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How do you evaluate the quality of a medication review?
Would you evaluate the quality of the
service delivery, the quality of the process
and the report, or the practitioner/patient
Many pharmacists who conduct
medication reviews believe a 'good
quality' medication review is an integral
part of managing chronic conditions and
delivering patient-centred care. However,
regarding medical care, quality has been
defined as not consisting of the properties
of an object, but rather as the capacity
of these properties to achieve goals.1
The goal of medication management
review services is to reduce adverse
medicine events and associated hospital
admissions or medical presentations.2
What 'properties' of the medication review
process and the GP report are vital to
deliver important patient outcomes and
achieve these goals?
Relating to the process, recent studies
have demonstrated that multiple
factors may impact on the delivery of
effective medication reviews. A Canadian
study analysed the opinions of family
physicians and community pharmacists
regarding collaborative practice. The
researchers identified lack of time,
lack of appropriate remuneration, and
interaction with multiple pharmacists/
physicians as major barriers to
Previous explorations of the elements
of inter-professional collaboration
in medication review highlight that
successful collaboration between
pharmacists and physicians may
be related to the presence of prior
innovative collaborative ventures. For
instance frequent successful interactions
between pharmacists and physicians,
such as advice about patients for
specific pharmacotherapeutic problems,
may help establish trust between the
practitioners. This trust may impact on
future collaborative and effective service
Additionally, a recent systematic
review of the process and outcomes of
medication review in Australia concluded
that medication review is beneficial in
improving quality use of medications
and some health outcomes.5 This is
consistent with research conducted in
the UK where, for instance, pharmacist-
led medication review successfully
limited the prescribing of antipsychotics
to people with dementia.6
However, measuring the 'properties' of a
medication review report that will deliver
important patient-related outcomes can
be challenging, and may be associated
with the heterogeneity of current
medication review reports produced
by Australian accredited pharmacists.
Anecdotal evidence suggests that
reports may vary from one page briefs
to multiple page comprehensive
reviews. The expression 'quality over
quantity' comes to mind. However, some
pharmacists believe that other factors
influence the quality of the report.
These factors include: the accredited
pharmacists' clinical knowledge, and
access to patient information (e.g. case
notes, discharge summaries etc.)
At the recent PSA16 conference,
Australian Association of Consultant
Pharmacists (AACP) CEO Grant Martin
presented on the question: 'What can
be done to improve general practitioner
report quality?' This session generated
discussion with anecdotal 'reports' and
'evidence' from accredited pharmacists
on issues relating to the quality of some
The quality of a medication
BY LISA KOULADJIAN O'DONNELL
medication review reports. One of the
key options suggested by many of the
more experienced accredited pharmacists
strongly suggested that it was preferable
for newly accredited pharmacists to seek
support and guidance from an experienced
mentor in the early stages of their
medication review career. If you have any
thoughts or ideas on these issues, feel free
to email AACP (email@example.com).
Studies currently underway in Queensland
and NSW will be able to provide further
insight into the issues relating to the quality
of medication review reports. However,
practical tips for ensuring effective
medication reviews can be derived from
• Take the time to conduct a thorough
medication review interview -- longer
appointments may be able to examine
critical patient-related issues.
• Discuss the report format with the GP
ahead of time -- tailored reports may suit
GPs expectations and referral focus
• Prioritise recommendations to address
the referring doctor's concerns first.
• Liaise with regular community
pharmacists to ensure continuity of care.
• Be sure to address issues where
pharmacists are recognised for their
expertise. For example: adverse drug
reactions, drug-drug or drug-disease
interactions, compliance and adherence,
and links to patient/practitioner
medication related resources.
• Provision of simple and practical
1. Steffen GE. Quality medical care. A definition. JAMA.
2. 6th.Community.Pharmacy.Agreement. Medication
Management Programmes. 2016. At: http://6cpa.com.au/
review/. Accessed 29/08/2016.
3. Kelly DV, Bishop L, Young S, Hawboldt J, Phillips L, Keough TM.
Pharmacist and physician views on collaborative practice:
Findings from the community pharmaceutical care project.
Can Pharm J (Ott). 2013;146(4):218--26.
4. Chen TF, de Almeida Neto AC. Exploring elements of
interprofessional collaboration between pharmacists and physicians
in medication review. Pharm World Sci. 2007;29(6):574--6.
5. Jokanovic N, Tan EC, van den Bosch D, Kirkpatrick CM, Dooley
MJ, Bell JS. Clinical medication review in Australia: A systematic
review. Res Social Adm Pharm. 2016;12(3):384--418.
6. Child A, Clarke A, Fox C, Maidment I. A pharmacy led program
to review anti-psychotic prescribing for people with dementia.
BMC Psychiatry. 2012;12:155.
Lisa Kouladjian-O'Donnell is a practising accredited
pharmacist and Postdoctoral Research Associate with
the Cognitive Decline Partnership Centre, University
of Sydney, NSW.
ACCREDITED PHARMACIST SPECIAL INTEREST GROUP
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