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Medication Review for Chronic Conditions

We have quite a few patients in our practice who came to us with a laundry list of medications. One of the first things on the agenda is to do a medication review to determine the need for medications.

In Western Medicine, we have the term “polypharmacy,” which is interpreted differently. Needless to say, it’s common to accumulate multiple meds from multiple specialists as we get older.

Common Inappropriate Medications

Here at Digital Nomad Health, we do things a little differently; since we don’t profit from prescribing or dispensing medications, we aim to minimize the number of medications a patient has.

Fewer medications have been proven to be beneficial to patients. Since medications are one-dimensional drugs, they often affect one pathway aggressively and should only be used when the benefit outweighs the risk.

Aspirin and beta blockers are common medications we have to stop. They are used for primary prevention of heart attacks or strokes and blood pressure management. However, the studies we’ve reviewed have proven them to be rather ineffective in this space.

Medication Review

A medication review is an individualized process – there is no way to apply a single process to everyone. As we get older chronic diseases pile up and it’s necessary to assess which warrant any intervention in the first place.

We first determine the risk of our patients and then set out to determine which actions lower that risk the most; perhaps it’s lifestyle or it’s medications.

Each medication is assessed for whether it will have the expected outcome in our patient based on the data we have. If so, we continue it; if not, we will discontinue it or choose an alternative.

Discontinuing Medications

The major downside to stopping a medication after a prescription review is that it often causes a rebound.

Classic examples are blood pressure medications and acid reflux medications. We warn our patients that they will get worse before getting better.

Pain medications, of course, are often quite problematic and cause severe rebound effects.

Vitamins, Herbals, Supplements

Other than whole foods, anything we add to our bodies in the form of supplements, herbals, or vitamins are considered medications in our practice.

We assess them based on quality & efficacy. If they are offering the intended benefits, then they can be safely continued, but we like to assess that regularly. This is better than just being on magnesium, for example, lifelong.

Herbals such as St. Johns Wort and Saw Palmetto are quite effective, and they have a long enough track record that they warrant considering in the big picture of medication reconciliation.

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