Monitoring drug therapy is at the heart of the pharmacist’s professional activities. The review of medication therapy is also part of these activities. Generally speaking, the pharmacist will evaluate a new treatment introduced for a patient, and optimize it if necessary, so that the patient can benefit from the most effective and safest drug therapy possible. However, this review must not stop at the new treatment alone, but must also include the patient’s entire current drug therapy. The aim of this process is to determine whether the patient’s current drug therapy is still optimal in the light of the latest information concerning the patient, such as a new pathology, a new treatment, new laboratory results, and so on. Since January 25, 2021, pharmacists in Quebec have had considerable autonomy in adjusting their patients’ drug therapy. This autonomy is accompanied by an obligation to justify these modifications to the patient and the care team if necessary, using an evidence-based approach. Although the Pharm.D. program’s pharmaceutical care process covers this topic, we felt it appropriate to develop a structured step-by-step approach, which presents the method of reviewing and optimizing drug therapy from a simplified visual angle. The concepts presented in the algorithm are adapted to and respect the pharmaceutical care process developed by UdeM. A reference article presents theoretical concepts for optimizing drug therapy.

Yours sincerely

Dr Petr Dvorak, pharmacist