Examining the missing link in repeat prescribing systems: patient-centered medication reviews

Problem

We face a growing challenge of tackling problematic polypharmacy; where the benefits of long-term use of multiple medications is often outweighed by the burden and potential harm. There has been a call for more tailoring of medication in people with polypharmacy. However, in 2017 there were over 800 million repeat prescriptions issued, so the problem faced is designing repeat prescribing systems that allow for patient-specific tailoring. We seek to describe/deliver a new complex intervention to address polypharmacy that actively builds person-centred medication reviews into the model. We have started by assessing the current evidence base on how this can be/is being achieved in practice.

The aim of this scoping literature review is to describe currently the key components of person-centred medication reviews in repeat prescribing.

Approach

A scoping literature review was undertaken with an information specialist. We conducted a systematic search of key databases: CINAHL complete, Embase, Academic Search Premier, Medline, PsycINFO, HMIC using piloted search terms. Searches were restricted to the UK. Our wide-lens inclusion and exclusion criteria included: repeat prescribing AND Patient centred; holistic; multimorbities/multi-morbid/long term condition/co-morbidities; medication review or annual review; system/task/safety; attitudes/behaviours; how do repeat prescribing systems work – logistics/mechanisms/processes; prescribing decisions (clinical). Any non-UK or papers before 2000 were excluded.

We screened 415 articles following duplication removal. Abstracts were screened by AH, JB and KH against inclusion/exclusion criteria. Discrepancies were discussed within the team. Full text articles were all double screened to confirm inclusion. A standard data extraction tool was used to identify details from the included studies on setting, intervention, study methods, study quality. Thematic analysis will be used on the final data set through constant comparison to describe the core components of patient centred medication reviews. The review process was supported by the use of Rayyan software.

Findings

Data Extraction and analysis is ongoing. Emerging findings suggest a focus on safe repeat prescribing systems, receptionist’s roles and practice based pharmacists but there appears to be a paucity on patient centered repeat prescribing. There appears to be limited research in the context of repeat prescribing systems.

Consequences

The findings will feed in to our work to describe a new complex intervention to embed patient centred reviews in repeat prescribing systems. Medication optimisation needs to be patient centred. The findings from this systematic review will help to identify any current patient centredness within repeat prescribing systems in primary care. From this, we plan to identify possible changes that need to be made to the repeat prescribing systems to ensure they are tailored to patients with multimorbidities. Overall, this systematic review aims to explore and help us develop patient centred systems in primary care to deliver better outcomes for our patients.