A medication review, and what to expect from one

What a medication review is

NICE defines a medication review as a structured, critical examination of your medicines, with the aim of reaching agreement with you about treatment, getting the most from each medicine, reducing medicine-related problems and cutting waste [1]. It covers everything you take, including medicines bought without a prescription and complementary remedies [1].

A good review is a two-way conversation. Your own views, concerns and questions about your medicines count as much as the clinical checks [1].

Who benefits most

NICE suggests a structured review when there is a clear purpose, particularly for people taking several medicines or living with long-term conditions, and for older people too [1]. Its guideline on multimorbidity goes further, advising an approach that looks at the whole person for anyone prescribed 15 or more regular medicines, and considering it at 10 to 14 [2].

There is no single cut-off for taking too many medicines. A systematic review found 138 definitions of polypharmacy, the most common being five or more medicines a day, used in 46.4% of the articles it examined [3]. A review also makes sense at fewer medicines after a hospital stay, a new diagnosis, a fall, or when a side effect has crept in.

What happens in the review

The doctor goes through each medicine in turn. NICE lists what to weigh, including how safe each medicine is, how well it works for you, whether it follows current guidance, any risk of side effects and any monitoring it needs [1].

For older adults, doctors can use screening tools such as STOPP/START, which flags medicines that may now carry more risk than benefit and medicines that could help but are missing [2]. The AGS Beers Criteria list medicines best avoided by most adults aged 65 and over, and are meant to support shared decisions rather than replace them [4]. A review can add a medicine as well as remove one [2].

Benefits and limitations

The aim is that you leave knowing what each medicine is for, how to take it and what to watch for. Medication harm is common worldwide, and the World Health Organization estimates that medication errors cost $42 billion a year [5].

A review is the start of a plan, with results that come from the changes you make together over the following weeks. It works best when the doctor can see your full records and recent blood results.

Risks, and who it is not for

Do not stop a prescribed medicine on your own, even one you suspect is no longer needed. Some medicines must be reduced slowly, and stopping others can let a condition return, so any change is planned with you and checked afterwards.

A review is a planned appointment, so it is not the route for a sudden reaction. If you have swelling of the face or throat, difficulty breathing, a widespread rash or sudden faintness after a new medicine, call 999 in the UK or the local emergency number [6]. For side effects that are not urgent, anyone can report them to the MHRA Yellow Card scheme, which helps identify new safety issues early [7].

How to prepare

The most useful thing you can bring is every medicine you take, in its original packaging. NICE advises recording the name, strength, dose, timing and purpose of each one [1].

• All prescribed medicines, including inhalers, creams, eye drops and injections
• Anything bought from a pharmacy, supermarket or online
• Vitamins, supplements and herbal remedies
• Recent blood results and any hospital letters
• A note of side effects, missed doses and the questions you want answered

Questions to ask your doctor

These questions help turn the review into decisions you understand and agree with.

• What is each of my medicines for, and is it still needed?
• Could any of them be causing my side effects?
• Do any of them interact with each other or with my supplements?
• Which blood tests do my medicines need, and how often?
• If we change something, how will we know it is working?

How The Wellness can help

A GP appointment gives you time to go through every medicine with a GMC registered doctor, at Baker Street in Marylebone or Eccleston Street in Belgravia, or at your home or hotel in London. Blood results are explained by a doctor.

Once your medicines are settled, our prescription service issues repeat prescriptions electronically, with free next-day delivery [8].