Structured medication reviews for adults with multimorbidity and polypharmacy in primary care: a systematic review

Abstract

Abstract Objectives Structured medication reviews (SMRs) in primary care offer a patient-centred approach to optimising medicines for adults with multimorbidity and polypharmacy, but their effect on endpoint outcomes is not yet well-established. This review summarises their impact on these outcomes and on medicines optimisation, while also highlighting common delivery methods (in-person or remote). Design Systematic review using narrative synthesis. Data sources Ovid MEDLINE, Ovid EMBASE, Web of Science and CINAHL via OVID were searched for studies published between January 1997 and August 2025. Eligibility criteria Studies of adults with multimorbidity and polypharmacy receiving an SMR in primary care, compared with usual care. Randomised controlled trials, non-randomised controlled trials, cohort and cross-sectional designs were eligible. Data extraction and synthesis Two reviewers independently screened studies; one reviewer extracted data and a second verified them. Study quality was assessed using the National Heart, Lung, and Blood Institute quality assessment tools. Findings were synthesised narratively. Results Nine studies (8213 participants) assessed SMRs in relation to physical health (n=5), functional status (n=5), safety (n=2), healthcare utilisation (n=7), cost-effectiveness (n=3) and person-centred outcomes (n=3). Most reported no changes in physical health and falls (n=5), with no improvement in functional status (n=5). Safety outcomes showed no differences in survival or mortality (n=2). Healthcare use was largely unchanged (n=7), with only one study reporting fewer medication-related admissions. Person-centred outcomes remained unchanged (n=2). Cost outcomes were favourable, with savings (n=3) and quality-adjusted life year gains (n=2). SMRs were associated with prescription changes (n=4), reduced inappropriate prescribing (n=3) and improved adherence (n=2), although several between-group comparisons showed no significant differences. SMRs were usually delivered by general practitioners, pharmacists or multidisciplinary teams to older adults, although the mode of delivery (in-person or remote) was often unclear. Conclusions SMRs showed little effect on endpoint outcomes, but most studies focused on prescribing rather than clinical effects, limiting this conclusion. Realising their potential requires supportive policy and collaborative practice. Unclear delivery methods hinder evaluation, and as primary care adopts digital solutions, further research on remote SMRs is needed. Trial registration number PROSPERO CRD42023454965.