Impact of structured medication reviews on prescribing in English primary care: a retrospective observational cohort study
Year: 2026
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Structured medication reviews (SMRs) were introduced in 2020 to address polypharmacy in patients most at risk of medicines-related harm. AIM: To evaluate the impact of SMRs on prescribing in primary care. DESIGN AND SETTING: Retrospective observational cohort study of electronic health records from patients aged ≥65 years, prescribed ≥1 medications, and fulfilling the specific eligibility criteria for an SMR, registered at practices contributing data to the Oxford Clinical Informatics Digital Hub, between 1 April 2020 and 30 September 2022. METHOD: The association between SMRs and prescription changes was examined by matching individuals who received an SMR to individuals who did not receive an SMR, according to age, sex, and primary care practice, using cumulative density sampling. Analyses were undertaken using adjusted logistic regression. RESULTS: Of 635 698 eligible patients, 82 285 (12.9%, 95% confidence interval [CI] = 12.9 to 13.0) received ≥1 SMR during the study observation period. In those prescribed potentially inappropriate drug combinations prior to an SMR, between 12.5% and 40.0% were corrected up to 3 months later. In matched analyses, SMRs were most strongly associated with an increase in new prescriptions of angiotensin-converting enzyme inhibitors (adjusted odds ratio [aOR] 1.56, 95% CI = 1.35 to 1.81), statins (aOR 1.78, 95% CI = 1.57 to 2.02), and antidepressants (aOR 1.45, 95% CI = 1.28 to 1.63). SMRs were also most strongly associated with stopping these drug classes in those previously prescribed treatment. CONCLUSION: SMRs were associated with starting new medications and stopping existing prescriptions compared with usual care. Further work is needed to understand if these changes improved patient outcomes.
Authors: James P Sheppard, Paul A Bateman, Cynthia Wright-Drakesmith, Christopher Elles Clark, Rebecca K Barnes, 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, Claire Reidy, Anna Seeley, Samuel Seidu, Katherine Tucker, Rik van der Veen, Marney Williams, Richard J McManus
Institutions: University of Oxford, University of Exeter, University of Leeds, Bradford Teaching Hospitals NHS Foundation Trust, Bradford Institute for Health Research, University of Leicester, Medical University of Białystok, University of Liverpool, 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
Awards: G1471986608, Adverse Drug Events in Ageing Populations (ADDRESS-AP): Who, why and which drugs to stop?, Optimising patient risk management in urgent primary care services, STRatifying Antihypertensive Treatments In multi-morbid hypertensives For personalised management of Blood Pressure (STRATIFY-BP), STRatifying Antihypertensive Treatments In multi-morbid hypertensives For personalised management of Blood Pressure (STRATIFY-BP)
OpenAlex ID: W7154589240