Prescription or medication review
Prescription review or medication review is a clinical assessment of a patient’s medication, most often on repeat prescription in General Practice and drug chart reviews on ward rounds in the hospital setting. As well as medical prescribers, pharmacists are often key people involved in medication reviews both in secondary care and in the community. Clinicians regularly review their own prescribing or that of their colleagues to ensure it remains safe and appropriate. By doing regular prescription reviews unnecessary medications can be stopped, medication errors can be discovered and potential drug interactions can be identified. Some medications need regular blood tests to ensure safe continuation, examples include urea and electrolytes for patients on ACE inhibitors and thyroid function tests and liver function tests for patients on amiodarone. This is all part of a medication review and when done well reduces the risk associated with prescribing.
Tip: Reviewing drug charts on the wards or prescriptions in primary care is an excellent way to test yourself. Can you explain or justify why each drug has been prescribed?
Compliance with prescribed medication
Why might patients not take prescribed medication? What do you understand about the term compliance?
Compliance with prescribed medication
The following phrases can be used to elicit the patient’s adherence to prescribed medication. Identify which ones will keep the spirit of the consultation patient centred and which have the power base firmly with the clinician:
“What medications are you supposed to be taking, but aren't?”
“What medications are you taking differently to the way you were told to take them?”
“Some people taking prescribed medicines stop taking them for a number of reasons, has that been the case for you?”
“I imagine that taking medication everyday can be a hassle, do you ever have problems sticking to the treatment?”
“What medications are you taking in a way that is different from how you were asked to take them?”
“Some patients may stop taking medications when they shouldn’t, is that the same for you?”
“These medications are quite important; you don’t forget to take them do you?”
“You are taking quite a few medications, it must be difficult to remember to take them, do you sometimes forget?”
“Do you sometimes stop taking your medication because you feel better; or in fact because you feel worse?”
This activity challenged you to consider the word ‘compliance’ and deliberate the potential power connotations associated with the words you may use and how verbal and non-verbal interaction with patients may influence how you are ultimately perceived by patients. This is inextricably linked to why patients do or do not take prescribed treatments, although it is not simply about you as clinician; non-adherence is multi-factorial and is a regularly researched issue. It is expensive in terms of both human cost (poor health outcomes for patients) and in economic terms.
Copyright eBook 2019, University of Leeds, Leeds Institute of Medical Education.