Bastiaan Sallevelt

16 CHAPTER 1 patients in previous trials. However, their effects on other clinical outcomes, such as drug-related hospitalisations, remain to be established [56,59–62]. European geriatric clinical practice guidelines – including the Dutch geriatric guideline on polypharmacy – endorse considering using STOPP/START to facilitate medication reviews in older people [63,64]. Medication review in older people A medication review can be defined as ‘a structured, critical examination of a person’s medicines with the objective of reaching an agreement with the person about treatment, optimising the impact of medicines, minimising the number of medicationrelated problems and reducing waste’ [63]. A medication review aims to optimise a patient’s existing pharmacotherapy to prevent worsening medical conditions or complications (related to pharmacotherapy) while individualising pharmacotherapy to a patient’s needs to promote medication self-management. This purpose differs from regular medication safety monitoring, usually performed when preparing and dispensing (new) medication to ensure safe and effective pharmaceutical products related to co-medication or patient characteristics while limiting the likelihood of harm from the products’ use [65]. The STRIP method for medication review The Systematic Tool to Reduce Inappropriate Prescribing (STRIP) is a medication review method that combines implicit (judgement-based) questions with explicit screening tools (e.g. STOPP/START criteria) to increase appropriate prescribing in older people [64–67]. The STRIP method consists of five steps: 1. Medication reconciliation: Obtaining information about thepatient’smedicationhistory and actual medication use while understanding wishes, experiences and beliefs about medications; 2. Pharmacotherapy analysis: Identifying potential drug-related problems (e.g. underuse, overuse, misuse, potential adverse drug reactions, drug-drug interactions, drug-disease interactions, practical intake issues); 3. Pharmaceutical care plan: Agreeing about therapeutic aims between the physician and pharmacist and how these aims could be achieved;