Table 3.
Terminology and definition of medication-related problems used across included studies
| Terminology to define a medication-related problem | Definition | Study |
| Inappropriate medication Discontinuation | Unintentional discontinuation of chronic medications (eg, a statin or antiplatelet/anticoagulant) |
Bell et al (2006)22 |
| Discrepancy: the need for a pharmacy intervention | Interventions included dose adjustments, additional therapy, inappropriate therapy discontinued and patient/family counselling | Bottom-Tanzer et al (2020)16 |
| PIMs AIMs |
Beer criteria63
For example, stress ulcer prophylaxis which should have been discontinued at ICU/hospital discharge |
Morandi et al (2011)12
Morandi et al (2013)13 Galli et al 201618 |
| Medication-related problem | Included drug omissions, drug adjustments, duration of treatment advice; patient education and counselling (eg, re-titration of preadmission gabapentin for neuropathic pain) | MacTavish et al (2019)5
MacTavish et al (2020)19 |
| Pharmacist intervention | Included drug omissions, drug adjustments, adverse drug event identified or prevented, duration of treatment advice; patient education and counselling (eg, identification of adverse drug events such as hypoglycaemia) | Stollings et al (2018)21 |
| Pharmacist intervention | Included GDMT optimisation, refill assistance, medication cost assistance, pill box provision, lab monitoring, medication cessation, medication addition and medication dose adjustment (eg, GDMT optimisation of heart failure drug treatment) | Adie et al (2021)14 |
| Medication changes | Classified as appropriate or inappropriate based on discussion with clinical team, patient and ongoing clinical indication (eg, inappropriate continuation of anticoagulants) | MacTavish et al (2021)20 |
| Potential medication errors and medicine-related problem | Included Inappropriate discontinuation of chronic medications, difficulties obtaining supplies, administration, information and understanding of the suitability of prescriptions (eg, inappropriate continuation of sedatives at hospital discharge) | Eijsbroek et al (2013)17 |
AIM, actually inappropriate medication; GDMT, guideline-directed medical therapy; ICU, intensive care unit; PIM, potentially inappropriate medication.