Medicines optimisation: the safe and effective use of medicines to enable the best possible outcomes
This guideline offers best practice advice on the care of all people who are using medicines and also those who are receiving suboptimal benefit from medicines, from the point of view of NICE based of the best available evidence.
Medicines prevent, treat or manage many illnesses or conditions and are the most common intervention in healthcare. However, it has been estimated that between 30% and 50% of medicines prescribed for long?term conditions are not taken as intended (World Health Organization 2003). This issue is worsened by the growing number of people with long term conditions (long?term condition is defined as 'a condition that cannot, at present, be cured but is controlled by medication and/or other treatment/therapies'). The number of long term conditions a person may have also increases with age, being reported that 25% of people aged over 60 years report having 2 or more long?term conditions. As the population ages and life expectancy increases, more people are living with several long?term conditions that are being managed with an increasing number of medicines. Maintaining a careful balance gets more difficult for people and health professionals, particularly when also trying to reduce health inequalities of the population. To ensure that a person is taking their medicine as intented and is managing their own long-term conditions, multimorbidities and polypharmacy, it is important to optimise person's medicines.
Medicines optimisation is defined as 'a person centred approach to safe and effective medicines use, to ensure people obtain the best possible outcomes from their medicines. Medicines optimisation applies to people who may or may not take their medicines effectively. Shared decision?making 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' (Greenhalgh et al. 2014; Sackett et al. 1996). Treatment and care should take into account individual needs and preferences and patients should have the opportunity to make informed decisions about their care and treatment, in partnership with their health professionals.
This guideline reviews the evidence available to support health and social care practitioners, and health and social care organisations, in considering the systems and processes required to ensure safe and effective medicines optimisation.
- 1.1 Systems for identifying, reporting and learning from medicines?related patient safety incidents
- 1.2 Medicines-related communication systems when patients move from one care setting to another
- 1.3 Medicines reconciliation
- 1.4 Medication review
- 1.5 Self-management plans
- 1.6 Patient decision aids used in consultations involving medicines
- 1.7 Clinical decision support
- 1.8 Medicines-related models of organisational and cross-sector working
 Greenhalgh T et al.(2014) Evidence based medicine: a movement in crisis? BMJ 348:3725
 Sackett D et al. (1996) Evidence based medicine: what it is and what it isn't. BMJ 312:71–72