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Observational Study
. 2023 Jul 14;23(1):435.
doi: 10.1186/s12877-023-04143-2.

Frequency and impact of medication reviews for people aged 65 years or above in UK primary care: an observational study using electronic health records

Rebecca M Joseph  1   2 , Roger D Knaggs  3 , Carol A C Coupland  1   2 , Amelia Taylor  1 , Yana Vinogradova  1 , Debbie Butler  4 , Louisa Gerrard  4 , David Waldram  4 , Barbara Iyen  1 , Ralph K Akyea  1 , Darren M Ashcroft  5   6 , Anthony J Avery  1   2   6 , Ruth H Jack  7   8
Affiliations
Observational Study

Frequency and impact of medication reviews for people aged 65 years or above in UK primary care: an observational study using electronic health records

Rebecca M Joseph et al. BMC Geriatr. .

Abstract

Background: Medication reviews in primary care provide an opportunity to review and discuss the safety and appropriateness of a person's medicines. However, there is limited evidence about access to and the impact of routine medication reviews for older adults in the general population, particularly in the UK. We aimed to quantify the proportion of people aged 65 years and over with a medication review recorded in 2019 and describe changes in the numbers and types of medicines prescribed following a review.

Methods: We used anonymised primary care electronic health records from the UK's Clinical Practice Research Datalink (CPRD GOLD) to define a population of people aged 65 years or over in 2019. We counted people with a medication review record in 2019 and used Cox regression to estimate associations between demographic characteristics, diagnoses, and prescribed medicines and having a medication review. We used linear regression to compare the number of medicines prescribed as repeat prescriptions in the three months before and after a medication review. Specifically, we compared the 'prescription count' - the maximum number of different medicines with overlapping prescriptions people had in each period.

Results: Of 591,726 people prescribed one or more medicines at baseline, 305,526 (51.6%) had a recorded medication review in 2019. Living in a care home (hazard ratio 1.51, 95% confidence interval 1.40-1.62), medication review in the previous year (1.83, 1.69-1.98), and baseline prescription count (e.g. 5-9 vs 1 medicine 1.41, 1.37-1.46) were strongly associated with having a medication review in 2019. Overall, the prescription count tended to increase after a review (mean change 0.13 medicines, 95% CI 0.12-0.14).

Conclusions: Although medication reviews were commonly recorded for people aged 65 years or over, there was little change overall in the numbers and types of medicines prescribed following a review. This study did not examine whether the prescriptions were appropriate or other metrics, such as dose or medicine changes within the same class. However, by examining the impact of medication reviews before the introduction of structured medication review requirements in England in 2020, it provides a useful benchmark which these new reviews can be compared with.

Keywords: General Practice; Medication Review; Older Adults; Polypharmacy; Routinely Collected Health Data.

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Conflict of interest statement

The authors declare support from the National Institute for Health and Care Research (NIHR) School for Primary Care Research (all), NIHR Nottingham Biomedical Research Centre (RMJ, RHJ, CACC), and NIHR MindTech MedTech Co-operative (DB, LW). AJA is National Clinical Director for Prescribing for NHS England. All other authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram showing people included in each part of the study. CPRD Clinical Practice Research Datalink, n number of people, SD standard deviation. *a marker of data quality in CPRD
Fig. 2
Fig. 2
Medicines most frequently started or stopped after a medication review. These results are sorted by percentage started, are based on a study population of 309,207 people, and include only tablets prescribed as a repeat prescription. The time periods of interest are the three months before and three months after a medication review
See this image and copyright information in PMC

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