What's happening in Wessex?
Working together with the Health Innovation Network Polypharmacy Programme, Health Innovation Wessex has supported six primary care networks to help seldom heard communities access structured medication reviews (SMRs).
This project builds on work completed across the Health Innovation Network to use evidence-based materials to invite and support patients to get the most from their SMR. The project has focussed on patients living in more deprived areas where studies in Nottingham and Manchester have started to show some important improvements.
View the project summary
Resources to support patients having a Structured Medication Review
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Key findings:
- Using these materials, that have been designed with patients and tested in PCNs, increased the uptake of SMRs, reduced “did not attend rates and both clinicians and patients reported that this improved the quality of conversations between patients and their prescriber.
- Variation in how practices shared patient information resources
- Planning the SMR process carefully at practice level is vital
- Useful results achieved with vulnerable groups of patients that may not traditionally engaged with structured medication reviews such as housebound individuals
- Further work needs to be done to understand the relative benefits and downsides of telephone and face to face SMRs
What's happening nationally?
The Health Innovation Network has published a new report sharing insights and lessons from its initiative to improve access to Structured Medication Reviews for patients in seldom-heard communities, particularly those living in areas of high deprivation and from ethnic minority groups.
The report, based on pilots delivered in 27 Primary Care Networks (PCNs) across England, demonstrates how targeted approaches and dedicated patient resources can increase engagement and attendance at these crucial appointments.
The pilots served as a valuable catalyst for PCNs to refine or establish new SMR pathways. Patient feedback suggests the resources enhance understanding and preparation for reviews, while health and care professionals describe their value in engaging vulnerable populations and improving the quality of consultations, despite challenges related to digital exclusion.
Key findings:
- Increased SMR activity: While direct comparison was challenging due to varying study periods, all participating PCNs saw an increase in SMRs completed. Across 27 PCNs, a total of 2,587 SMRs were completed during the study period.
- Reduced Did Not Attend (DNA) rates: Most areas were able to demonstrate a clear reduction in DNA rates for SMR appointments.
- Improved engagement with seldom-heard communities: 85% of PCN teams agreed that the Health Innovation Network patient-facing resources helped them engage with target communities. Specific examples include improved engagement with veterans, people with a learning disability, and those with English as a second language.
- Catalyst for pathway improvement: The project provided a structured opportunity for PCNs to review their SMR processes, including patient identification, screening, pre-SMR work, and time allocation. Some PCNs designed new SMR pathways or moved from reactive to proactive approaches.
- Value of patient resources: The Health Innovation Network SMR resources, which were funded by NHS England, were appreciated by both patients and healthcare professionals, particularly the improved quality of conversations and shared decision making. The availability of resources in 12 community languages and easy-read versions was particularly helpful in engaging diverse patient groups.
- The role of pharmacists: The initiative reinforced the value of the pharmacist's role in multidisciplinary teams and their knowledge. Pharmacists carried out SMRs in almost all participating PCNs, often with dedicated time allocations.
- Funding as an enabler: Although small, the funding, was seen as a significant enabler, creating dedicated time for PCNs to think about and deliver SMRs.
- Enhanced patient understanding and preparation: Half of respondents felt the materials helped patients better understand and prepare for their SMR, leading to improved quality of the review and increased likelihood of patients asking questions.
- Empowering patients: Patient feedback highlighted feelings of empowerment, valuing time for preparation, and appreciating receiving resources in their own language. Patients reported feeling more confident talking to their GP or pharmacist after reading the materials.
Why is this work important?
Over one million people in England take 10 or more medicines for their long-term conditions.
As patients live longer with multiple long-term conditions, physiological reserves to cope with taking so many medicines are reduced. What might have been an appropriate medicine in our 50s may be putting us at risk from harm in our 80s.
Work from Scotland, Ireland and in the UK has demonstrated savings not only in the drugs budget (from stopping inappropriate prescribing) but also in wider healthcare utility costs.
However, it is important that patients understand the SMR and its purpose. Evidence has shown that we need to do more to support patients to understand and make the most of their SMR.
To find out more about our Polypharmacy work or for any enquiries please email medicines.optimisation@hiwessex.net or use our general enquiries contact page.
