How to Review the Medication History to Find the Next Best Drug: The “Pretreatment-Next Treatment Algorithm and Checklist”

Michael      Linden; Lena      Pyrkosch

Abstract

Objective: It is a daily task in medical treatment to decide about when drug treatment should be initiated and how to select the best drug from all available alternatives for the individual patient in a particular moment. Especially in chronic illnesses and long-term treatment, loss of information regarding earlier pharmacological interventions can lead to negative treatment effects.

Method: Referring to principles of medical decision making and action theory it is reviewed which information about pretreatment can help to increase safety and efficacy of the next prescribed medication. This is translated into a decision algorithm.

Results: Pivotal information in the drug selection process includes (a) an overview on the available drug options, (b) a hierarchy of drug qualities, (c) a list of drug pretreatments, (d) assessment of positive and negative experiences with pretreatment, and (e) evaluation of the appropriateness and aggressiveness of pretreatment. This information can be integrated in a sequential algorithm for the selection of the best treatment choice (“Pretreatment-Next Treatment Algorithm and Checklist, PN-checklist”).

Conclusion: The treatment history can provide important information for the selection of the next drug. The assessment and decision making can be organized and simplified according to a decision algorithm as given in the PN-checklist. It can also help to increase patient empowerment and cooperation in long term treatment.

Keywords: Drug selection, treatment algorithm, treatment history, medical decision making, shared decision making, safety of drug treatment, quality assurance, SNRIs, MAO, serotonin reuptake inhibitor, SRI, noradrenaline dopamine reuptake inhibitor, NDRI, serotonin noradrenalin reuptake inhibitor, SNRI, lithium augmentation, trycyclic antidepressant, monoamine oxidase inhibitor