| Need and indication—Does he know why he takes each drug? Does he still need them? Was long term treatment intended? Is the dose appropriate? Has the diagnosis been refuted? Would-pharmacological treatments be better?
Open questions—Give him the opportunity to express his views by asking questions: “I realise a lot of people don’ttake all their tablets. Do you have any problems?” “Can I check that we both agree what you’re taking regularly?” or “Do you think your tablets work?” Compare his replies with the number of prescription requests. Tests and monitoring—Assess disease control. Are any of his conditions undertreated? Get advice on appropriate monitoring from prescribing guidelines such as the British National Formulary or the US Physicians’ Desk Reference and other primary care documents. Evidence and guidelines—Has the evidence base changed since his prescription was initiated? Do the prescribing guidelines indicate that any of his drugs are now less suitable fo prescribing?Is the dose appropriate? (For example, dose optimisation of angiotensin-converting enzyme inhibitors in cardiac failure.)Are other investigations now advised, such as echocardiography or testing for Helicobacter pylori? Adverse events—Does he have any side effects? Is he taking complementary medicines or over the counter preparations? Check for interactions, duplications, or contraindications. Remember the “prescribing cascade” (misinterpreting an adverse reactions a new medical condition). |
10-minute consultation: Using the NO TEARS tool for medication review. Tessa Lewishttp://bmj.com/cgi/content/full/329/7463/434?etoc