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Nina Fudge

Dr Nina Fudge

Area of study
Primary care
Fellowship level
Year awarded
Host university
Centre for Primary Care, Wolfson Institute of Population Health
Queen Mary University of London
Nina has a background in social anthropology and undertakes interdisciplinary projects in applied health research. She is committed to using innovative, participant-focused approaches and methods: ethnographic, narrative, and visual. Her research explores interrelationships between knowledge, expertise, and practice in complex healthcare settings.
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Medicines optimisation in general practice: an interpretive policy analysis and video reflexive ethnographic approach to improve delivery of structured medication reviews


In the UK, the number of people prescribed five or more medicines, known as polypharmacy, is increasing. Sometimes polypharmacy is problematic; it can increase the risks of falls, hospitalisation, and adverse drug reactions. Higher risk polypharmacy may also present patients and clinicians with a burden of work, such as processing prescriptions, assembling and organising medicines, managing medicines supplies. Some prescribed medicines may not be needed or taken, resulting in financial waste and environmental harm.

Medicines optimisation in general practice is seen as a way to reduce the harms and risks of polypharmacy. Recently, a new contract has been introduced in England which requires Primary Care Networks to deliver structured medication reviews (SMRs) to patients with higher risk polypharmacy. The introduction of SMRs builds on recent initiatives to integrate clinical pharmacists into the general practice workforce, with an expectation that clinical pharmacists will undertake most of the SMRs.


The aim of this project is to explore how and to what extent SMRs contribute to addressing the complex challenge of optimising medicine use for people prescribed more than 10 different items of medication. The participatory approach adopted in this project will encourage primary care clinicians’ reflexive capabilities, enabling them to think about the work they do afresh and develop their delivery of the structured medication review.

An interpretive policy analysis (policy review and stakeholder interviews) will be conducted to learn how policy makers frame the role of the structured medication review to address polypharmacy.

A video reflexive ethnographic study will be undertaken in three general practices, observing how SMRs are delivered in practice. Video-recordings of SMRs will be made, with clips from these videos shown back to practice staff to prompt reflective discussions about their practice and changes that could be made to improve the quality and safety of medicine prescribing.

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