“I just do it in the quickest way possible to say that I’ve done it.” GP and pharmacists’ perceptions of medication reviews in UK General Practice: a qualitative interview study.
Problem
Polypharmacy is increasing in the UK, driven by an ageing population and the application of multiple single-disease guidelines to patients with multimorbidity. The number of drug related problems, such as adverse drug reactions, medication errors and interactions, increases with the number of medicines prescribed, resulting in increased hospital attendances, morbidity and mortality. One opportunity to reduce harmful prescribing is to perform an annual medication review and NICE recommends prioritising older people with polypharmacy and multimorbidity. Involving patients in decisions about their medicines is central to NICE guidance. The purpose of this study was to explore GP and pharmacist perspectives on how medication reviews are carried out in UK General Practice.
Approach
Thirteen GPs and ten pharmacists from intervention and usual care practices enrolled in the 3D Study were interviewed between January and October 2017. Eighteen clinicians were based in the South West of England, four in Northern England and one in Scotland. Each 40 to 60-minute semi-structured interview focused initially on usual practice and latterly on the 3D intervention (reported elsewhere). Interviews were grounded using case study patients. We achieved saturation of data, with no new insights arising from latter interviews. Audio-recorded interviews were transcribed and analysed thematically.
Findings
All clinicians perceived medication reviews as an opportunity to improve the safety of prescribing (e.g. by checking monitoring blood tests and stopping or reducing high risk medicines). Whilst GPs and pharmacists recognised that it was best practice to involve patients in decisions about their medicines, high workload pressures meant that most medication reviews were conducted without any patient input, or rapidly during ten-minute appointments, often alongside two or three other problems. Several clinicians described medication reviews as a “tick-box” exercise carried out in the quickest way possible. In practices that employed a practice pharmacist, few were routinely involved in medication reviews because, although many GPs and pharmacists recognised this might improve the safety of prescribing and patient involvement, both professions described GPs as being more time efficient. Many argued that it was easier to start and continue medicines than it was to stop them, particularly because stopping medicines required involving the patient and this generated extra work.
Consequences
This is the first qualitative study to explore GP and pharmacist perspectives of how medication reviews are conducted in UK General Practice. We found that, due to high workload pressures, most medication reviews were carried out with little or no patient involvement. This appears to be an important barrier to stopping or reducing medicines. Further research is needed to test this hypothesis. For example, routinely collected data could be used to examine the proportion of medication reviews completed outside of consultations, and video-recorded consultations could be used to assess patient involvement in decisions about their medicines.