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My Medication Passport is a written record of a patient's medicines. It is designedto improve communication between patients, carers and healthcare professionalsand maintain a record of changes made to the patient's medication.

Medicines are prescribed for patients, usually appropriately, in response to illness and symptoms. Many are continued for life, especially when prescribed for chronic conditions. With increasing age, some medicines, particularly those requiring adequate organ function for drug clearance, can produce more harm than benefit. Research shows that high risk prescribing increases with the number of medicines, and that patients prescribed five or fewer medicines are less likely to present to hospital with adverse events.1,2 Polypharmacy can be appropriate with increasing morbidities in older age, but regular review is needed to ensure that each medicine is still appropriate, based on clear outcomes. We have recently described our experience of reviewing, holding and stopping medicines in the rehabilitation setting using the North West London STOPIT tool.3 Here, we describe our early experience of adapting the Screening Tool for Older People’s Inappropriate Treatments (STOPIT), including specific consideration of anticholinergic burden, for use in the outpatient setting. This was a service improvement pilot to explore the practicalities and challenges of deprescribing for elderly outpatients at the Chelsea and Westminster Hospital NHS Foundation Trust (CWFT).

This thesis describes the author’s publication history from 2001 to 2019, and relates this to their key career milestones from registration as a pharmacist in 1991. From a career output of over 80 items published in a variety of media, eleven key publications form the\ud basis of four publication themes, which the author has related to the concept of medicines optimisation. An exemplar case is used to illustrate these publication themes, arranged into four chapters: a) improving the patient experience and supporting medication adherence b) providing safe care: medication review, polypharmacy and\ud deprescribing c) making medicines optimisation part of routine practice through clinical education, and d) supporting safe practice through professional and personal development of healthcare staff.\ud Following Chapter 1 (introduction), the second chapter discusses the author’s contribution to the medication adherence agenda which closely relates to their outputs encouraging the development of pharmacists’ consultation skills, particularly with\ud patients who have a learning disability. The third chapter discusses the author’s published outputs in the areas of medication review, polypharmacy and deprescribing, the success of which they outline as contingent on the improved communication skills and person-centred approach described in Chapter 2. Chapters four and five discuss the author’s wide-ranging contribution as a clinical educator with a focus on developing others, which the author contends is an essential\ud underpinning of the mission to deliver the benefits of medicines optimisation. The exemplar case from the introduction is briefly revisited to illustrate that the author’s publications directly relate to the challenges of the patient’s medication regime which in turn relate to three of the four Royal Pharmaceutical Society principles of medicines\ud optimisation. The conclusion of this thesis includes a summary of the methodologies used in the key publications, and summarises the author’s belief that their career activity, leading to their\ud publications, broadly align to the concept of medicines optimisation. Moreover, a recommendation can be made that education of all stakeholders should be explicitly mentioned in any future refinements of its definition.