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Exploring the implementation and integration of structured medication reviews in primary care: A qualitative evaluation using normalization process theory
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DOI：10.3399/BJGP.2025.0522.png)
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Abstract
En 中文
Background: Structured Medication Reviews (SMRs) were introduced into primary care in England in 2020 for patients living with multiple long-term conditions (MLTCs), 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: Toexplore 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 withclinicalpharmacists undertaking SMRs and SMR service leaders/managers (SMR leads) in England between February 2023 and November 2024.Method: Participants were recruitedas part of a wider evaluation of the roll-out of SMRs in England. Interview topic guides and qualitative data analysis were informed by Normalization Process Theory (NPT). 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 due 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 due to 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.
Keywords:
General Practice
Clinical Pharmacists
Structured Medication Reviews
Medicines Optimisation
Normalization Process Theory
Polypharmacy
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