Exploring the implementation and integration of structured medication reviews in primary care: a qualitative evaluation using normalisation process theory
Year: 2026
Type: article
Abstract: BACKGROUND: Structured medication reviews (SMRs) were introduced into primary care in England in 2020 for patients living with multiple long-term conditions (MLTC), polypharmacy, increased frailty, in care homes, or at risk of medicines-related harm. SMRs aim to optimise the therapeutic potential of medication and reduce medicine-related harms through holistic reviews. AIM: To explore the day-to-day work being undertaken with, and by, clinical pharmacists to implement, embed, and integrate SMRs into practice, and consider how to optimise SMRs. DESIGN AND SETTING: Qualitative one-to-one interviews with clinical pharmacists undertaking SMRs and SMR service leaders/managers (SMR leads) in England between February 2023 and November 2024. METHOD: Participants were recruited as part of a wider evaluation of the roll-out of SMRs in England. Interview topic guides and qualitative data analysis were informed by normalisation process theory. RESULTS: Eighteen clinical pharmacists and five SMR leads participated. Participants reported often having to explain the purpose of SMRs and clinical pharmacists' roles to patients, partly owing to patients not being informed about SMRs. Participants valued SMRs and expressed that trust-building and tailored consultations were important for optimising medications. Integration of SMRs into routine practice varied because of high workload, inconsistent leadership support, inadequate administrative/pharmacist technician resource, and lack of training. However, participants described SMRs as valuable for identifying and addressing unmet needs and supporting holistic, person-centred care across MLTC pathways. CONCLUSION: The findings demonstrate the need for improved information on SMRs for patients and primary care teams, adequate and appropriate resource allocation, and enhanced support for consultation skills training to optimise medicines use.
Authors: Claire Reidy, Anna Seeley, Katherine Tucker, Adaku Agwunobi, Paul A Bateman, Christopher Elles Clark, Andrew Paul Clegg, Gary A Ford, Seema Gadhia, William Hinton, FD Richard Hobbs, Sundus Jawad, Kamlesh Khunti, Gregory YH Lip, Simon de Lusignan, Jonathan Mant, Deborah McCahon, Bernardo Meza-Torres, Rupert A Payne, Rafael Perera-Salazar, Samuel Seidu, James Sheppard, Marney Williams, Cynthia Wright Drakesmith, Richard J McManus, Rebecca K Barnes
Institutions: University of Oxford, University of Exeter, University of Leeds, Bradford Teaching Hospitals NHS Foundation Trust, Bradford Institute for Health Research, Oxford University Hospitals NHS Trust, University of Leicester, Medical University of Białystok, University of Liverpool, Liverpool Heart and Chest Hospital, Liverpool John Moores University, Aalborg University, University of Cambridge, University of Bristol, Brighton and Sussex Medical School, University of Sussex, University of Brighton
Language: English
Subfield: Geriatrics and Gerontology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Funder: Curtin University of Technology
OpenAlex ID: W7148451199