Medication review in primary care: a patient-user perspective

Problem

Within the NICE guidelines for medicines optimisation, regular medication review is recognised as a key priority for implementation and mechanism for making medicines optimisation part of routine practice. NICE define medication review as a ‘structured, critical examination of a person’s medicines with the objective of reaching an agreement with the person about treatment, optimising the impact of medicines, minimising the number of medication related problems and reducing waste’. To date there has been little investigation of the patient perspective of medication review as undertaken in primary care. This study aimed to explore patient attitudes to and experiences of medication review with a GP or pharmacist in general practice including the processes and activities that led up to and shaped the review. Such understanding will help to direct the development of medication review as a resource to improve patient outcomes.

Approach

Semi-structured interview study. Seven practices in the Bristol area were purposively sampled to achieve diversity in participants and a range of experiences and perspectives of medication review. Practices identified community dwelling adults receiving at least four repeat prescription medications for a minimum of two long-term conditions who had a recent record (within the preceding 8 weeks) of medication review in their notes. Audio-recordings of the interviews were transcribed, anonymised and analysed thematically utilising a data-driven inductive approach.

Findings

Twenty-one patients (ten female), (aged 59-88) were interviewed. Around half of patients lacked awareness that they had recently received a medication review. Several of the patients who recalled their review, perceived medication review as a tick box exercise that the practice needed to conduct as part of the process of repeat prescribing. Others valued medication review as opportunity for reassessment of the need for drugs which had been on repeat prescription for a long time and/or to seek reassurance regarding drug-drug interactions. Patients who had no previous experience of medication review, reported feeling unprepared and suggested that they would have benefited from having more information about the scope and nature of a medication review.

Consequences

Findings provide a valuable insight into the ways in which official guidelines for medicines optimisation are being applied and enacted within general practice from the perspective of the patient. To ensure patients are informed and prepared for an active role in these clinician-patient encounters, good communication before and during the review is essential. Additional data related to motivation to attend medication review and challenges to involvement in discussion and decision making around the use of medicines during such reviews will be provided. Future research and innovation in primary care will be discussed.