Optimising Structured Medication Reviews for Older People with Severe Frailty and Care Home Residents to Reduce Overprescribing and Associated Inequalities
Background
Overprescribing is a growing challenge in healthcare and can increase the risk of harm, particularly for older people living with frailty. Many people aged 80 and over take multiple medications, and medicines can accumulate over time without regular review of whether they continue to provide benefit. This can lead to adverse drug reactions, falls, cognitive decline, loss of independence and avoidable use of health and care services. Polypharmacy is also more common among people experiencing socioeconomic disadvantage and some ethnic minority communities. Structured Medication Reviews (SMRs) were introduced by NHS England in 2021 to support safer prescribing and deprescribing, but there is limited evidence about whether older people with severe frailty and care home residents have equitable access to SMRs and benefit equally from them.
Aims and Objectives
This project aims to optimise Structured Medication Reviews (SMRs) for older people with severe frailty and care home residents by identifying and addressing inequalities in access, delivery and outcomes.
The objectives are to:
- Identify patterns of inequality in the delivery and outcomes of SMRs for older people with severe frailty and care home residents.
- Examine how factors such as age, gender, ethnicity and socioeconomic position influence access to and experiences of SMRs.
- Understand how SMRs are implemented in practice and what helps or hinders equitable delivery.
- Co-design resources, guidance and training to improve the accessibility and quality of SMRs.
- Inform NHS policy and practice to reduce overprescribing and improve outcomes for older people living with frailty.
Methods
The study consists of three work packages.
- Work Package 1 will analyse routinely collected linked health and care datasets, including CPRD and Connected Bradford, to identify inequalities in the delivery and outcomes of SMRs for older people with severe frailty and care home residents.
- Work Package 2 will use observations and semi-structured interviews with older people, care home residents, family carers and health and social care professionals to understand experiences of SMRs and explore barriers and facilitators to equitable access and engagement.
- Work Package 3 will bring together older people, carers, professionals, commissioners and policymakers to co-design practical solutions, including training materials, guidance and resources to support more equitable delivery of SMRs.
The study uses an intersectional approach, recognising that overlapping factors such as frailty, ethnicity, gender and deprivation may combine to influence experiences and outcomes.
Further Information
The project is funded by the NIHR Health Services and Delivery Research (HSDR) programme and runs from January 2024 to June 2027.
Expected outputs include:
- Evidence on inequalities in SMR delivery and outcomes.
- Training for pharmacy teams on engaging older people with frailty from diverse backgrounds.
- Guidance and toolkits for Primary Care Networks (PCNs) and Integrated Care Systems (ICSs).
- A policy report for NHS England recommending improvements to the SMR framework.
The research aims to improve equity in medication reviews, reduce overprescribing, lower the risk of medication-related harm and support better health outcomes for older people with frailty and care home residents. It also has the potential to reduce pressure on health and social care services through fewer adverse drug reactions, medication errors and avoidable healthcare use.
