Medicines optimisation is a patient-focused approach to getting the best from investment in and use of medicines. It requires a holistic approach, an enhanced level of patient centred professionalism, and partnership between clinical professionals and a patient.
Shared decision-making (SDM) is an essential part of evidence-based medicine, seeking to use the best available evidence to guide decisions about the care of the individual patient, taking into account their needs, preferences and values. SDM supports person centred, alongside care planning and self-management. For further information and resources to support person centred care see link
Medicines optimisation approach requires multidisciplinary team working. Healthcare professionals will need to work together to individualise care, monitor outcomes, review medicines appropriately and support patients when needed.
Below is a selection of resources that can support medicines optimisation.
NPC - Medication Review Guidance - A guide to medication review - March 2008 This document from 2008 continues to provide a framework for medication review in a variety of settings, including primary care. It details the involvement of patients/carers in the medication review to enable partnership in decision making about medicines.
Clinical decision support tools
STOPPFrail (Screening Tool of Older Persons Prescriptions in Frail adults with limited life expectancy): consensus validation (see table 1 under results for agreed STOPPFrail criteria)
NHS Scotland - Anticholinergic Burden Scale (There is no single standard anticholinergic burden scale, this is an example that may aid medication reviews)
Resources to support patient decision making
Also see Me and My Medicines. The Me and My Medicines campaign encourages patients, families and carers to ask questions about their medicines so that they can be helped to get the most benefit and make informed shared decisions. This leaflet can be used in consultations to support conversations.
Patient information leaflet to support:
Polypharmacy and deprescribing resources
- Polypharmacy Scotland guidance - March 2015
- Monitored Dosage Systems and 7 Day Prescribing - Includes Prescribing Periodicity Letter and Assessment Tool - May 2021
- All Wales Medicines Strategy Group - Polypharmacy: Guidance for Prescribing. Supplementary Guidance – BNF Sections to Target - July 2014
- Ensuring appropriate polypharmacy tool (one sided flow chart)
- Ensuring appropriate polypharmacy: agreeing treatment goals before prescribing (B162)- Full
- Ensuring appropriate polypharmacy: agreeing treatment goals before prescribing (B162)– Brief
- General deprescribing algorithm
- PPI deprescribing algorithm
Multimorbidity and frailty and moving towards end of life
- Polypharmacy and deprescribing – Multimorbidity (B190) – Full
- Polypharmacy and deprescribing – Multimorbidity (B190) – Brief
- Ensuring appropriate polypharmacy: Patients with frailty or moving towards end of life Care (B153) - Full
- Ensuring appropriate polypharmacy: Patients with frailty or moving towards end of life care (B153) – Brief
Tools to help with review