Frequency and impact of medication reviews for people aged 65 years or above in UK primary care: an observational study using electronic health records

Joseph, Rebecca M.; Knaggs, Roger D.; Coupland, Carol A.C.; Taylor, Amelia; Vinogradova, Yana; Butler, Debbie; Gerrard, Louisa; Waldram, David; Iyen, Barbara; Akyea, Ralph K.; Ashcroft, Darren M.; Avery, Anthony J.; Jack, Ruth H.

Abstract

Background Medication reviews in primary care provide an opportunity to review and discuss the safety and appropriateness of a person’s medicines. However, there is limited evidence about access to and the impact of routine medication reviews for older adults in the general population, particularly in the UK. We aimed to quantify the proportion of people aged 65 years and over with a medication review recorded in 2019 and describe changes in the numbers and types of medicines prescribed following a review. Methods We used anonymised primary care electronic health records from the UK’s Clinical Practice Research Datalink (CPRD GOLD) to define a population of people aged 65 years or over in 2019. We counted people with a medication review record in 2019 and used Cox regression to estimate associations between demographic characteristics, diagnoses, and prescribed medicines and having a medication review. We used linear regression to compare the number of medicines prescribed as repeat prescriptions in the three months before and after a medication review. Specifically, we compared the ‘prescription count’ - the maximum number of different medicines with overlapping prescriptions people had in each period. Results Of 591,726 people prescribed one or more medicines at baseline, 305,526 (51.6%) had a recorded medication review in 2019. Living in a care home (hazard ratio 1.51, 95% confidence interval 1.40-1.62), medication review in the previous year (1.83, 1.69-1.98), and baseline prescription count (e.g. 5-9 vs 1 medicine 1.41, 1.37-1.46) were strongly associated with having a medication review in 2019. Overall, the prescription count tended to increase after a review (mean change 0.13 medicines, 95% CI 0.12-0.14). Conclusions Although medication reviews were commonly recorded for people aged 65 years or over, there was little change overall in the numbers and types of medicines prescribed following a review. This study did not examine whether the prescriptions were appropriate or other metrics, such as dose or medicine changes within the same class. However, by examining the impact of medication reviews before the introduction of structured medication review requirements in England in 2020, it provides a useful benchmark which these new reviews can be compared with.

Citation

Joseph, R. M., Knaggs, R. D., Coupland, C. A., Taylor, A., Vinogradova, Y., Butler, D., …Jack, R. H. (2023). Frequency and impact of medication reviews for people aged 65 years or above in UK primary care: an observational study using electronic health records. BMC Geriatrics, 23(1), Article 435. https://doi.org/10.1186/s12877-023-04143-2

• Journal Article Type: Article
• Acceptance Date: Jun 30, 2023
• Online Publication Date: Jul 14, 2023
• Publication Date: Jul 14, 2023
• Deposit Date: Jul 17, 2023
• Publicly Available Date: Jul 17, 2023
• Journal: BMC Geriatrics
• Electronic ISSN: 1471-2318
• Publisher: Springer Verlag
• Peer Reviewed: Peer Reviewed
• Volume: 23
• Issue: 1
• Article Number: 435
• DOI: https://doi.org/10.1186/s12877-023-04143-2
• Keywords: Medication Review, Polypharmacy, General Practice, Older Adults, Routinely Collected Health Data
• Public URL: https://nottingham-repository.worktribe.com/output/23005083
• Publisher URL: https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-023-04143-2