Efficiency versus thoroughness in medication review

Background: Medication reviews may improve the safety of prescribing and NICE highlights the importance of involving patients in this process.Aim: To explore GP and pharmacist perspectives on how medication reviews are conducted in UK General Practice.Design and setting: Semi-structured interviews with 13 GPs and 10 pharmacists working in UK primary care sampled for heterogeneity.Methods: Interviews focused on experience of medication review. Data saturation was achieved with no new insights arising from later interviews. Interviews were analysed thematically.Results: GPs and pharmacists perceived medication review as an opportunity to improve prescribing safety. Whilst 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.