Resources for medication reviews
On this page:
Structuring your polypharmacy review
When reviewing patients with complex health problems and a long list of medicines, it can be challenging to determine the best course of action. In response to this, we have developed the Clinical Pharmacology Structured Review (CPSR). The CPSR is a table to help visualise a patient’s diagnoses, test results and prescriptions and document shared decision making about patients’ treatment. To access the CPSR, click here. The document includes instructions for its use and a worked example of an imaginary patient.
Clinical Pharmacology Structured Review (CPSR)
A screenshot of the Clinical Pharmacology Structured Review (CPSR), a tool to help review patients with complex polypharmacy
Deciding which medicines to stop and when
Even if we have identified a medicine or medicines that might be problematic, it can be difficult to know how best to stop them safely, or indeed if it is possible to do so. One concern we often hear is “What if the patient comes to harm as a result of stopping a medicine?” There is a strong body of evidence that deprescribing, when done thoughtfully, with decision making shared with a fully informed patient, is safe and effective (e.g. this large NIHR funded review: Reeve J, et al. Health Technol Assess. 2022;26(32):1-148.).
When thinking about stopping medicines, it is important to consider the potential risks of this action and this can help shape your plan. To aid this, we have developed the Stopping By Indication Tool (SBIT).
In order to use this tool, consider the broad indication of the medicine, discuss both the benefits and risks of continuing and stopping the medicine with your patient and decide together how to proceed.
Stopping By Indication Tool (SBIT)
A tool to help decide whether and how to stop medicines safely
Legal implications
The legal implications of deprescribing are explored in several articles published by consultant pharmacist, the late Professor Nina Barnett and healthcare litigation solicitor and pharmacist Órla Kelly:
- Barnett, N, Kelly, Ó. Legal implications of deprescribing: A case scenario, Prescriber. 2017;28(3), pp. 49–52.
- Barnett N, Kelly Ó. Deprescribing: is the law on your side?. Eur J Hosp Pharm. 2017;24(1):21-25.
Details of the development of the CPSR and SBIT are available here:
Threapleton CJD, Kimpton JE, Carey IM, DeWilde S, Cook DG, Harris T, Baker EH. Development of a structured clinical pharmacology review for specialist support for management of complex polypharmacy in primary care. Br J Clin Pharmacol. 2020 Jul;86(7):1326-1335.