Drug-related problems (DRPs) are events or circumstances related to drug therapy that actually or potentially interfere with desired health outcomes [1–3]. DRPs are prevalent among older patients and substantially increase the risk of morbidity, (re-) hospitalization and mortality [4, 5]. DRPs include ineffectiveness of treatment, occurrence of adverse reactions and dissatisfaction of patients with their therapies [3]. DRPs may be the result of a wide variety of causes including medication errors, frequent medication changes, specific drug effects and drug combinations, inappropriate use of medicines, inappropriately prescribed medicines, and non-adherence to treatment [3, 6]. Factors increasing the risk of DRPs are advanced age, comorbidity, polypharmacy and a lack of coordination between different caregivers after having initiated, altered or discontinued treatments [6]. Over the years, substantial effort has been made to prevent and detect potentially inappropriate medicines (PIM) [6, 7]. Several sets of explicit criteria, of which the Beers criteria are the oldest and best known, have been developed to assist caregivers in making appropriate drug choices or assessing the quality of medication [6–8]. Explicit criteria, occasionally combined with other measures, are also used as tools to conduct medication reviews [9]. Since their introduction in 1991, the Beers criteria, and subsequently adapted sets (STOPP/START criteria) in various countries have been revised and refined with respect to structure and comprehensiveness [7, 10]. In order to detect DRPs and optimize treatment, primary caregivers should periodically review the medication of older patients with chronic diseases [6, 11–14]. Being the most comprehensive form of medication review [15], a clinical medication review (CMR) is a structured, critical examination of a patient’s medications. Its objective is to reach an agreement with the patient about treatment, optimizing the impact of medicines, minimizing the number of DRPs and reducing waste [12–16].
Although a review of medication records solely on the basis of explicit criteria may be useful, the result in terms of detected DRPs will be of limited value since medical status, clinical parameters and the way patients experience their treatment have not been considered [11, 13, 15, 17]. Therefore, only a medication review with direct input from the patient, addressing perceptions of convenience and effectiveness of treatment and eventual discomfort due to adverse events. In this way, treatment can be continued in an effective, satisfactory and safe manner [11, 15, 17, 18]. This more clinical approach to the medication review, however, requires expert judgement and is likely to be time consuming [6, 13]. Due to its comprehensive nature, the large input of data and involvement of the general practitioner (GP), pharmacist and patient, the review process must be highly structured in order to be both cost-effective and practicable [11, 13]. The availability of a tool to be used for the gathering of medication data and DRPs and their evaluation within the framework of a CMR process essentially similar to that described and used by Lowe and colleagues, would be very helpful in implementing CMR in daily practice [12, 15]. The aim of the present study was therefore to develop a structured, comprehensive, but practicable tool to facilitate and support the periodic review of older patients’ medication by community pharmacists and GPs. The tool accounts for the perspective of the patient.
