Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Jul;90(7):1600-1614.
doi: 10.1111/bcp.16030. Epub 2024 Mar 26.

The impact of COVID-19 on medication reviews in English primary care. An OpenSAFELY-TPP analysis of 20 million adult electronic health records

OpenSAFELY Collaborative; Christopher Wood  1 , Victoria Speed  1   2 , Louis Fisher  1 , Helen J Curtis  1 , Andrea L Schaffer  1 , Alex J Walker  1 , Richard Croker  1 , Andrew D Brown  1 , Christine Cunningham  1 , William J Hulme  1 , Colm D Andrews  1 , Ben F C Butler-Cole  1 , David Evans  1 , Peter Inglesby  1 , Iain Dillingham  1 , Sebastian C J Bacon  1 , Simon Davy  1 , Tom Ward  1 , George Hickman  1 , Lucy Bridges  1 , Thomas O'Dwyer  1 , Steven Maude  1 , Rebecca M Smith  1 , Amir Mehrkar  1 , Chris Bates  3 , Jonathan Cockburn  3 , John Parry  3 , Frank Hester  3 , Sam Harper  3 , Ben Goldacre  1 , Brian MacKenna  1
Affiliations

The impact of COVID-19 on medication reviews in English primary care. An OpenSAFELY-TPP analysis of 20 million adult electronic health records

OpenSAFELY Collaborative et al. Br J Clin Pharmacol. 2024 Jul.

Abstract

Aims: The COVID-19 pandemic caused significant disruption to routine activity in primary care. Medication reviews are an important primary care activity ensuring safety and appropriateness of prescribing. A disruption could have significant negative implications for patient care. Using routinely collected data, our aim was first to describe codes used to record medication review activity and then to report the impact of COVID-19 on the rates of medication reviews.

Methods: With the approval of NHS England, we conducted a cohort study of 20 million adult patient records in general practice, in-situ using the OpenSAFELY platform. For each month, between April 2019 and March 2022, we report the percentage of patients with a medication review coded monthly and in the previous 12 months with breakdowns by regional, clinical and demographic subgroups and those prescribed high-risk medications.

Results: In April 2019, 32.3% of patients had a medication review coded in the previous 12 months. During the first COVID-19 lockdown, monthly activity decreased (-21.1% April 2020), but the 12-month rate was not substantially impacted (-10.5% March 2021). The rate of structured medication review in the last 12 months reached 2.9% by March 2022, with higher percentages in high-risk groups (care home residents 34.1%, age 90+ years 13.1%, high-risk medications 10.2%). The most used medication review code was Medication review done 314530002 (59.5%).

Conclusions: There was a substantial reduction in the monthly rate of medication reviews during the pandemic but rates recovered by the end of the study period. Structured medication reviews were prioritized for high-risk patients.

Keywords: general practice; prescribing; primary care.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest statement

All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare the following: BG has received research funding from the Laura and John Arnold Foundation, the NHS National Institute for Health Research (NIHR), the NIHR School of Primary Care Research, NHS England, the NIHR Oxford Biomedical Research Centre, the Mohn-Westlake Foundation, NIHR Applied Research Collaboration Oxford and Thames Valley, the Wellcome Trust, the Good Thinking Foundation, Health Data Research UK, the Health Foundation, the World Health Organisation, UKRI MRC, Asthma UK, the British Lung Foundation, and the Longitudinal Health and Wellbeing strand of the National Core Studies programme; he is a Non-Executive Director at NHS Digital; he also receives personal income from speaking and writing for lay audiences on the misuse of science.

Figures

Figure 1
Figure 1. The percentage of patients that had had a medication review in the previous 12 months, reported monthly for the period April 2019 to March 2022 (inclusive) stratified by a) Sex (age standardised) b) Age bands (sex standardised) c) Ethnicity (age/sex standardised) d) Region (age/sex standardised) e) IMD quintiles (age/sex standardised) f) Record of learning disability g) Record of living in a nursing/care home.
Vertical dashed lines represent the start of three lockdown periods (23rd March 2020, 5th November 2020, 5th January 2021).
Figure 2
Figure 2. Practice level decile plots of medication review activity for the period April 2019 to March 2022 (inclusive): Percentage of patients with: a) Medication review recorded in the previous 12 months b) Medication review recorded monthly.
The median percentage is displayed as a thick blue line and deciles are indicated by dashed blue lines. Vertical dashed lines represent the start of three lockdown periods (23rd March 2020, 5th November 2020, 5th January 2021). All deciles are calculated across 2546 OpenSAFELY-TPP practices.
Figure 3
Figure 3. The percentage of patients with two or more prescriptions in the previous 12 months for a high-risk drug that had had a medication review in the previous 12 months, reported monthly for the period April 2019 to March 2022 (inclusive).
Vertical dashed lines represent the start of three lockdown periods (23rd March 2020, 5th November 2020, 5th January 2021).
Figure 4
Figure 4. The percentage of patients that had had a structured medication review in the previous 12 months, reported monthly for the period January 2020 to March 2022 (inclusive) stratified by a) Sex (age standardised) b) Age bands (sex standardised) c) Ethnicity (age/sex standardised) d) Region (age/sex standardised) e) IMD quintiles (age/sex standardised) f) Record of learning disability g) Record of living in a nursing/care home h) High-risk medications.
Vertical orange dashed lines represent the start of three lockdown periods (23rd March 2020, 5th November 2020, 5th January 2021). Vertical green line represents the launch of Structured Medication Review guidance (17th September 2020).
See this image and copyright information in PMC

References

    1. Moynihan R, Sanders S, Michaleff ZA, Scott AM, Clark J, To EJ, et al. Impact of COVID-19 pandemic on utilisation of healthcare services: a systematic review. BMJ Open. 2021;11(3):e045343. doi: 10.1136/bmjopen-2020-045343. - DOI - PMC - PubMed
    1. Mansfield KE, Mathur R, Tazare J, Henderson AD, Mulick AR, Carreira H, et al. Indirect acute effects of the COVID-19 pandemic on physical and mental health in the UK: a population-based study. The Lancet Digital Health. 2021;3(4):e217–e230. doi: 10.1016/S2589-7500(21)00017-0. - DOI - PMC - PubMed
    1. Curtis HJ, MacKenna B, Croker R, Inglesby P, Walker AJ, Morley J, et al. OpenSAFELY NHS Service Restoration Observatory 1: primary care clinical activity in England during the first wave of COVID-19. Br J Gen Pract. 2022;72(714):e63–e74. doi: 10.3399/BJGP.2021.0380. - DOI - PMC - PubMed
    1. Curtis HJ, MacKenna B, Wiedemann M, Fisher L, Croker R, Morton CE, et al. OpenSAFELY NHS Service Restoration Observatory 2: changes in primary care activity across six clinical areas during the COVID-19 pandemic. Br J Gen Pract. 2023;73(730):e318–e331. doi: 10.3399/BJGP.2022.0301. - DOI - PMC - PubMed
    1. Fisher L, Curtis HJ, Croker R, Wiedemann M, Speed V, Wood C, et al. Eleven key measures for monitoring general practice clinical activity during COVID-19 using federated analytics on 48 million adults’ primary care records through OpenSAFELY. medRxiv. doi: 10.7554/eLife.84673. Published online October 31, 2022. - DOI - PMC - PubMed