Exploring the implementation and integration of structured medication reviews in primary care: a qualitative evaluation using normalisation process theory

Claire Reidy; Anna Seeley; Katherine Tucker; Adaku Agwunobi; Paul A Bateman; Christopher Elles Clark; Andrew Paul Clegg; Gary A Ford; Seema Gadhia; William Hinton; FD Richard Hobbs; Sundus Jawad; Kamlesh Khunti; Gregory YH Lip; Simon de Lusignan; Jonathan Mant; Deborah McCahon; Bernardo Meza-Torres; Rupert A Payne; Rafael Perera-Salazar; Samuel Seidu; James Sheppard; Marney Williams; Cynthia Wright Drakesmith; Richard J McManus; Rebecca K Barnes

doi:10.3399/BJGP.2025.0522

Published eLetters

eLetter submission guidelines

Submit a Response to This Article

Compose eLetter

Title *

Author Information

Contributors

First Name and Middle Initial *

First or given name, e.g. 'Peter'.

Last Name *

Your last, or family, name, e.g. 'MacMoody'.

Email Address *

Your email address, e.g. higgs-boson{at}gmail.com. PLEASE NOTE: your email address will be published.

Occupation *

Your role and/or occupation, e.g. 'Orthopedic Surgeon'.

Affiliation *

Your organization or institution (if applicable), e.g. 'Royal Free Hospital'.

Statement of Competing Interests

Competing interests? *

Yes

Please describe the competing interests

CAPTCHA

This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.

Vertical Tabs

Jump to comment:

Structured medication reviews: structure the system, not the conversation
Kinan Mokbel

Published on: 10 August 2026

Published on: (10 August 2026)
Page navigation anchor for Structured medication reviews: structure the system, not the conversation
Structured medication reviews: structure the system, not the conversation
Kinan Mokbel, Honorary Professor at Brunel University London, Senior Lecturer (Clinical Pharmacy, Advanced Clinical Practice, Pharmacology), University of Exeter
Reidy and colleagues expose a paradox at the heart of structured medication reviews (SMRs). The reviews are deliberately “structured”, yet the features pharmacists considered most valuable were often the least standardisable: time, trust, preparation, continuity and difficult conversations about deprescribing. Experienced pharmacists described using templates more flexibly, while newer colleagues relied on them as a safety net¹. This makes pharmacists wonder whether they are standardising the wrong part of the intervention. What should define a high-quality SMR: completion of a template or the conditions that allow clinical judgement and shared decision making? If preparation can take 10–20 minutes, consultations 30–45 minutes (or longer) and some decisions require further appointments¹, can an SMR really be treated as a discrete activity?

There is another question. This study tells us what pharmacists and service leads believe makes an SMR meaningful, but patients themselves were not interviewed¹. Would patients identify the same markers of quality? Does a comprehensive review still count as person-centred if the patient did not understand why they were invited or does not know who will follow up?

I think international models can sharpen the debate; US comprehensive medication management combines a standard patient-care process with longitudinal pharmacist–patient relationships and follow-up². Australia...
Show More

Reidy and colleagues expose a paradox at the heart of structured medication reviews (SMRs). The reviews are deliberately “structured”, yet the features pharmacists considered most valuable were often the least standardisable: time, trust, preparation, continuity and difficult conversations about deprescribing. Experienced pharmacists described using templates more flexibly, while newer colleagues relied on them as a safety net¹. This makes pharmacists wonder whether they are standardising the wrong part of the intervention. What should define a high-quality SMR: completion of a template or the conditions that allow clinical judgement and shared decision making? If preparation can take 10–20 minutes, consultations 30–45 minutes (or longer) and some decisions require further appointments¹, can an SMR really be treated as a discrete activity?

There is another question. This study tells us what pharmacists and service leads believe makes an SMR meaningful, but patients themselves were not interviewed¹. Would patients identify the same markers of quality? Does a comprehensive review still count as person-centred if the patient did not understand why they were invited or does not know who will follow up?

I think international models can sharpen the debate; US comprehensive medication management combines a standard patient-care process with longitudinal pharmacist–patient relationships and follow-up². Australia’s Domiciliary Medication Management Reviews formally links pharmacist assessment with GP discussion and a written medication management plan³. In Ontario, ethnographic work found medication reviews varied markedly in duration, setting and interaction style, with local context shaping delivery.⁴ Structure, therefore, does not itself guarantee quality. A systematic review of 50 trials similarly identified collaborative working, patient goal-setting and action planning, and additional support and follow-up as components associated with better outcomes⁵.

Perhaps England should standardise the scaffolding rather than the conversation: patient preparation, protected time, access to clinical information, multidisciplinary responsibility and follow-up. Should commissioners count how many SMRs were completed and ask whether patients understood the decisions, whether difficult deprescribing was revisited, and whether someone remained responsible afterwards?

If SMRs exist because patients are complex, why are we still tempted to measure success by how efficiently they can be completed?

References

1. Reidy, C., Seeley, A., Tucker, K, et al. Exploring the implementation and integration of structured medication reviews in primary care: a qualitative evaluation using normalisation process theory. Br J Gen Pract. 2026;76(769):e613–e623. doi:10.3399/BJGP.2025.0522.
2. Funk, K.A., Sorge, L.A., Bazemore, A.W, et al. How Comprehensive Medication Management Contributes to Foundational Elements of Primary Care. J Am Board Fam Med. 2021;34(2):420–423. doi:10.3122/jabfm.2021.02.190318.
3. Australian Government Department of Health, Disability and Ageing. Medicare Benefits Schedule Note AN.0.52: Domiciliary Medication Management Reviews. Available from: www9.health.gov.au/mbs/fullDisplay.cfm?type=note&q=AN.0.52&qt=noteID
4. Patton SJ, Miller FA, Abrahamyan L, Rac VE. Expanding the clinical role of community pharmacy: A qualitative ethnographic study of medication reviews in Ontario, Canada. Health Policy. 2018;122(3):256-262. doi:10.1016/j.healthpol.2017.10.007.
5. Craske ME, Hardeman W, Steel N, Twigg MJ. Components of pharmacist-led medication reviews and their relationship to outcomes: a systematic review and narrative synthesis. BMJ Qual Saf. 2024;33(12):808-822. Published 2024 Nov 20. doi:10.1136/bmjqs-2024-017283.
Show Less

Competing Interests: None declared.