GPs and pharmacists don't have time to involve patients in medication reviews
12 February 2019
GPs and pharmacists struggle to find the time to involve patients in medication reviews, despite National Institute for Health and Care Excellence (NICE) guidance advising them to do so, according to a study by researchers at the University of Bristol’s Centre for Academic Primary Care.
Medication reviews are important for patients who are taking more than one medication, as some medicines may be harmful (e.g. causing falls or confusion) or may no longer be needed as a patient’s condition changes or improves. NICE has highlighted the importance of involving patients in this process.
The study, funded by the National Institute for Health Research, Royal College of General Practitioners and Avon Primary Care Research Collaborative, and published in the British Journal of General Practice today, found that while both GPs and some practice pharmacists who also do medication reviews felt involving patients was important, they rarely had the time to discuss medications with patients. They also reported that, as a result, it was easier to continue medications than to stop them.
Thirteen GPs and 10 pharmacists from South West England, Northern England and Scotland were interviewed for the study.
The researchers found that there was a trade-off between being efficient (getting the medication review done) and being thorough (doing it properly). Pharmacists tended to be more thorough than GPs but less time efficient. They tended to require longer appointments focusing just on the patients’ medications, whereas GPs tended to squeeze a medication review in alongside several other problems during a 10-minute consultation.
Dr Polly Duncan, a GP and lead author of the study said:
“Our research shows that involving patients in medication reviews is difficult to achieve. It’s not that GPs and pharmacists don’t want to involve patients, it’s that they often don’t have the time to have a proper discussion, which might result in some medications being stopped.
“Stopping medications is not always necessary, of course. For some patients, taking lots of medications improve their quality of life or extends their life. But for others, the balance can shift, so that the harm caused by taking lots of medications outweighs the benefits.
“The GPs and pharmacists in our study have taken a pragmatic approach, with reviews being done outside the 10-minute consultation or during consultations alongside other problems. We need more research into patients’ experience of medication review, what works well and who is best placed to carry them out.”
Paper: Efficiency versus thoroughness in medication review: a qualitative interview study in UK primary care. Polly Duncan et al. Published in British Journal of General Practice. 12 February 2019.
About the Centre for Academic Primary Care
The Centre for Academic Primary Care (CAPC) at the University of Bristol is a leading centre for primary care research in the UK, one of nine forming the NIHR School for Primary Care Research. It sits within Bristol Medical School, an internationally recognised centre of excellence for population health research and teaching. Follow us on Twitter: @capcbristol.
About the National Institute for Health Research
The National Institute for Health Research (NIHR) is the nation's largest funder of health and care research. The NIHR:
- funds, supports and delivers high quality research that benefits the NHS, public health and social care
- engages and involves patients, carers and the public in order to improve the reach, quality and impact of research
- attracts, trains and supports the best researchers to tackle the complex health and care challenges of the future
- invests in world-class infrastructure and a skilled delivery workforce to translate discoveries into improved treatments and services
- partners with other public funders, charities and industry to maximise the value of research to patients and the economy.
The NIHR was established in 2006 to improve the health and wealth of the nation through research and is funded by the Department of Health and
Social Care. In addition to its national role, the NIHR commissions applied health research to benefit the poorest people in low- and middle-income countries, using Official Development Assistance funding.
This work uses data provided by patients and collected by the NHS as part of their care and support and would not have been possible without access to this data. The NIHR recognises and values the role of patient data, securely accessed and stored, both in underpinning and leading to improvements in research and care. www.nihr.ac.uk/patientdata