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Up to 40% of participants in a study of more than 600,000 patients had potentially inappropriate prescriptions corrected after receiving a structured medication review (SMR).
Publishing their findings in the British Journal of General Practice on 6 April 2026, researchers analysed data on the electronic health records of 635,698 patients aged 65 years and over in England between 1 April 2020 and 30 September 2022.
More than one in ten eligible patients (n=82,285; 13%) received at least one SMR during the study observation period.
“Medication reviews were associated with a significant increase in starting new medications and stopping existing prescriptions across nearly all drug classes of interest,” the researchers noted.
In those prescribed potentially inappropriate drug combinations prior to an SMR, between 12.5% and 40.0% of patients were corrected up to three months later, the results showed.
Among the 82,285 patients who had changes made, the results also revealed more than one-quarter (29.6%, n=3,882) of patients who previously took NSAIDs had the prescription stopped.
Other commonly stopped drugs included laxatives (19.9%, n=3,427), z-drugs (16.1%, n=637) and opioids (15.5%, n=4,230).
Of those patients who were started on a new medication following an SMR, the most common medications started were proton pump inhibitors (11.3%, n=4,075), statins (7.7%, n=2,662), opioids (7.6%, n=4,197) and laxatives (6.4%, n=4,194), the researchers observed.
While the study results showed that SMRs are associated both with significant deprescribing and new prescribing, the authors said the “effect on clinically relevant patient outcomes remains unknown”, while future studies should “examine the association between SMRs and clinical outcomes such as hospitalisation due to adverse drug events”.
“It remains unclear whether the investment in practice-based pharmacists to deliver SMRs is a cost-effective approach, and health economic modelling of this service would provide valuable information for policymakers in the future,” they added.
Danny Bartlett, clinical lead at Kent, Surrey and Sussex Primary Care School, commented: “SMRs clearly drive medication changes, but that’s only part of the picture. The real value emerges when you give complex patients with multiple conditions the time and space to be reviewed holistically, not as a tick box exercise. That means systematically working through each medication, checking appropriateness, monitoring, and how the patient’s actually coping with it.
“The challenge is that shallow reviews often miss what needs changing, then medications get reauthorised for a year without proper safety checks. For structured reviews to work properly, the system needs to support them with clear frameworks and authority to make real changes, including broader chronic disease reviews.
“In care homes, for example, pharmacy teams often do the structured review but then can’t follow through on hypertension or other disease reviews, or something as simple as reauthorising all of the medications they’re discussing – because their protocols limit them. There’s little point doing half the job and leaving patients needing another review cycle. The benefit comes when you can assess the totality, including all their comorbid conditions.”
Amandeep Doll, director for England at the Royal College of Pharmacy, commented: “SMRs are a vital tool for optimising medicines, helping to reduce harm and ensure treatment is appropriate and patient centred.
“In the context of a new US trade deal and continued pressure on NHS budgets, it will be crucial to boost access to medication reviews to maximise the benefits from medicines for patients and the NHS.
“It was disappointing that SMRs were deprioritised in the [primary care network directed enhanced service] contract. The government should think again about how to ensure pharmacy teams are supported to deliver SMRs in practice,” she added.
SMRs were introduced in England in October 2020. In 2022, financial incentives were introduced for carrying them out, but these were later removed.
