Early implementation of the structured medication review in England: a qualitative study

The British journal of general practice: the journal of the Royal College of General Practitioners

article

Mary Madden¹  Thomas Mills²  Karl Atkin³  Duncan Stewart⁴  Jim McCambridge¹ 

[1] Department of Health Sciences, University of York;PHIRST London, London South Bank University;Department of Sociology, University of York;Centre for Primary Health and Social Care, School of Social Professions, London Metropolitan University

关键词: consultation standards;    COVID-19;    implementation;    medication review;    polypharmacy;    primary health care;   

DOI  :  10.3399/BJGP.2022.0014

学科分类：卫生学

来源: Royal College of General Practitioners

【 摘 要 】

Background NHS England has introduced a new structured medication review (SMR) service within primary care networks (PCNs) forming during the COVID-19 pandemic. Policy drivers are addressing problematic polypharmacy, reducing avoidable hospitalisations, and delivering better value from medicines spending. This study explores early implementation of the SMR from the perspective of the primary care clinical pharmacist workforce.Aim To identify factors affecting the early implementation of the SMR service.Design and setting Qualitative interview study in general practice between September 2020 and June 2021.Method Two semi-structured interviews were carried out with each of 10 newly appointed pharmacists (20 in total) in 10 PCNs in Northern England; and one interview was carried out with 10 pharmacists already established in GP practices in 10 other PCNs across England. Audiorecordings were transcribed verbatim and a modified framework method supported a constructionist thematic analysis.Results SMRs were not yet a PCN priority and SMR implementation was largely delegated to individual pharmacists; those already in general practice appearing to be more ready for implementation. New pharmacists were on the primary care education pathway and drew on pre-existing practice frames, habits, and heuristics. Those lacking patient-facing expertise sought template-driven, institution-centred practice. Consequently, SMR practices reverted to prior medication review practices, compromising the distinct purposes of the new service.Conclusion Early SMR implementation did not match the vision for patients presented in policy of an invited, holistic, shared decision-making opportunity offered by well-trained pharmacists. There is an important opportunity cost of SMR implementation without prior adequate skills development, testing, and refining.

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