Optimising structured medication reviews: a real time observational cohort study with integrated qualitative evaluation


The objective it to study how implementation of the national policy on structured medication reviews (SMR) is impacting on the care of those with complex multimorbidity (4+ conditions) as a group with the most potential to benefit from such an intervention. The proposed evaluation will aim to: Understand how SMRs are being applied to people with complex multimorbidity; Use best practice examples along with practice dashboards to feedback performance to optimise SMRs including reducing inequalities in provision or performance; In this way to optimise the performance of SMRs for people with complex multimorbidity.

Timescale: 30 months starting on April 1st, 2021.

Outcome measures: Evidence of changes in prescribing using the STOPP/START criteria for
inappropriate and appropriate prescribing is the key outcome measure. Additional outcomes will include:

  • Detailed markers of potential benefit: recording of cardiovascular risk factors, before and after SMR:
  • presence of AF, blood pressure, cholesterol, monitoring tests (e.g., U&Es). Detailed markers of potential harm: anticholinergic medication index. And other outcomes (referrals, hospital admissions (including falls/fractures/cardiovascular events).

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