The impact of COVID-19 on medication reviews in English primary care. An OpenSAFELY-TPP analysis of 20 million adult electronic health records
Authors:   The OpenSAFELY Collaborative, Wood Christopher , Speed Victoria , Fisher Louis , Curtis Helen J. , Schaffer Andrea L. , Walker Alex J. , Croker Richard , Brown Andrew D. , Cunningham Christine , Hulme William J. , Andrews Colm D. , Butler-Cole Ben F. C. , Evans David , Inglesby Peter , Dillingham Iain , Bacon Sebastian C.J. , Davy Simon , Ward Tom , Hickman George , Bridges Lucy , O’Dwyer Thomas , Maude Steven , Smith Rebecca M. , Mehrkar Amir , Bates Chris , Cockburn Jonathan , Parry John , Hester Frank , Harper Sam , Goldacre Ben , MacKenna Brian 
Published: August 2023

Background

The COVID-19 pandemic caused significant disruption to routine activity in primary care. Medication reviews are an important primary care activity to ensure safety and appropriateness of ongoing prescribing and a disruption could have significant negative implications for patient care.

Aim

Using routinely collected data, our aim was to i) describe the SNOMED CT codes used to report medication review activity ii) report the impact of COVID-19 on the volume and variation of medication reviews.

Design and setting

With the approval of NHS England, we conducted a cohort study of 20 million adult patient records in general practice, in-situ using the OpenSAFELY platform.

Method

For each month between April 2019 - March 2022, we report the percentage of patients with a medication review coded monthly and in the previous 12 months. These measures were broken down by regional, clinical and demographic subgroups and amongst those prescribed high risk medications.

Results

In April 2019, 32.3% of patients had a medication review coded in the previous 12 months. During the first COVID-19 lockdown, monthly activity substantially decreased (-21.1% April 2020), but the rate of patients with a medication review coded in the previous 12 months was not substantially impacted according to our classification (-10.5% March 2021). There was regional and ethnic variation (March 2022 - London 21.9% vs North West 33.6%; Chinese 16.8% vs British 33.0%). Following the introduction of “structured medication reviews”, the rate of structured medication review in the last 12 months reached 2.9% by March 2022, with higher percentages in high risk groups (March 2022 - care home residents 34.1%, 90+ years 13.1%, high risk medications 10.2%). The most used SNOMED CT medication review code across the study period wasMedication review done - 314530002(59.5%).

Conclusion

We have reported a substantial reduction in the monthly rate of medication reviews during the pandemic but rates recovered by the end of the study period.

What is already known about this subject

The COVID-19 pandemic brought substantial disruption to the delivery of routine tasks in primary care.

For the first time on this scale, our study reports the impact of COVID-19 on medication review activity, including the launch of the structured medication review service in England broken down by key demographic, social, and clinical factors.

What this study adds

There was a substantial reduction in the monthly rate of medication reviews during the pandemic but rates recovered quickly.

The percentage of patients with a medication review varies according to region and ethnicity.

Structured medication reviews were adopted rapidly and prioritised for patients at greatest risk of harm from their medicines.