Exploring the implementation and integration of structured medication reviews in primary care: a qualitative...

Area of Science:

• Primary Care Pharmacy Practice
• Medication Management
• Health Services Research

Background:

• Structured Medication Reviews (SMRs) were implemented in English primary care for patients with multiple long-term conditions (MLTCs), polypharmacy, frailty, or at risk of harm.
• SMRs aim to optimize medication effectiveness and minimize medicine-related harms through comprehensive patient assessments.

Purpose of the Study:

• To investigate the practical implementation, integration, and optimization of SMRs by clinical pharmacists in primary care.
• To understand the day-to-day activities and challenges faced by clinical pharmacists and SMR leads in delivering SMR services.

Main Methods:

• Qualitative study involving one-to-one interviews with 18 clinical pharmacists and 5 SMR leads in England (February 2023 - November 2024).
• Participants were recruited from a broader evaluation of the SMR roll-out.
• Normalization Process Theory (NPT) guided interview questions and data analysis.

Main Results:

• Patients often required explanations of SMRs and pharmacist roles due to insufficient prior information.
• Trust-building and personalized consultations were identified as crucial for medication optimization.
• Barriers to SMR integration included high workloads, inconsistent leadership, insufficient administrative/technician support, and lack of training.

Conclusions:

• Improved patient and primary care team information regarding SMRs is essential.
• Adequate resource allocation and enhanced training in consultation skills are necessary to optimize SMRs and medicines use.
• SMRs are valued for identifying unmet needs and supporting person-centred care in MLTC management.