Step 4: Are therapeutic objectives being achieved?

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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
  • 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