{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T14:03:02Z","timestamp":1793714582200,"version":"4.6.1"},"reference-count":26,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T00:00:00Z","timestamp":1759190400000},"content-version":"unspecified","delay-in-days":29,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"NIHR Applied Research Collaboration East Midlands","award":["NIHR201895"],"award-info":[{"award-number":["NIHR201895"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,9,2]]},"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>This study explored how Structured Medication Reviews (SMRs) are being undertaken and the challenges to their successful implementation and sustainability.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>A cross-sectional mixed methods online survey.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Setting<\/jats:title>\n                  <jats:p>Primary care in England.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Participants<\/jats:title>\n                  <jats:p>120 clinical pharmacists with experience in conducting SMRs in primary care.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Survey responses were received from clinical pharmacists working in 15 different regions. The majority were independent prescribers (62%, n=74), and most were employed by Primary Care Networks (65%, n=78), delivering SMRs for one or more general practices. 61% (n=73) had completed, or were currently enrolled in, the approved training pathway. Patient selection was largely driven by the primary care contract specification: care home residents, patients with polypharmacy, patients on medicines commonly associated with medication errors, patients with severe frailty and\/or patients using potentially addictive pain management medication. Only 26% (n=36) of respondents reported providing patients with information in advance. The majority of SMRs were undertaken remotely by telephone and were 21\u201330\u2009min in length. Much variation was reported in approaches to conducting SMRs, with SMRs in care homes being deemed the most challenging due to additional complexities involved. Challenges included not having sufficient time to prepare adequately, address complex polypharmacy and complete follow-up work generated by SMRs, issues relating to organisational support, competing national priorities and lack of \u2018buy-in\u2019 from some patients and General Practitioners.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>These results offer insights into the role being played by the clinical pharmacy workforce in a new country-wide initiative to improve the quality and safety of care for patients taking multiple medicines. Better patient preparation and trust, alongside continuing professional development, more support and oversight for clinical pharmacists conducting SMRs, could lead to more efficient medication reviews. However, a formal evaluation of the potential of SMRs to optimise safe medicines use for patients in England is now warranted.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-097012","type":"journal-article","created":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T08:03:15Z","timestamp":1759305795000},"page":"e097012","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":10,"title":["Understanding structured medication reviews delivered by clinical pharmacists in primary care in England: a national cross-sectional survey"],"prefix":"10.1136","volume":"15","author":[{"given":"Adaku J","family":"Agwunobi","sequence":"first","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna E","family":"Seeley","sequence":"additional","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6544-8066","authenticated-orcid":false,"given":"Katherine L","family":"Tucker","sequence":"additional","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul A","family":"Bateman","sequence":"additional","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7526-3038","authenticated-orcid":false,"given":"Christopher Elles","family":"Clark","sequence":"additional","affiliation":[{"name":"Exeter Collaboration for Academic Primary Care, University of Exeter Medical School, Exeter, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5972-1097","authenticated-orcid":false,"given":"Andrew","family":"Clegg","sequence":"additional","affiliation":[{"name":"University of Leeds School of Medicine, Leeds, West Yorkshire, UK"},{"name":"Bradford Teaching Hospitals NHS Foundation Trust, Bradford, Bradford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gary","family":"Ford","sequence":"additional","affiliation":[{"name":"Radcliffe Department of Medicine, University of Oxford, Oxford, UK"},{"name":"Oxford and Thames Valley, Health Innovation Network, Oxford, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seema","family":"Gadhia","sequence":"additional","affiliation":[{"name":"Oxford and Thames Valley, Health Innovation Network, Oxford, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F D Richard","family":"Hobbs","sequence":"additional","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kamlesh","family":"Khunti","sequence":"additional","affiliation":[{"name":"University of Leicester Diabetes Research Centre, Leicester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory Y H","family":"Lip","sequence":"additional","affiliation":[{"name":"Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK"},{"name":"Department of Clinical Medicine, Aalborg Universitet, Aalborg, Region Nordjylland, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5613-6810","authenticated-orcid":false,"given":"Simon","family":"de Lusignan","sequence":"additional","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9531-0268","authenticated-orcid":false,"given":"Jonathan","family":"Mant","sequence":"additional","affiliation":[{"name":"University of Cambridge Primary Care Unit, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deborah","family":"McCahon","sequence":"additional","affiliation":[{"name":"Population Health Sciences, Bristol Medical School, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rupert A","family":"Payne","sequence":"additional","affiliation":[{"name":"Exeter Collaboration for Academic Primary Care, University of Exeter Medical School, Exeter, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2418-2091","authenticated-orcid":false,"given":"Rafael","family":"Perera","sequence":"additional","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel","family":"Seidu","sequence":"additional","affiliation":[{"name":"University of Leicester, Leicester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4461-8756","authenticated-orcid":false,"given":"James P","family":"Sheppard","sequence":"additional","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marney","family":"Williams","sequence":"additional","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cynthia","family":"Wright-Drakesmith","sequence":"additional","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, 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