title: A composite screening tool for medication reviews of outpatients: general issues with specific examples.
abstract: Regular performance of medication reviews is prominent among methods that have been advocated to reduce the extent and seriousness of drug-related problems, such as adverse drug reactions, drug-disease interactions, drug-drug interactions, drug ineffectiveness and cost ineffectiveness. Several screening tools have been developed to guide practising healthcare professionals and researchers in reviewing the medication patterns of elderly patients; however, each of these tools has its own limitations. This review discusses a wide range of general prescription-, treatment- and patient-related issues that should be taken into account when reviewing medication patterns by implicit screening. These include generic and therapeutic substitution; potentially superfluous or inappropriate medications; potentially inappropriate dosages or duration of treatment; drug-disease and drug-drug interactions; under-treatment; making use of laboratory test results; patient adherence, experiences and habits; appropriate dosage forms and packaging. A broad selection of specific examples and references that can be used as a basis for explicit screening of medication patterns in outpatients is also offered.
authors.affiliation: Scientific Institute Dutch Pharmacists, The Hague, The Netherlands. pdesmet@winap.nl
authors.forename: Peter A G M
authors.initials: PA
authors.lastname: De Smet
authors.forename: Wilma
authors.initials: W
authors.lastname: Denneboom
authors.forename: Cees
authors.initials: C
authors.lastname: Kramers
authors.forename: Richard
authors.initials: R
authors.lastname: Grol
mesh_terms: D016907:Adverse Drug Reaction Reporting Systems; D000368:Aged; D004304:Dosage Forms; D004347:Drug Interactions; D004349:Drug Packaging; D011307:Drug Prescriptions; D017723:Drug Utilization Review / Q000379:methods*; D005853:Geriatrics; D006801:Humans; D008508:Medication Errors; D010045:Outpatients; D019338:Polypharmacy; D013810:Therapeutic Equivalency; D016312:Treatment Refusal
chemical_list: D004304:Dosage Forms