Table 1. Focused Psychotropic Medication Review—Summary of Content and Delivery.

Source	Participants, Setting	Psychotropic Drugs Reviewed	Professionals Involved	Patient or Patient Representative Involvement	Review Delivery	Guidelines and Instruments Used	Review Level18
One-Off Medication Reviews
Ballard et al,23 2016, and Ballard et al,24 2017	277 People with dementia, nursing home	Antipsychotic drugs	Physician	NR	General practitioner or psychiatrist performed antipsychotic review using clinical guidelines to determine appropriateness and direct withdrawal attempts	NICE dementia guidelines; Alzheimer Society guidelines	CD
Moncrieff et al,25 2016	60 People with severe mental illness, community	Antipsychotic drugs	Physician and care coordinator (nurse, social worker, occupational therapist)	Yes: patient	Patients used a medication review tool with their care coordinator prior to a psychiatrist appointment; the tool incorporated perceived benefits and disadvantages of antipsychotic drugs and desired changes, which could be discussed with the prescriber	Medication Review Tool (developed for the study)	3
Gallimore et al,42 2016	144 Children and adults with mental illness, community	Psychotropic drugs	Pharmacist	No	Pharmacist reviewed medication record and electronic health record 1-3 mo after psychiatrist appointment; drug monitoring reviewed against best practice guidelines and potential for drug-drug interactions assessed using drug interaction database; recommendations sent to prescriber	American Psychiatric Association Practice Guidelines, Mount Sinai Conference Consensus recommendations, Development Conference on Antipsychotic Drugs and Obesity and Diabetes guidelines used to define monitoring standards	1
Prentice and Wright,41 2014	3165 Older adults, nursing home	Antipsychotic drugs	Pharmacist, care staff, physician	No	Pharmacist reviewed symptoms, adverse effects, and medication-related information, discussed with care staff, and made recommendations to physician	NICE guidelines, standard data collection form to inform decision making	2
Gemelli et al,43 2016	34 Older adults, nursing home	Sedative and hypnotic drugs	Pharmacist	No	Pharmacist reviewed medication records and, where indicated, made recommendations (dose reduction, drug discontinuation, reevaluation of symptoms, or switch to alternative drugs) to the prescriber	No formal guidelines or standard instruments used in this medication review	1
Child et al,38 2012	70) People with dementia, care home or community	Antipsychotic drugs	Pharmacist	Yes: patient and family	Pharmacist reviewed medication record and clinical records and discussed changes to antipsychotic prescribing with general practitioner, care staff, and patient (±family)	No formal guidelines or standard instruments used in this medication review	3
Johnson et al,44 2012	2849 Adults, community	Antidepressant drugs	Physician	Yes: patient	Physician completed face-to-face medication review	No formal guidelines or standard instruments used in this medication review	3
Napolitano et al,45 2012	32 Adults, community	Antidepressant drugs	Nurse	Yes: patient	Nurse prescriber completed face-to-face medication review including illness- and medication-related variables, patient understanding and beliefs, and risk assessment	Patient Health Questionnaire, Generalized Anxiety Disorder Scale, Work and Social Adjustment Scale, Phobic Scale	3
Regular Medication Review Programs
Jordan et al,26 2015	41 Elderly, nursing home	Psychotropic drugs	Nurse	Yes: patient and family	Monthly nurse review according to a checklist incorporating psychotropic drug adverse effects other and unmet needs; completed with patient and acting as a prompt to further activity, including prescriber medication review	West Wales Adverse Drug Reaction profile	3
Patterson et al,27 2010	334 Elderly individuals, nursing home	Psychotropic drugs	Pharmacist, physician	Yes: patient and family	Monthly pharmacists reviewed patient records and interviewed patients and family to identify drug-related problems and used an algorithm to identify potentially inappropriate psychotropic drug prescribing; pharmacist recommendations discussed with physician and drug decisions made	Fleetwood algorithm for appropriateness of psychotropic drug prescription	3
Bach et al,37 2017	20 People with dementia, nursing home	Antipsychotic drugs	Pharmacist	No	Monthly pharmacist screened medication charts against criteria for appropriate antipsychotic use and made recommendations to the physician	Antipsychotic Use Survey Tool was used to determine appropriate and inappropriate antipsychotic prescribing	1
Morrison,40 2009	22 Older adults, nursing home	Antipsychotic drugs	General practitioner	NRa	General practitioner completed structured review of antipsychotic prescribing supported by a checklist based on NICE guidance every 6 mo	No formal guidelines or standard instruments used in this medication review	CD
Dahl et al,39 2008	110 People with dementia, long-term care	Psychotropic drugs	Nurse, social worker, pharmacist, physician	Yes: family	Multidisciplinary team gather information using a standardized psychotropic assessment form covering symptoms, behavior, adverse effects, and patient and family concerns every 6 mo; followed by a multidisciplinary team meeting where recommendations to optimize prescribing are agreed and sent to the prescriber	Psychotropic Assessment Tool	3
