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. 2023 Apr 29;23:414. doi: 10.1186/s12913-023-09439-y

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© The Author(s) 2023

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

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Fig. 2 — Conceptual Framework for pMTM Intervention. This protocol is conceptualized based on the SHED-MEDS model of deprescribing [60]. With permission, we modified this model with the broader core activity of pMTM, during which parents and providers review medication changes, continuation, proper use, monitoring, and follow-up. For children with polypharmacy, our model specifies that the pMTM intervention (which accounts for and prioritizes safety, quality of life, and parental considerations) will lead to patient-centered optimization of medications, resulting in improved health and symptoms manifest as fewer MRPs [4, 12, 30].