Step 4: Are therapeutic objectives being achieved? | Right Decisions

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Polypharmacy guidance: realistic prescribing
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Step 4: Are therapeutic objectives being achieved?

Please update your RDS mobile app to version 4.7.1

We are pleased to advise that deep linking capability, enabling users to directly download individual mobile toolkits, has now been released on the RDS mobile app. When you install the update, you will see that each toolkit has a small QR code icon the header area beside the search icon – see screenshot below. Clicking on this icon will open up a window with a full-size QR code and the alternative of a short URL for sharing with users. Instructions are provided.

You may need to actively install the update to install RDS app version 4.7.1 to see this improvement. Installing this update is also strongly recommended to get the full benefits of the new contingency arrangements – specifically, that if the RDS website should fail, you will still be able to download new mobile app toolkits.

To check your current RDS version, click on the three dots bottom right of the RDS app screen. This takes you to a “More” page where you will see the version number. To install latest updates:

On iPhones – go to the Apple store, click on your profile icon top right, scroll down to see the apps waiting to be updated and update the RDS app.

On Android phones – these can vary, but try going to the Google Play store, click on your profile icon top right, click on “Manage apps and device”, select and update the RDS app.

Please get in touch with ann.wales3@nhs.scot with any questions.

Process

Identify the need for adding/intensifying drug therapy in order to achieve therapeutic objectives:

To achieve symptom control
To achieve biochemical/clinical targets
To prevent disease progression/exacerbation

Description

Check treatment choice is the most effective to achieve intended outcomes
If this is not the case, the possibility of patient non-adherence should be investigated as a potential explanation. Otherwise, the need for dose titration may also be considered. 50% of patients taking four or more medicines don’t take them as prescribed. (World Health Organisation).

Drug Info

If therapeutic objectives are not achieved:

Consider intensifying existing drug therapy

Laxative - Constipation
Antihypertensives - BP control
Antidiabetics - HbA1c control
Warfarin - INR control
Rate limiting drugs - Heart rate?
Respiratory drugs – Symptoms?
Pain control

For patients with the following potential indications:

Consider if patient would benefit from the specified drug therapy

(see NNT section)
CHD - Antithrombotic, statins, ACEI/ARB, beta blocker
Previous stroke/TIA - Antithrombotic, statin, ACEI/ARB
LVSD - Diuretic, ACEI/ARB, beta blocker
AF - Antithrombotic, rate control
DMT2 - Metformin
High fracture risk - Bone protection