When do patients need a medication review?

A significant amount of time is wasted in practices because patients are booked for medication reviews before annual reviews are completed or when medication monitoring is overdue. Our system works based on getting patients up-to-date with reviews and monitoring before any medication review is carried out.

There are principally four elements of data that are used to determine when a patient is ready for a medication review:

1) The authorisation for issuing repeat medication has run out, or is going to run out soon

Depending on the practice setup and approach, this either means 1 or fewer issues left, or a review date that's coming up within the next 5 weeks. Its necessary to realise...

• We look for any repeat medication that is due for review. For example, if one medication is due for review but the others aren't, it will still consider this patient as being due a medication review.
• Authorisation for admin staff to issue medication is based on review dates or issue numbers, NOT when a med review was last coded. Whilst med review codes are important, our system is much more interested in this authorisation.

2) Annual Review Status

Our Recall System employs a colour-coded approach to indicate the stage of patients' Annual Review processes. (See this article for details - What do the Coloured Annual Review Stages mean?).

These are the categories we consider for doing a medication review:

• Green - this is ideal as it means all reviews are complete
• Amber - this is only if medication monitoring is up-to-date and can be opted out of as a category
• Blue, not due review soon and no Med review code in last 14m - Ideally we'd move these patients' review dates/issues to last until their birth month, but if there's been no med review in the last 14m, this should be reviewed before moving dates on
• No Annual Review at all - many patients will be on medication but not have an Annual Review or annual medication monitoring, e.g. a patient only on an SSRI

3) Medication Monitoring Status

These can be configured in two ways principally. 

- All monitoring for any reason, must be up-to-date

- Only monitoring related to medication must be up-to-date (default). e.g. if a patient on an ACE for their hypertension, but not on any treatment for their diabetes, would count as up-to-date if their UE isn't due, even if they hadn't had a HbA1c in the last 12m. Our focus is also more on the safety of medication than its efficacy. e.g. the patient on an ACE for their hypertension may not have had their BP check, be in category Amber, but still be in categories to review medication. (If you don't like the sound of this, then you can opt not to include Amber patients!)

Annual monitoring can also be configured to ignore monitoring that is reasonable to leave until the next annual review, provided it has reached 16 months since the monitoring was carried out.

Of course, many patients don't need any monitoring for their medication, in which case this isn't a consideration.

4) Medication that is high priority for review

There are medications that are high priority to have a medication review:

• Benzos on repeat or issued >=10 times in the last 12m
• Gabapentoids on repeat or issued >=3 times in the last 6m
• Hypnotics (excluding low risk) on current repeat
• Strong Opioids on current repeat

If patients in any of these, with no Medication review in the last 13m, move into the medication review category, irrespective of other considerations. Ideally, this won't often take effect as we've allowed 13m since the last medication review, i.e. normal processes should kick in before that point. This category is optional, though included by default. It's also an option to not send med review questionnaires to these patients and skip straight to booking a structured medication review.

Summary

Putting all of that together, these are the categories that are considered ready for medication review, provided their repeats are coming up for review:

• Annual Review Green & no med monitoring due
• Annual Review Amber & no med monitoring due*
• Annual Review Blue, no med monitoring due, no Med Rev coded in last 14m, not due Annual Review soon
• No Annual Review, Med Monitoring Up-to-date
• No Recall (Annual Review or Med Monitoring)
• High Priority for Review and no Med Review in last 13m*

*Optional to include