Approaches to Medication Review and Care Integration in IranMahdi Dankoub1,21 School of Medicine, Tehran University of Medical Sciences, Tehran, Iran2 School of Public Health, Tehran University of Medical Sciences, Tehran, IranDear Editor,I have read with interest the study by Payen et al who focused on medication review (MR) as an integrated care intervention (ICI) (1). They assessed association of this intervention with shifts in two important healthcare outcome and in turn health impact variables. Their study demonstrated that, among hospitalized older adults (HOA), MR did not coincide a decrease in the mean number of potentially inappropriate medications (PIMs). However, it was associated with a significant reduction in the number of hospital readmissions at 30 days.Based on two studies of pharmacy prescriptions in Tehran, the overall prevalence of PIMs among the elderly was estimated to be between 26% in 2014 and 31.2% in 2017.(2, 3). These colleagues also considered related factors in their sub-group analyses. PIMs was significantly higher among general practitioners (GPs) than among medical specialists. Benzodiazepines and pain killers were the two drug classes most frequently misprescribed. PIMs affected the elderly with health insurance more frequently compared with those without, but it was not statistically significant. In the case of the continuation of these PIM trends in our country, it seems that our health policy makers could greatly benefit from the findings in Payen et al investigation. In other words, ICIs and in particular MR could be used to improve the prescribing habits of entire Iranian doctors which work within a largely “fragmented” rather than “integrated” health care environments.In March 2019, the international Medication Use Review (MUR) network, consisting of 11 countries including Iran, was launched to look further at the opportunities for optimizing medication use and ensuring medication safety at three levels amongst patients at risk of polypharmacy (4). According to this MUR, factors which had more impact included access to electronic lists of medicines as well as medical records. On the other hand, barriers to medication safety included unfamiliarity with those electronic facilities amongst physicians, pharmacists and patients. Other barriers cited in this review were: inappropriate health financing models, insufficient workforce collaboration and high workload and forms of poor health infrastructure (4).Since older people are frequently exposed to polypharmacy and adverse drug events, MR which facilitates shared decision-making could be used for treatment recommendations (5). Dautzenberg et al. demonstrated that MR in isolation did not significantly reduce hospital readmissions. They showed however that whenever this ICI was combined with other interventions such as medication reconciliation, patient education, professional education, and transitional care, it was associated with a lower risk of hospital readmissions.(6) Another Iranian investigation sheds light on the other side of the matter nonetheless. This study of the elderly users of primary health centers in Tehran concluded that in any reform for making healthcare more integrated, priority should be given to medication use awareness (7). They also emphasize on the importance of applying educational strategies that are more suitable and hence influential in making the elderly aware of PIM risks (7).Based on these findings, it appears that despite several organizational obstacles, key stakeholders in Iran are increasingly exploring the untouched potentials and possibilities of ICIs.1. Payen A, Godard-Sebillotte C, Sourial N, Soula J, Verloop D, Defebvre M-M, et al. The impact of including a medication review in an integrated care pathway: A pilot study. British Journal of Clinical Pharmacology. 2022.2. Saboor M, Kamrani AA, Momtaz YA, Sahaf R. Prevalence and associated factors of potentially inappropriate medications among Iranian older adults. Med Glas (Zenica). 2019;16(1):121-7.3. Kargar M, Atrianfar F, Rashidian A, Heidari K, Noroozian M, Gholami K, et al. Prescribing for geriatrics in Tehran; is it appropriate and rational? Med J Islam Repub Iran. 2019;33:143.4. Tuula A, Volmer D, Jõhvik L, Rutkovska I, Trečiokienė I, Merks P, et al. Factors Facilitating and Hindering Development of a Medication Use Review Service in Eastern Europe and Iran-Cross-Sectional Exploratory Study. Healthcare (Basel). 2021;9(9).5. Beuscart JB, Pelayo S, Robert L, Thevelin S, Marien S, Dalleur O. Medication review and reconciliation in older adults. Eur Geriatr Med. 2021;12(3):499-507.6. Dautzenberg L, Bretagne L, Koek HL, Tsokani S, Zevgiti S, Rodondi N, et al. Medication review interventions to reduce hospital readmissions in older people. J Am Geriatr Soc. 2021;69(6):1646-58.7. Ziaeefar H, Tajvar M, Yaseri M, Pourreza A. Evaluation of Elderly’s Integrated Healthcare components in primary healthcare centers of Tehran, Iran. J Educ Health Promot. 2021;10:222.