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Summary of recommendations1. Suggest decrease dose of XX [name of drug] to 150 mg once daily given low creatinineclear ance of 40 mL/min.2. Suggest tapering XX [name of drug] to X mg[dose] at bedtime for 1 week, then stoppingalt ogether (have discussed with patient; sheis willing to start today if you agree).3. Mrs. Y has agreed to stop XX [name of drug](which may have been contributing to recenthigh BP) and will monitor BP daily at hometo make sure it decreases to <130/80 mm HgBOX 1 The IMPACT experience The IMPACT project was a large-scale demonstration project funded by the Ontario Primary Health Care Transition FundProject in which 7 nondispensing pharmacists were integrated into 7 different family physician group practices between June2004 and July 2006. The IMPACT pharmacists worked approximately 2.5 days per week over the 2-year period conductingcomprehensive medication assessments for patients, providing drug information and education for health care providers,and implementing approaches to optimize drug prescribing and use within the practice.

Demonstrating Value, Documenting Care: Lessons Learned about Writing Comprehensive Patient Medication Assessments in the IMPACT Project