Identify patients that have not achieved clinical goals of therapy.
Understand the patient’s personal medication experience/history and preferences/beliefs.
Identify actual use patterns of all medications including OTCs, bioactive supplements, and prescribed medications.
Assess each medication (in the following order) for appropriateness, effectiveness, safety (including drug interactions), and adherence, focused on achievement of the clinical goals for each therapy.
Identify all drug therapy problems (the gap between current therapy and that needed to achieve optimal clinical outcomes).