General Medical Practices in the UK are increasingly employing pharmacists. As a part of a broader intervention in  a study of the management of chronic disease, remote medication reviews leading to up to four recommendations for the GP to discuss with the patient were examined. Essentially, the outcome from this was that the intervention had no effect on the number of drugs prescribed. The analysis examined the impact of the intervention on medication regimen complexity and looked at the types of recommendations made by the pharmacists and the reasons for these, the proportion of recommendations were actioned by GPs; and and whether medication regimen complexity reduced relative to an approach involving usual care. In this analysis 609/797 (76%) of intervention patients had a pharmacist review but in 115/609 (19%) no pharmacist recommendation was made. Of 1100 recommendations made, 218 (20%) were described by GPs as either vague, indirect or “a question.” The most common interventions were to stop/reduce a medication (26%), switch a medication within the same class (18%) or ‘review’ a medication (16%). Of the recommendations advising changes to prescriptions, over half were not actioned by the GPs. Analysis of medication complexity scores was not complete at the time that the data was presented at 2019 meeting of the Society for Academic Primary care meeting.

It is difficult to make sense of the true meaning of this research – possible interpretations include:

  • GPs don’t value the recommendations of pharmacists, and are not prepared to follow advice. It is unclear if this is because they are unwilling to cede an aspect of professional autonomy in the interests of enhancing pharmacotherapy for their patients
  • Pharmacists lack the training, experience or expertise to be able to write medication review recommendations that are of clinical significance in this situation
  • The model for medication review was not functional, leading to sub-optimal outcomes, or the process for interdisciplinary interaction is flawed or ineffective

Whatever the reasons are for the findings, the outcome is bitterly disappointing and speaks to the need for a major re-think. If investment in pharmacy input through medication review is to continue, the model needs to be redefined to achieve much more effective outcomes.