TY - JOUR
T1 - Efficiency versus thoroughness in medication review
T2 - A qualitative interview study in UK primary care
AU - Duncan, Polly
AU - Cabral, Christie
AU - McCahon, Deborah
AU - Guthrie, Bruce
AU - Ridd, Matthew J.
N1 - This research was funded by the Scientific Foundation Board of the Royal College of General Practitioners (reference number: SFB-2016-25) and the Avon Primary Care Research Collaborative. The 3D Study was funded by the National Institute for Health Research Health Services and Delivery Research Programme (project number: 12/130/15).
PY - 2019/3
Y1 - 2019/3
N2 - Background: Medication reviews may improve the safety of prescribing and the National Institute for Health and Care Excellence (NICE) highlights the importance of involving patients in this process. Aim To explore GP and pharmacist perspectives on how medication reviews were conducted in general practice in the UK. Design and setting Analysis of semi-structured interviews with GPS and pharmacists working in the South West of England, Northern England, and Scotland, sampled for heterogeneity. Interviews took place between January and October 2017.Method: Interviews focused on experience of medication review. Data saturation was achieved when no new insights arose from later interviews. Interviews were analysed thematically.Results: In total, 13 GPS and 10 pharmacists were interviewed. GPS and pharmacists perceived medication review as an opportunity to improve prescribing safety. Although interviewees thought patients should be involved in decisions about their medicines, high workload pressures meant that most medication reviews were conducted with limited or no patient input. For some GPS, a medication review was done 'in the quickest way possible to say that it was done'. Pharmacists were perceived by both professions as being more thorough but less time efficient than GPS, and few pharmacists were routinely involved in medication reviews even in practices employing a pharmacist. Interviewees argued that it was easier to continue medicines than it was to stop them, particularly because stopping medicines required involving the patient and this generated extra work.Conclusion: Practices tended to prioritise being efficient (getting the work done) rather than being thorough (doing it well), so that most medication reviews were carried out with little or no patient involvement, and medicines were rarely stopped or reduced. Time and resource constraints are an important barrier to implementing NICE guidance.
AB - Background: Medication reviews may improve the safety of prescribing and the National Institute for Health and Care Excellence (NICE) highlights the importance of involving patients in this process. Aim To explore GP and pharmacist perspectives on how medication reviews were conducted in general practice in the UK. Design and setting Analysis of semi-structured interviews with GPS and pharmacists working in the South West of England, Northern England, and Scotland, sampled for heterogeneity. Interviews took place between January and October 2017.Method: Interviews focused on experience of medication review. Data saturation was achieved when no new insights arose from later interviews. Interviews were analysed thematically.Results: In total, 13 GPS and 10 pharmacists were interviewed. GPS and pharmacists perceived medication review as an opportunity to improve prescribing safety. Although interviewees thought patients should be involved in decisions about their medicines, high workload pressures meant that most medication reviews were conducted with limited or no patient input. For some GPS, a medication review was done 'in the quickest way possible to say that it was done'. Pharmacists were perceived by both professions as being more thorough but less time efficient than GPS, and few pharmacists were routinely involved in medication reviews even in practices employing a pharmacist. Interviewees argued that it was easier to continue medicines than it was to stop them, particularly because stopping medicines required involving the patient and this generated extra work.Conclusion: Practices tended to prioritise being efficient (getting the work done) rather than being thorough (doing it well), so that most medication reviews were carried out with little or no patient involvement, and medicines were rarely stopped or reduced. Time and resource constraints are an important barrier to implementing NICE guidance.
KW - Care of older people
KW - Medication review
KW - Polypharmacy
KW - Primary health care
KW - Qualitative research
UR - http://www.scopus.com/inward/record.url?scp=85062585091&partnerID=8YFLogxK
U2 - 10.3399/bjgp19X701321
DO - 10.3399/bjgp19X701321
M3 - Article
C2 - 30745357
SN - 0960-1643
VL - 69
SP - E190-E198
JO - British Journal of General Practice
JF - British Journal of General Practice
IS - 680
ER -