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Letter to the Editor| Volume 19, ISSUE 8, P717-718, August 2018

Consolidated Medication Review Algorithm to Improve Medications Use in Older Adults: Components, Scoring Scheme, and Implementation

Published:April 18, 2018DOI:https://doi.org/10.1016/j.jamda.2018.03.007
Consolidated Medication Review Algorithm to Improve Medications Use in Older Adults: Components, Scoring Scheme, and Implementation
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      Medication review algorithms and minimization frameworks are known to aid reviewers in identifying and discontinuing potentially inappropriate medications, which may otherwise lead older population to harmful events.
      • Poudel A.
      • Ballokova A.
      • Hubbard R.E.
      • et al.
      Algorithm of medication review in frail older people: Focus on minimizing the use of high-risk medications.
      Geriatr Gerontol Int. 2015; 16: 1002-1013
      There have been many algorithms and minimization frameworks that have been developed to aid to evaluate medication reviews, with each one offering benefits in various settings. In 2007, Pollock et al proposed an 8-step approach to improve prescribing by family physicians.
      • Pollock M.
      • Bazaldua O.V.
      • Dobbie A.E.
      Appropriate prescribing of medications: An eight-step approach.
      Am Fam Physician. 2007; 75: 231-236
      Scott et al further developed the concept proposed by Pollock et al to a 10-step framework that aimed to improve medicine use and to reduce the number of inappropriate medications prescribed to older people.
      • Scott I.A.
      • Gray L.C.
      • Martin J.H.
      • Mitchell C.A.
      Minimizing inappropriate medications in older populations: A 10-step conceptual framework.
      Am J Med. 2012; 125: 529-537.e4
      Poudel et al further condensed the 10-step framework to a 4-step algorithm that guides clinicians in reviewing the medications, but it is targeted at frail older patients living in aged care facilities.
      • Poudel A.
      • Ballokova A.
      • Hubbard R.E.
      • et al.
      Algorithm of medication review in frail older people: Focus on minimizing the use of high-risk medications.
      Geriatr Gerontol Int. 2015; 16: 1002-1013
      Many other independent models and algorithms also have been designed.
      • Holmes H.M.
      • Hayley D.C.
      • Alexander G.C.
      • Sachs G.A.
      Reconsidering medication appropriateness for patients late in life.
      Arch Intern Med. 2006; 166: 605-609
      , 
      • Jetha S.
      Polypharmacy, the elderly, and deprescribing.
      Consult Pharm J Am Soc Consult Pharm. 2015; 30: 527-532
      , 
      • Hilmer S.N.
      • Gnjidic D.
      • Le Couteur D.G.
      Thinking through the medication list—Appropriate prescribing and deprescribing in robust and frail older patients.
      Aust Fam Physician. 2012; 41: 924-928
      A commonality that exists among all medication review algorithms and minimization frameworks is that all of them lack a scoring scheme to quantify a medication review process. In this context, a new consolidated medication review algorithm is being developed.
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      References

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        • Ballokova A.
        • Hubbard R.E.
        • et al.
        Algorithm of medication review in frail older people: Focus on minimizing the use of high-risk medications.
        Geriatr Gerontol Int. 2015; 16: 1002-1013
        View in Article
        • Pollock M.
        • Bazaldua O.V.
        • Dobbie A.E.
        Appropriate prescribing of medications: An eight-step approach.
        Am Fam Physician. 2007; 75: 231-236
        View in Article
        • Scott I.A.
        • Gray L.C.
        • Martin J.H.
        • Mitchell C.A.
        Minimizing inappropriate medications in older populations: A 10-step conceptual framework.
        Am J Med. 2012; 125: 529-537.e4
        View in Article
        • Holmes H.M.
        • Hayley D.C.
        • Alexander G.C.
        • Sachs G.A.
        Reconsidering medication appropriateness for patients late in life.
        Arch Intern Med. 2006; 166: 605-609
        View in Article
        • Jetha S.
        Polypharmacy, the elderly, and deprescribing.
        Consult Pharm J Am Soc Consult Pharm. 2015; 30: 527-532
        View in Article
        • Hilmer S.N.
        • Gnjidic D.
        • Le Couteur D.G.
        Thinking through the medication list—Appropriate prescribing and deprescribing in robust and frail older patients.
        Aust Fam Physician. 2012; 41: 924-928
        View in Article
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        View in Article
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        View in Article
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        View in Article

      Article info

      Publication history

      Published online: April 18, 2018

      Identification

      DOI: https://doi.org/10.1016/j.jamda.2018.03.007

      Copyright

      © 2018 AMDA - The Society for Post-Acute and Long-Term Care Medicine.

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