Structured medication reviews (SMRs) have become a cornerstone of modern medicines optimisation and medicines management in UK primary care across England. Unlike traditional medication reviews, SMRs follow a standardised framework that ensures patients receive thorough, evidence-based assessments of their medicines. However, with limited clinical time and resources, identifying which patients will benefit most from structured medication reviews is essential for maximising their impact.
Understanding Structured Medication Reviews
A structured medication review is a systematic evaluation of a patient’s medicines, conducted by a qualified healthcare professional, typically a clinical pharmacist, nurse or GP. The process examines whether each medicine remains appropriate, effective, and safe for the patient’s current health status. SMRs consider potential interactions, side effects, problems with adherence, and whether treatment goals are being met.
The NHS distinguishes SMRs from simpler medication reviews by their comprehensive nature. They include shared decision-making with patients, consider the person’s individual circumstances and preferences, and result in an agreed plan that’s documented in the patient’s medical record.
Priority Patient Groups for SMRs
Patients with Polypharmacy
Polypharmacy, generally defined as taking five or more regular medicines, is the primary indicator for structured medication reviews. The Department of Health and Social Care’s National Overprescribing Review found that around 15% of people in England take five or more medicines daily, with this figure rising significantly in older age groups.
Patients taking multiple medicines face increased risks of adverse drug reactions, drug interactions, and reduced adherence. Each additional medicine increases the likelihood of prescribing cascades, where new medicines are prescribed to treat the side effects of existing ones. SMRs help identify these issues before they cause harm.
Care Home Residents
People living in care homes typically manage multiple long-term conditions with complex medication regimens. NHS guidance specifically identifies care home residents as a priority group for structured medication reviews, recommending they receive reviews at least annually.
Care home residents often experience changes in their health status that necessitate medication adjustments. They may also have cognitive impairment affecting their ability to report side effects or adherence difficulties, making regular professional review particularly important.
Patients with Multiple Long-Term Conditions
Individuals managing several chronic conditions, such as diabetes, heart disease, chronic kidney disease, and hypertension, benefit significantly from SMRs. Their treatment typically involves multiple medicines from different specialists and prescribers, increasing the risk of conflicting treatment goals or duplicated therapies.
Structured medication reviews provide an opportunity to take a holistic view of these patients’ overall health, ensuring their medicines work together effectively rather than in isolation.
Patients Recently Discharged from Hospital
Hospital discharge represents a high-risk transition point for medication safety. Patients often leave hospital with changed medicines, new prescriptions, or discontinued treatments. Without careful review, these changes can lead to confusion, duplication, or dangerous omissions.
SMRs conducted shortly after hospital discharge help reconcile hospital changes with existing GP prescriptions, clarify the rationale for modifications, and make sure patients understand their updated treatment plan.
Patients with Uncontrolled Symptoms
When patients experience persistent symptoms despite treatment, or report side effects that impact their quality of life, an SMR can identify whether medication-related factors are contributing. This might reveal issues such as suboptimal dosing, drug interactions causing symptoms, or medicines that are no longer necessary.
Additional Considerations
Patients Prescribed High-Risk Medicines
Certain medicines require more intensive monitoring due to their potential for serious adverse effects. These include anticoagulants, immunosuppressants, disease-modifying drugs, and medicines with narrow therapeutic windows. Patients on these treatments benefit from regular structured reviews to ensure ongoing safety and effectiveness.
Older Patients with Frailty
Frailty increases vulnerability to medication-related harm. Older adults with frailty may experience altered drug metabolism, increased sensitivity to medicines, and greater difficulty managing complex regimens.
Patients with Reduced Kidney or Liver Function
Impaired organ function significantly affects how the body processes medicines. Patients with chronic kidney disease or liver disease require regular medication reviews to adjust doses appropriately and avoid medicines that could worsen organ function or accumulate to toxic levels.
Patients Reporting Non-Adherence
When patients struggle to take medicines as prescribed, whether due to side effects, complexity, cost, or other barriers, an SMR provides an opportunity to explore these challenges. The review can identify simpler alternatives, address concerns, and develop a more manageable treatment plan that patients can realistically follow.
Implementing Effective SMR Services
Primary Care Networks have been commissioned to deliver structured medication reviews as part of their Enhanced Access requirements, with specific targets for care home residents and patients with multiple conditions. Clinical pharmacists and pharmacy technicians working within PCNs typically lead this work, bringing specialist medicines expertise to identify optimisation opportunities.
Effective SMR services prioritise patients based on clinical need rather than simply working through practice lists chronologically. Using clinical system searches to identify high-risk patients ensures reviews reach those who stand to benefit most.
Measuring the Impact
Well-targeted SMRs can reduce GP workload related to medication queries, decrease hospital admissions caused by adverse drug events, and improve patient outcomes through better-optimised treatment. Their success depends on focusing resources where they’ll make the greatest difference.
By identifying priority patients using the criteria outlined above, primary care teams can ensure structured medication reviews deliver maximum value for both patients and the healthcare system.
