Medication Review

Medication reconciliation provides the starting point for a reliable assessment by establishing which medicines a patient is currently taking and how they are intended to be used. Comparing this information with the existing regimen can reveal discrepancies, omissions, or unintended changes. Resolving those differences helps clinicians evaluate the regimen accurately and reduces the risk of medication-related problems.

Renal and hepatic function are patient-specific factors that can affect whether a medicine remains appropriate and safe. Including them in the assessment helps clinicians judge the regimen in the context of the individual patient rather than reviewing medicines in isolation. This consideration is particularly relevant when treatment changes, new symptoms, or other concerns prompt reassessment.

Drug interactions concern the effects medicines may have on one another, whereas duplicate therapy refers to unnecessary overlap within the regimen. Reviewing both issues helps identify different types of drug-related problems that may otherwise be missed. The clinician can then determine whether the medicines remain appropriate, effective, and safe for the patient’s current treatment goals.

Adherence shows whether medicines are being used as intended, so it is essential when judging whether treatment is effective. An apparent lack of benefit may require a different response if the regimen has not been followed as planned. Discussing adherence also supports shared treatment decisions and allows the clinician to address medication use as part of the overall assessment.

The process begins with a complete medication reconciliation, followed by assessment of indications, doses, adherence, adverse effects, interactions, duplicate therapy, and relevant patient factors. Clinicians use these findings to identify drug-related problems, resolve concerns, and discuss treatment decisions with the patient. The resulting review connects the medication list with safety, effectiveness, and intended use.

Medication Review is especially important during transitions between care settings, when a patient takes multiple medicines, and after treatment changes. It is also useful when new symptoms raise concern about the regimen. In these situations, reassessment can uncover discrepancies or other drug-related problems, helping clinicians address preventable harm while keeping treatment aligned with the patient’s needs.