This study explored how Structured Medication Reviews (SMRs) are being undertaken and the challenges to their successful implementation and sustainability.

A cross-sectional mixed methods online survey.

Primary care in England.

120 clinical pharmacists with experience in conducting SMRs in primary care.

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 21–30 min 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 ‘buy-in’ from some patients and General Practitioners.

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.

To analyse patient profiles, transportation patterns and time delays in ischaemic time and door-to-balloon (DTB) time and evaluate the effect of these delays on in-hospital mortality among patients undergoing primary percutaneous coronary intervention (P-PCI) for ST-segment elevation myocardial infarction (STEMI) at a tertiary care hospital in Colombo.

Retrospective observational study.

Tertiary care hospital specialising in STEMI treatment, located in Sri Lanka.

The study included adults aged 16–87 years admitted for P-PCI between January 2018 and September 2023, presenting with STEMI and undergoing emergency P-PCI. Patients with incomplete records or unrealistic values on ischaemic time or DTB time were excluded.

Outcome measures include ischaemic time, DTB time and in-hospital mortality. The associations of demographic factors, transfer methods and DTB time with survival rates were analysed.

A total of 1758 patients underwent P-PCI (mean age, 53.0±11.64), with 85.2% being male. The male risk group was 46–60 years (OR, 1.22), whereas the female risk group was predominantly older than 60 years (OR, 1.87). The median ischaemic time was 4 hours and 36 min, and the median DTB time was 110 min. The in-hospital mortality rate was 3.8% (63/1,664). Prolonged DTB times exceeding 120 min were significantly associated with increased mortality (p=0.046), although alternative thresholds (45, 60 or 90 min) were not significant (p>0.05). Binary logistic regression with multiple variables identified female sex (OR, 2.52; 95% CI, 1.168 to 5.435, p=0.018), increasing age (OR 1.05; 95% CI, 1.016 to 1.085, p=0.004) and DTB times (OR, 1.001; 95% CI, 1.000 to 1.002, p=0.027) as independent predictors of mortality.

Despite improvements in DTB times, this study indicates that prolonged delays exceeding 120 min remain associated with increased mortality. Older age and female sex were identified as independent predictors of higher mortality. These findings underscore the need for efficient patient transfer methods and prompt decision-making at the primary healthcare level to minimise delays and disparities in P-PCI outcomes.