Branford,29 1996	198 People with intellectual disability, institution	Antipsychotic drugs	Nurse, psychiatrist, pharmacist	No	Regular multidisciplinary meeting to review diagnosis, behavior, and medication prescribing; prescribing decisions made by consensus	Aberrant Behavior Checklist, Psychopathology Instrument for Mentally Retarded Adults, Reiss screen	2
Bisconer et al,28 1995	80 People with intellectual disability, institution	Psychotropic drugs	Physician, pharmacist, psychologist, nurse, other professional staff, lay participants	No	Multidisciplinary meetings to discuss presentation, drug adverse effects, and broader treatment plan every 6 mo; changes to prescribing made by consensus	Standard report (no validated instruments)	2
Jauernig et al,34 1995	25 People with intellectual disability, institution	Psychotropic drugs	Pharmacist, physician, psychologist, care staff, clinical manager	No	Multidisciplinary meetings every 2 mo to discuss presentation and progress, review data collected on standardized forms, and agree drug recommendations to be made to treating physician	Behavior monitoring record forms, Aberrant Behavior Checklist, adverse effect monitoring checklist	2
Glaser et al,32 1986	28 People with intellectual disability, institution	Antipsychotic drugs	Physician, nurse, pharmacist, psychologist, care staff, administrator	No	Monthly multidisciplinary team review including indication for medication, symptoms, alternative treatments, and medication response; recommendations made	No formal guidelines or standard instruments used in this medication review	2
Marcoux,36 1985	255 People with intellectual disability, institution	Psychotropic drugs	Physician, psychologist, nurse, pharmacist	No	Multidisciplinary meetings every 3 mo to review symptoms, adverse effects, and other information and inform medication decisions	Standard data sheets completed	2
Lepler et al,35 1993	12 People with intellectual disability, community	Psychotropic drugs	Nurse, psychologist, care staff, physician	Yes: family or advocate	Multidisciplinary review every 3 mo of clinical presentation, medication response, and adverse effects, laboratory monitoring, alternative interventions, and other factors leading to drug recommendations based on team consensus; final decisions are a combination of team recommendations, patient and family preference, and physician opinion	No formal guidelines or standard instruments used in this medication review	3
Ferguson et al,31 1982	97 People with intellectual disability, institution	Antipsychotic drugs	Physician, psychologist, social worker, nurse, pharmacist, care staff	No	Monthly multidisciplinary review of target symptoms and medication adverse effects with data (counts of challenging behavior) used to direct drug dose changes according to a specified protocol	No formal guidelines or standard instruments used in this medication review	2
Inoue,33 1982	251 People with intellectual disability, institution	Psychotropic drugs	Pharmacist, physician, nurse, care staff	No	Monthly pharmacist collected data on patient condition, response to treatment, drug adverse effects presented at multidisciplinary meetings; pharmacist recommendations for treatment discussed and accepted or declined	Standard data forms used to inform reviews	2
Ellenor et al,30 1977	208 People with intellectual disability, institution	Psychotropic drugs	Physician, pharmacist, nurse, psychologist, sociologist, therapist	No	Pharmacist collected data every 3 mo on drug history, interactions, adverse effects, clinical presentation, response to treatment, and made recommendations that were discussed and accepted or declined at multidisciplinary meetings	Data collected on a standard form	2
Electronic Identification of Prescribing Followed by Clinician Medication Review
Donat,46 2006	People with mental illness, hospitala	Psychotropic drugs (as-needed use)	Psychiatrist, psychologist	No	Automated identification of patients receiving as-needed medication ≥3 times a week followed by case review by psychiatrist and psychologist using a semistructured form to guide decisions; further review by a senior management committee in some cases	Local guidelines	2
Seltzer et al,49 2000	Adults and children, communitya	Sedatives and hypnotics	Physician	NRa	Automated identification of patients prescribed long-term or high-dose sedatives or intraclass polypharmacy followed by letter to prescriber to prompt review of medication (this stage of medication review not well described)	No formal guidelines or standard instruments used in this medication review	1
Craig et al,47 1984	People with mental illness, hospitala	Psychotropic drugs	Physician	No	Automated identification of patients receiving high or low drug doses or polypharmacy followed by clinical review by 2 physicians to judge appropriateness of prescribing; further review by senior physicians when agreement not reached	No formal guidelines or standard instruments used in this medication review	2
Laska et al,48 1980	People with mental illness, hospitala	Psychotropic drugs	Physicians	No	Automated identification of patients receiving high or low drug doses or polypharmacy followed by drug review by 2 physicians and consultation with a peer group, if necessary	No formal guidelines or standard instruments used in this medication review	2

Abbreviations: CD, cannot determine; NICE, National Institute for Health and Care Excellence; NR, not reported.

^aNo. of participants not given.