Medicines and treatment burden

Medicines can improve health and simultaneously create burden, falls, renal injury or cognitive effects. CGA needs a structured way to balance benefit and harm.

Medicines review within CGA is a structured examination of indication, effectiveness, safety, adherence, monitoring and burden. The goal is not simply to reduce the number of medicines, but to improve the overall fit between treatment and the person’s priorities and physiology.

NICE medicines-optimisation guidance supports structured medication review, particularly in older people and those taking multiple medicines. Multimorbidity guidance also asks clinicians to consider whether prognostic treatments still offer worthwhile benefit when frailty, limited life expectancy or treatment burden alter the balance.

Common CGA questions include: Is every medicine still indicated? Is there duplication? Could a medicine contribute to hypotension, falls, bleeding, constipation, delirium or renal injury? Is monitoring feasible? Is the regimen manageable? If treatment is changed, who reviews the effect and when?

Mrs Morgan takes ten regular medicines. She reports dizziness on standing and occasionally misses evening doses. The team must review benefit and harm without assuming that “polypharmacy” means automatically stopping medicines.

Medicines grid: indication, benefit, harm, adherence, monitoring and burden. Learner chooses which medicines need urgent review and which require planned follow-up.

• Document baseline as well as current state.
• Use collateral information when history is incomplete.
• Convert every important finding into an action or explicit decision not to act.
• State uncertainty rather than disguising it as a score.
• Name ownership and review whenever the plan crosses teams or settings.

Identify one way treatment burden is currently under-recognised in your practice.