International Journal of Clinical Pharmacy

, Volume 34, Issue 4, pp 510–514 | Cite as

Comprehensive medication review: development of a collaborative procedure

  • Saija LeikolaEmail author
  • Lea Tuomainen
  • Sirpa Peura
  • Antti Laurikainen
  • Alan Lyles
  • Eeva Savela
  • Marja Airaksinen


This commentary describes the development and evidence-base of the Comprehensive Medication Review (CMR) procedure for community and hospital settings in Finland. The development was coordinated by a national steering group. The group collaborated with 26 experienced pharmacists who developed and tested CMR procedures during a 1.5 year accreditation training for CMR. The development consisted of: (1) a literature review and inventory of medication review procedures in different countries; (2) the creation of potential procedures and related documentation; (3) integration of potential procedures into a national standard procedure; and (4) piloting the standard procedure in practice settings. The resulting comprehensive medication review procedure requires access to a patient’s clinical information, an inhome patient interview and a case conference with the collaborating physician. This procedure covers the four main dimensions critical for safe and appropriate geriatric pharmacotherapy: aging and safety; co-morbidities; polypharmacy; and adherence. The CMR measures and documentation build on these dimensions.


Elderly Finland Medication review Medication safety Pharmacist Pharmacotherapy 



The following persons are acknowledged as key members of the steering group responsible for CMR procedure development: Anne Lehtonen, Centre for Pharmacotherapy Development ROHTO; Harri Ovaskainen, The Finnish Pharmacists’ Association; Nina Sevón-Vilkman, Pharmaceutical Learning Centre; Paavo Tanskanen, University of Eastern Finland. The contribution of Dr. Timothy Chen, University of Sydney, Australia is acknowledged to the CMR procedure development.


This study was supported through personal grants (SL) from the Association of Finnish Pharmacies and Pharma Industry Finland Research Foundation.

Conflicts of interest

The authors have no conflicts of interest that are relevant to this manuscript.


  1. 1.
    Budnitz DS, Pollock DA, Weidenbach KN, Mendelsohn AB, Schroeder TJ, Annest JL. National surveillance of emergency department visits for outpatient adverse drug events. JAMA. 2006;296:1858–66.PubMedCrossRefGoogle Scholar
  2. 2.
    Jyrkkä J, Vartiainen L, Hartikainen S, Sulkava R, Enlund H. Increasing use of medicines in elderly persons: a 5 year follow-up of the Kuopio 75+ Study. Eur J Clin Pharmacol. 2006;62:151–8.PubMedCrossRefGoogle Scholar
  3. 3.
    Cipolle R, Strand L, Morley P. Drug therapy problems. In: Pharmaceutical Care Practice. The Clinician’s Guide. 2nd ed. McGraw-Hill: NewYork; 2004. p. 171–200. ISBN: 0-07-136259-2.Google Scholar
  4. 4.
    Westerlund T, Almarsdóttir A, Melander A. Factors influencing the detection rate of drug-related problems in community pharmacy. Pharm World Sci. 1999;21:245–50.PubMedCrossRefGoogle Scholar
  5. 5.
    Sorensen L, Stokes JA, Purdie DM, Woodward M, Elliott R, Roberts MS. Medication reviews in the community: results of a randomized, controlled effectiveness trial. Br J Clin Pharmacol. 2004;58:648–64.PubMedCrossRefGoogle Scholar
  6. 6.
    American Pharmacists Association; National Association of Chain Drug Stores Foundation. Medication therapy management in pharmacy practice: core elements of an MTM service model (version 2.0). J Am Pharm Assoc. 2003;2008(48):341–53.Google Scholar
  7. 7.
    The Ministry of Social Affairs and Health, Finland. Safe pharmacotherapy among the aged: obligations for the municipalities (In Finnish). Kuntainfo 6/2007. Accessed 2 Sep 2011.
  8. 8.
    Leikola SN, Tuomainen L, Ovaskainen H, Peura S, Sevón-Vilkman N, Tanskanen P, et al. Continuing education course to attain collaborative comprehensive medication review competencies. Am J Pharm Educ. 2009;73:108.PubMedCrossRefGoogle Scholar
  9. 9.
    Hakkarainen K. Models of pharmacists-conducted medication review—An international comparison. Master’s Thesis: University of Helsinki; 2008.Google Scholar
  10. 10.
    Kansanaho H, Puumalainen I, Varunki M, Ahonen R, Airaksinen M. Implementation of a professional program in Finnish community pharmacies in 2000–2002. Patient Educ Couns. 2005;57:272–9.PubMedCrossRefGoogle Scholar
  11. 11.
    Leikola S Development and application of a comprehensive medication review procedure to community-dwelling elderly [dissertation]. Helsinki: University of Helsinki; 2012. Accessed 16 May 2012.
  12. 12.
    Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of self-reported measure of medication adherence. Med Care. 1986;24:67–74.PubMedCrossRefGoogle Scholar
  13. 13.
    Lingjaerde O, Ahlfors UG, Bech P, Dencker SJ, Elgen K. Side effect rating scale. A new comprehensive rating scale for psychotropic drugs and cross-sectional study of side effects in neuroleptic-treated patients. Acta Psychiatr Scand Suppl. 1987;334:1–100.PubMedCrossRefGoogle Scholar
  14. 14.
    Brooks R. EuroQol: the current state of play. Health Policy. 1996;37:53–72.PubMedCrossRefGoogle Scholar
  15. 15.
    Fick DM, Cooper JW, Wade WE, Waller JL, Maclean JR, Beers MH. Updating the beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. Arch Intern Med. 2003;163:2716–24.PubMedCrossRefGoogle Scholar
  16. 16.
    Fimea Database of medication for the elderly. Accessed 20 Sep 2011.
  17. 17.
    National Board of Health and Welfare (Socialstyrelsen). Indicators for evaluation of the quality of drug use in the elderly (In Swedish). Accessed 5 Jun 2011.
  18. 18.
    Cao YJ, Mager DE, Simonsick EM, Hilmer SN, Ling SM, Windham BG, et al. Physical and cognitive performance and burden of anticholinergics, sedatives, and ACE inhibitors in older women. Clin Pharmacol Ther. 2008;83:422–9.PubMedCrossRefGoogle Scholar
  19. 19.
    Sorensen L, Stokes JA, Purdie DM, Woodward M, Roberts MS. Medication management at home: medication risk factor prevalence and inter-relationships. J Clin Pharm Ther. 2006;31:485–91.PubMedCrossRefGoogle Scholar
  20. 20.
    Yang JC, Tomlinson G, Naglie G. Medication lists for elderly patients: clinic-derived versus in-home inspection and interview. J Gen Intern Med. 2001;16:112–5.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2012

Authors and Affiliations

  • Saija Leikola
    • 1
    Email author
  • Lea Tuomainen
    • 2
  • Sirpa Peura
    • 3
  • Antti Laurikainen
    • 4
  • Alan Lyles
    • 5
  • Eeva Savela
    • 6
  • Marja Airaksinen
    • 1
  1. 1.Division of Social Pharmacy, Faculty of PharmacyUniversity of HelsinkiFinland
  2. 2.Centre for Training and DevelopmentUniversity of Eastern FinlandKuopioFinland
  3. 3.The Association of Finnish PharmaciesHelsinkiFinland
  4. 4.Ylitornio PharmacyYlitornioFinland
  5. 5.School of Public and International Affairs, School of Health and Human ServicesUniversity of BaltimoreBaltimoreUSA
  6. 6.First Pharmacy in LohjaLohjaFinland

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