There are a number of ways that people taking multiple medicines might be identified or may present to the pharmacy team for a medication review:

• Self referral
• Individuals may express concern about a family member who takes a number of medicines
• Individuals may be referred by their GP.

In addition, community pharmacy teams may identify patients from their medicines history, from identifying adverse effects from medicines or people they think might be struggling with their medicines. For example, when a patient requests over-thecounter medicines, pharmacy teams can look out for certain trigger symptoms that might be related to a medicine side effect. This relies on the whole team being able to recognise symptoms and refer appropriately.

In addition, throwaway comments from patients about medicines being a burden should be explored in more detail. An MUR or the new medicine service (NMS) can identify not only adverse effects but also medicines which may no longer be needed.

Health and social care professionals use screening criteria to identify patients who may benefit from a medication review. For instance, there are four questions that can be used to identify patients who need help from a pharmacist. These cover issues with medicines access, adherence and day-today management as well as clinical issues:

1. Do you need help getting a regular supply of your medicines?
2. Do you always take all of your medicines the way that your doctor wants you to?
3. Can you swallow and use all of your medicines and get all of your medicines out of their containers?
4. Do you think that some of your medicines could work better?

Another screening tool is to assess high-risk prescribing indicators. These are:

• Older person (75 years or older) prescribed an antipsychotic medicine
• Older person (75 years or older) prescribed an NSAID without gastro-protection
• Older person (65 years or older) currently taking an ACE inhibitor/angiotensin receptor blocker and a diuretic, who is prescribed an NSAID (the ‘triple whammy’)
• Older person (65 years or older) currently taking aspirin or clopidogrel, who is prescribed an NSAID without gastro-protection
• Current anticoagulant user prescribed an NSAID without gastro-protection
• Current anticoagulant user prescribed aspirin or clopidogrel without gastroprotection.

Practice point

What triggers or indicators might alert you to the fact that a patient or customer has potentially problematic polypharmacy? What steps would you take to help and support them?