Supplementary Table 1. The five steps of a
complete medication review (MR)
Step of MR
Activity and outcome per step
1. Pharmaceutical patient history
Pharmacists gather information by interviewing the
patients on medication use, experiences and
expectations herewith.
2. Pharmacotherapy review
Pharmacists check the complete medication history of
a patient with the information on the pharmaceutical
patient history to identify potential drug therapy
related problems.
3.Designing of a pharmaceutical care plan
Pharmacists discuss the identified medication
problems from the pharmacotherapy review with the
GP. Combined with additional information from the
GP on diagnosis and laboratory measures, both
professionals decide on priorities for an improved care
plan for the patient.
4. Implementation of the pharmaceutical care plan
Pharmacists or GPs inform the patient on the intended
changes of the pharmaceutical care plan and they
agree on its definitive version.
5. Evaluation of the pharmaceutical care plan after 3
Pharmacists contact the patient and inform on
months
questions, problems and benefits of the new care plan.
If necessary, the pharmaceutical care plan is
(re)adjusted
Supplementary Table 2. Algorithms for potential
inappropriate medication (PIM) use
PIM
Definition by ATC code
1.Use of Non Steroid Anti Inflammatory
Use of NSAIDs was screened by the following ATC codes:
Drugs (NSAIDs) without gastro-
M01A (NSAIDs without M01H, COX-2 inhibitors and
intestinal protection by persons of 65
without M01AB55, diclofenac), N02BA01 and N02BA51
years and older
(acetylic salicylic acid), N02BA15 and N02BA65
(carbasalat calcium), N02BA11 (diflunisal)
Patients between 65 and 70 years of age additionally had to
dispose of at least one of the following corticosteroids::
H02AB01, H02AB02, N02AB06, H02AB08, H02AB10 or
spironolactone, C03DA01 or a selective serotonin reuptake
inhibitor, N06AB or a vitamin K antagonist, B01AA.
Lack of gastro protection was highlighted if there were no
dispensings in the preceding 7 months screened for
misoprostol, A02BB01 or proton pump inhibitors, A02BC.
2. Use of opioids without laxative.
Patients were screened for the use of the following opioids:
natural opioids, N02AA without codeine, N02AA59 or
N02AA79, fenylpiperidine derivatives, N02AB,
difenylprpylamine derivatives, N02AC, benzomorphan
derivatives, N02AD, combinations with opioids, N02AG,
oripavine derivatives, N02AE.
Patients were selected for the lack of a laxative if none of
the following drugs were dispensed in the prior 4 months:
laxatives A06A without volume increasing drugs, A06AC;
magnesium oxide, A02AA02, magnesium peroxide,
A02AA03, magnesium hydroxide, A02AA04..
3. Long term use of corticosteroids
Long term corticosteroid use at high dosages was identified
above 7.5 mg prednisone equivalent per
by at least 2 dispensings of the following ATC codes for
day without co-medication of
corticosteroids: H02AB01, H02AB02, H02AB06,
bisphosphonates.
H02AB07, H02AB08, H02AB10.
The lack of a bisphosphonates was screened when no
dispensing had occurred in the prior 4 months for: M05BA,
M05BB, M05XX.
4 No cessation of proton pump inhibitors
Use of gastro-protective drugs was identified by use of
(PPIs) after stopping with Non steroidal
PPI,, A02BC of misoprostol, A02BB01. Patients were
anti-inflammatory drugs (NSAIDs) or
selected if they had no concomitant use of at least one of
low dosage acetylic salicylic acid (ASA)
the following drugs: NSAIDs, M01A, acetylic salicylic
acid, N02BA01, B01AC06or N02BA51, carbasalt calcium,
N02BA15, B01AC08or N02BA65, diflunisal, N02BA11,
dipyridamol, B01AC07, combination drugs,B01AC30.
5 Long term use of benzodiazepines$
Use of benzodiazepines was selected for the following
ATC codes: N05BA, N05CD, N05CF.
6 No cessation of bisphosphonates when
Use of bisphosphonates was screened by use of M05BA,
discontinuing corticosteroids.
M05BB, M05XX .Patients were identified who had no
concomitant use of a corticosteroid: H02AB01, H02AB02,
H02AB06, H02AB07, H02AB08, H02AB10.
7. Use of glibenclamide in persons older
Users of glibenclamide were screened by the following
than 70 years
ATC code: A10BB01.
8. Concomitant use of three potassium
The following drug groups were selected for simultaneous
use: C09A, C09B and C09C , C09D and C03DA01,
level increasing drugs
C03DA04.
9 Use of NSAIDs in combination with
Patients were screened for simultaneous use of a RAS
RAS inhibitors
inhibitor, C09 with an NSAID, M01, N02BA01,
N02BA15, N01BA11, N02BA51, N02BA65.