The impact of COVID-19 on medication reviews in English primary care. An OpenSAFELY analysis. Part 2: Results

In this blog series, pharmacists Chris Wood and Vicky Speed talk about their research on medication review activity including the launch of structured medications reviews during the COVID-19 pandemic.

In this second blog we describe the results of the study. We describe the impact of the COVID-19 pandemic on medication reviews and on the launch of structured medication reviews as a new service.

What happened with medication reviews?

We showed that following the first COVID-19 lockdown period (April 2020) there was a sudden drop in the monthly rates of medication review. As a consequence of this, the percentage of patients who had received a medication review in the preceding 12 months started to decline month-on-month, reaching the lowest rate in March 2021, before then starting to gradually recover, although still remaining below pre-pandemic levels at the end of the study period (March 2022).

This suggests that during a period of significant pressures on the healthcare system, medication reviews were understandably de-prioritised for more urgent work. However it is reassuring to see rates slowly begin to return to pre-pandemic levels as the healthcare system recovered.

Of particular interest we found substantial variation in the rates of medication reviews between different ethnicities and across NHS regions (after standardisation for age and sex). This identifies potential health inequalities in these groups and we would recommend that national bodies use OpenSAFELY to further identify and target these differences to improve the quality and equality of care.

We also showed that rates of medication reviews were consistently much higher in patients taking high risk medications, residing in nursing/care homes and those in advancing age groups. These groups represent some of those at the highest risk of harm from their prescribed medications and it would seem reasonable that these patients are prioritised for review.

Our paper provides more detailed results on medication reviews including additional data for practice level variation and breakdowns by age, sex, ethnicity, region, Index of Multiple Deprivation, care home or nursing home residents/ individuals with learning difficulties and patients prescribed high risk drugs.

What happened with structured medication reviews?

Following the launch in September 2020, we show that the percentage of patients having an SMR recorded within the previous 12 months increased steadily, despite national lockdown periods. In keeping with the results for medication reviews, patients on high risk medications, those residing in nursing/care homes and those in advancing age groups all had higher rates.

Patients on high risk medications appear to be a particular focus for SMRs, with patients taking addictive medication having the highest rate. This reflects national guidance on patients who are likely to benefit from an SMR.

We show significant variation also persists in the rates of structured medication reviews between different ethnicities and across NHS regions (after standardisation for age and sex), again highlighting the need for further focus and action from national bodies.

Our paper provides more detailed results on structured medication reviews including additional data for breakdowns by age, sex, ethnicity, region, Index of Multiple Deprivation, care home or nursing home residents/ individuals with learning difficulties and patients prescribed high risk medications.

Summary

We showed that the COVID-19 pandemic resulted in a reduction in the rates of medication reviews, with other activities likely being prioritised. Rates did however begin to return towards pre-pandemic levels as the healthcare system began to recover.

High risk patient groups appear to be appropriately prioritised for reviews. However potential health inequalities exist due to significant variation in rates across ethnicity and NHS regions.