (DHSC) “overprescribing” report1 any primary care clinician or patient / advocate will tell you there is much to do to support people to optimise treatments. Why? Because in our time poor, over stretched, NHS with an ever-increasing number of “single organologists” who invariably just “add medicines, never subtracting, therefore multiplying the problems” the dedicated time for a real holistic consultation to find out what matters to a person about their medicines & health/wellbeing should not just be welcomed, but cherished.
Poor adherence to medicines and adverse drug reactions, let alone full-blown problematic polypharmacy, are rife.2 The general over estimation of the benefits of medicines & an under appreciation of their risks, coupled with imprecise systems for maintaining accurate medicines records across care sectors also contribute to unnecessary follow up clinician appointments and medicines waste.
Dr Louis Polak3 is also right that clinicians performing SMRs need to be “competent to interpret evidence-based guidance, but also confident enough to disregard it where they and the patient agree that following it does not serve the patient’s agenda...
Show MoreCompeting Interests: DHSC, Good for you, good for us, good for everybody - A plan to reduce overprescribing 2021. Short life working group member. NHSE/I Network Contract Direct Enhanced Service SMRs 2019/20. Short life working group member. - Page navigation anchor for Structured medication reviews for frail older people should be done by GPs or experienced NPsStructured medication reviews for frail older people should be done by GPs or experienced NPs
A good medication review is a review of a person and of all the conditions for which we are prescribing medication. Of course, I agree with the editorial's authors1 that such a review can sometimes reduce polypharmacy and avoidable hospital admissions. But this is true especially in frail older people with multiple comorbidities, a group where relational continuity is particularly important. Shared decision-making about medication often involves relatives and other carers and agreeing to reduce dosages or stop medications invariably requires more than one conversation. As well as covering the standard medication-specific agenda, the conversation involves inviting the patient and their family to discuss the everyday burden of medication-taking and needs to establish the patient’s goals for their healthcare, particularly where medications are being taken to reduce the likelihood of future harm, rather than to mitigate or ward off symptoms. The clinician needs to be competent to interpret evidence-based guidance, but also confident enough to disregard it where they and the patient agree that following it does not serve the patient’s agenda. They also need a trusting relationship with the patient and their family, ideally a pre-existing relationship and necessarily one that can be continued into the future, because stopping one’s usual medication is frightening. So, I think that, at least for frail older people, “medication reviews...
Show MoreCompeting Interests: None declared.