Key aspects of Scottish and Welsh polypharmacy guidance
| Both sets of guidance provide basic principles, supported by summaries of medication effectiveness, disease-specific recommendations and advice on specific clinically-challenging areas. | |
| Welsh guidance31 recommends the use of the NO TEARS model for medication review32 and a focus on high-risk medication, with specific advice on medication adherence, deprescribing and assessment of whether patients can manage their medications. Particular consideration is given to groups with large numbers of medications, indications of shortened life expectancy, and frail and elderly patients. | |
| Scottish guidance30 is based around the following seven-step approach to medication review: | |
| Domain | Steps |
| Aims | 1 Identify objectives of drug therapy |
| Need | 2 Identify essential drug therapy |
| 3 Does the patient take unnecessary drug therapy | |
| Effectiveness | 4 Are therapeutic objectives being achieved? |
| Safety | 5 Does the patient have ADR or is at risk of ADRs? |
| Cost-effectiveness | 6 Is drug therapy cost-effective? |
| Concordance | 7 Is the patient willing and able to take drug therapy as intended? |
ADR = adverse drug reaction