Efficiency versus thoroughness in medication review: a qualitative interview study in UK primary care

Area of Science:

• General Practice
• Pharmaceutical Care
• Health Services Research

Background:

• Medication reviews are crucial for improving prescribing safety.
• The National Institute for Health and Care Excellence (NICE) emphasizes patient involvement in medication reviews.

Purpose of the Study:

• To explore General Practitioners' (GPs) and pharmacists' perspectives on conducting medication reviews in UK general practice.
• To understand the barriers and facilitators to effective medication reviews.

Main Methods:

• Semi-structured interviews were conducted with 13 GPs and 10 pharmacists in the UK.
• Interviews were sampled for heterogeneity and analyzed thematically to identify key insights.
• Data collection continued until thematic saturation was achieved.

Main Results:

• Both GPs and pharmacists viewed medication reviews as opportunities to enhance prescribing safety.
• High workload pressures resulted in limited or no patient input during most medication reviews.
• Pharmacists were perceived as more thorough but less time-efficient than GPs, with limited routine involvement in reviews.

Conclusions:

• UK general practices often prioritize efficiency over thoroughness in medication reviews, leading to minimal patient involvement.
• Medicines were rarely stopped or reduced, partly because patient involvement generates extra work.
• Time and resource constraints are significant barriers to implementing NICE guidance on medication reviews.