What partnership costs

Structured medication reviews: prescribing change is not the same as medicines optimisationSheppard and colleagues provide an important evaluation of structured medication reviews (SMRs) in English primary care.Their findings are encouraging: SMRs appear to have reached patients with frailty, multimorbidity, and polypharmacy, and were associated with starting and stopping medicines. 1However, because the study could not determine whether these changes improved outcomes, it raises a harder question: when has an SMR 'worked'?From a medicines optimisation standpoint, prescribing movement is not necessarily better care.Starting a medicine may be appropriate, but may add burden.Stopping a medicine may reduce risk, whereas continuing a potentially problematic medicine may be justified after discussion with the patient.Counts of medicines started or stopped show that something changed, not whether the change was necessary, person centred, or beneficial.