Why lists grow

Each prescription is usually reasonable when it is written. A cardiologist adds one, a hospital discharge adds two, a specialist adjusts a third, an over-the-counter remedy joins from the pharmacy aisle. No single decision is wrong, and no single person is responsible for looking at the whole list. Over years, that produces duplication, interactions, and medications still being taken for a reason that no longer applies.

Aging also changes how the body handles medication, so a dose that was appropriate at 60 may not be at 80. This is a normal part of care, not a failure by anyone involved.

What a structured review covers

  1. Every item you take, including prescriptions, over-the-counter products, vitamins and supplements
  2. Why each one is being taken, and whether that reason still stands
  3. Whether the dose still suits your current health and kidney or liver function
  4. Interactions between items, including ones bought without a prescription
  5. Side effects you have accepted as normal but may not have to
  6. Whether anything duplicates something else on the list
  7. Cost, and whether a therapeutically equivalent generic exists
  8. A plan for anything being reduced or stopped, with monitoring

How to prepare

Bring the bag, not the list

  • Put every bottle and box in a bag and bring it, or show them on video.
  • Include anything taken occasionally: sleep aids, antacids, pain relievers, herbal products.
  • Note what you actually take, not what the label says, if they differ.
  • Write down any symptom that started around the same time as a new medication.
  • Bring the names of prescribers, so changes can be coordinated.

The honest version of what you take is far more useful than the tidy version. Missed doses and half tablets are common and clinically relevant.

Questions worth asking about each item

  • What is this for, and how will we know it is working?
  • What would happen if I stopped it?
  • Is there a simpler or cheaper option that does the same job?
  • Does this interact with anything else I take?
  • Is this dose still right for me now?

Do not stop or change a prescribed medication on your own. Some medications require tapering, and stopping abruptly can be harmful. Any change should be planned with your prescriber.

How this works at Presence

Medication review is part of ongoing primary care rather than an add-on service. Local in-person care is provided by an adult-gerontology nurse practitioner for ages 13 and older, and members can raise a medication question by phone or video 24/7 without a per-visit charge for included care, which matters because side effects rarely announce themselves during office hours.

Members are also quoted cash pricing on many common medications through participating partners, so cost can be part of the conversation rather than something discovered at the pharmacy counter. More in older adult primary care.