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Structured medication reviews mark a huge success for PCN pharmacy

"We were able to deprescribe 44 medications across 240 care home residents"

PCN pharmacist Danny Bartlett explains how he is helping to optimise the medications of hundreds of care home patients under structured medication reviews (SMRs)

Medicines safety is becoming more and more of a talking point in the healthcare landscape. With patients taking a variety of medications, and some with complicated comorbidities, the impact and administration of these medicines need to be reviewed in much more detail.

GP appointment time is shortening, and, with remote consultations giving patients more access to their GP to discuss acute conditions, there is a need for other healthcare professionals to take up the mantle for monitoring chronic diseases and regular medications.

A more diverse and varied multidisciplinary team in GP practices is helping to manage the workload, but there is still more work to do. One goal set out by NHS England’s Network Contract Direct Enhanced Service in March is for pharmacists in GP practices to take a leading role in conducting structured medication reviews (SMRs).

SMRs are designed to optimise patient outcomes and pick up on chances to deprescribe or intervene on medications that may be causing side effects. They differ from the standard medication reviews currently conducted in general practice by having specific target groups and taking up more time – SMRs are around 30 minutes long.

The final guidance on SMRs is due to come out in October and will have more specific guidance on the ongoing strategy. However, that has not stopped my practice from trying to implement them across our patient population based on what we already know.

The available guidance on SMRs says to target eight main groups, including: patients in care homes; patients with severe frailty; patients taking 10 or more regular medications; and patients taking medications associated with prescribing errors.

My first target population was patients in care homes. My primary care network (PCN) had 240 patients to cover across eight homes in West Sussex.

With the cooperation of GPs and care home nursing staff, I was able to look at each patient’s medication objectively to assess overall treatment goals. With the combined consent of patients and carers, we were able to deprescribe 44 medications across the 240 residents.

These medications may have been overlooked by prescribers in the past due to time constraints in acute and chronic appointments. The added benefit of having a PCN pharmacist contributing to the structured medication reviews is that we can look at medications exclusively and offer a different viewpoint to a GP.

For instance, I might ultimately suggest things such a bisphosphonate holiday or a reduction in anticholinergic medications. These, among other medication strategies, are helping to both optimise medication and improve the overall monitoring of our patient cohorts.

With increasing reports of patients being under monitored and overprescribed medication, such as an 84-year-old dementia patient who was over-prescribed tramadol for an extended time without review, there is definitely scope for pharmacists in practice to target the DES-specified groups and make a real impact on their GP practice’s prescribing safety.

The goal of my PCN in the coming months, now that we have implemented a successful SMR model, will be to target our patients on complicated polypharmacy, as well as those on long-term opioid and benzodiazepine medications, to see if we can improve patient outcomes further. Introducing SMRs is a positive move that is reinforcing the importance of pharmacy within general practice, and I am excited for the future.

Danny Bartlett is a senior clinical pharmacist for the Coastal & South Downs Care Partnership PCN

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