Handling polypharmacy –a qualitative study using focus group interviews with older patients, their relatives, and healthcare professionals

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Abstract

Background

On average, older patients use five or more medications daily. A consequence is an increased risk of adverse drug reactions, interactions, or medication errors. Therefore, it is important to understand the challenges experienced by the patients, relatives, and healthcare professionals pertinent to the concomitant use of many drugs.

Methods

We conducted a qualitative study using focus group interviews to collect information from patients, relatives, and healthcare professionals regarding older patients’ management of prescribed medicine. We interviewed seven patients using five or more medications daily, three relatives, three general practitioners, nine nurses from different healthcare sectors, one home care assistant, two hospital physicians, and four pharmacists.

Results

The following themes were identified: (1) Unintentional non-adherence, (2) Intentional non-adherence, (3) Generic substitution, (4) Medication lists, (5) Timing and medication schedule, (6) Medication reviews and (7) Dose dispensing/pill organizers.

Conclusion

Medication is the subject of concern among patients and relatives. They become confused and insecure about information from different actors and the package leaflets. Therefore, patients often request a thorough medication review to provide an overview, knowledge of possible side effects and interactions, and a clarification of the medication’s timing. In addition, patients, relatives and nurses all request an indication of when medicine should be taken, including allowable deviations from this timing. Therefore, prescribing physicians should prioritize communicating information regarding these matters when prescribing.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-023-04131-6.

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Most cited references 40

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Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups.

A Tong, P SAINSBURY, J. Craig (2007)

Qualitative research explores complex phenomena encountered by clinicians, health care providers, policy makers and consumers. Although partial checklists are available, no consolidated reporting framework exists for any type of qualitative design. To develop a checklist for explicit and comprehensive reporting of qualitative studies (in depth interviews and focus groups). We performed a comprehensive search in Cochrane and Campbell Protocols, Medline, CINAHL, systematic reviews of qualitative studies, author or reviewer guidelines of major medical journals and reference lists of relevant publications for existing checklists used to assess qualitative studies. Seventy-six items from 22 checklists were compiled into a comprehensive list. All items were grouped into three domains: (i) research team and reflexivity, (ii) study design and (iii) data analysis and reporting. Duplicate items and those that were ambiguous, too broadly defined and impractical to assess were removed. Items most frequently included in the checklists related to sampling method, setting for data collection, method of data collection, respondent validation of findings, method of recording data, description of the derivation of themes and inclusion of supporting quotations. We grouped all items into three domains: (i) research team and reflexivity, (ii) study design and (iii) data analysis and reporting. The criteria included in COREQ, a 32-item checklist, can help researchers to report important aspects of the research team, study methods, context of the study, findings, analysis and interpretations.

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Systematic text condensation: a strategy for qualitative analysis.

Kirsti Malterud (2012)

To present background, principles, and procedures for a strategy for qualitative analysis called systematic text condensation and discuss this approach compared with related strategies. Giorgi's psychological phenomenological analysis is the point of departure and inspiration for systematic text condensation. The basic elements of Giorgi's method and the elaboration of these in systematic text condensation are presented, followed by a detailed description of procedures for analysis according to systematic text condensation. Finally, similarities and differences compared with other frequently applied methods for qualitative analysis are identified, as the foundation of a discussion of strengths and limitations of systematic text condensation. Systematic text condensation is a descriptive and explorative method for thematic cross-case analysis of different types of qualitative data, such as interview studies, observational studies, and analysis of written texts. The method represents a pragmatic approach, although inspired by phenomenological ideas, and various theoretical frameworks can be applied. The procedure consists of the following steps: 1) total impression - from chaos to themes; 2) identifying and sorting meaning units - from themes to codes; 3) condensation - from code to meaning; 4) synthesizing - from condensation to descriptions and concepts. Similarities and differences comparing systematic text condensation with other frequently applied qualitative methods regarding thematic analysis, theoretical methodological framework, analysis procedures, and taxonomy are discussed. Systematic text condensation is a strategy for analysis developed from traditions shared by most of the methods for analysis of qualitative data. The method offers the novice researcher a process of intersubjectivity, reflexivity, and feasibility, while maintaining a responsible level of methodological rigour.

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Patient barriers to and enablers of deprescribing: a systematic review.

Emily Reeve, Josephine To, Ivanka Hendrix … (2013)

Inappropriate medication use is common in the elderly and the risks associated with their use are well known. The term deprescribing has been utilised to describe the complex process that is required for the safe and effective cessation of inappropriate medications. Given the primacy of the consumer in health care, their views must be central in the development of any deprescribing process. The aim of this study was to identify barriers and enablers that may influence a patient's decision to cease a medication. A systematic search of MEDLINE, International Pharmaceutical Abstracts, EMBASE, CINAHL, Informit and Scopus was conducted and augmented with a manual search. Numerous search terms relating to withdrawal of medications and consumers' beliefs were utilised. Articles were included if the barriers or enablers were directly patient/carer reported and related to long-term medication(s) that they were currently taking or had recently ceased. Determination of relevance and data extraction was performed independently by two reviewers. Content analysis with coding was utilised for synthesis of results. Twenty-one articles met the criteria and were included in the review. Three themes, disagreement/agreement with 'appropriateness' of cessation, absence/presence of a 'process' for cessation, and negative/positive 'influences' to cease medication, were identified as both potential barriers and enablers, with 'fear' of cessation and 'dislike' of medications as a fourth barrier and enabler, respectively. The most common barrier/enabler identified was 'appropriateness' of cessation, with 15 studies identifying this as a barrier and 18 as an enabler. The decision to stop a medication by an individual is influenced by multiple competing barriers and enablers. Knowledge of these will aid in the development of a deprescribing process, particularly in approaching the topic of cessation with the patient and what process should be utilised. However, further research is required to determine if the proposed patient-centred deprescribing process will result in improved patient outcomes.

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Author and article information

Contributors

Thorbjørn Hougaard Mikkelsen: Thorbjorn.Hougaard.Mikkelsen@rsyd.dk

Journal

Journal ID (nlm-ta): BMC Geriatr

Journal ID (iso-abbrev): BMC Geriatr

Title: BMC Geriatrics

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2318

Publication date (Electronic): 8 August 2023

Publication date PMC-release: 8 August 2023

Publication date Collection: 2023

Volume: 23

Electronic Location Identifier: 477

Affiliations

[1 ]GRID grid.416811.b, ISNI 0000 0004 0631 6436, Emergency Department, , Hospital Sønderjylland, ; Aabenraa, Denmark

[2 ]GRID grid.10825.3e, ISNI 0000 0001 0728 0170, Research Unit of Emergency Medicine, Department of Regional Health Research, , University of Southern Denmark, ; Odense, Denmark

[3 ]GRID grid.10825.3e, ISNI 0000 0001 0728 0170, Research Unit of General Practice, Department of Public Health, , University of Southern Denmark, ; Odense, Denmark

[4 ]GRID grid.10825.3e, ISNI 0000 0001 0728 0170, Department of Clinical Research, , University of Southern Denmark, ; Odense, Denmark

[5 ]GRID grid.7143.1, ISNI 0000 0004 0512 5013, Department of Geriatric Medicine, , Odense University Hospital, ; 6 The, Odense, Denmark

[6 ]GRID grid.416811.b, ISNI 0000 0004 0631 6436, Hospital Sønderjylland, ; Kresten Philipsens vej 15, indgang F, Aabenraa, 6200 Denmark

Article

Publisher ID: 4131

DOI: 10.1186/s12877-023-04131-6

PMC ID: 10410867

PubMed ID: 37553585

SO-VID: 1bccd7b0-2528-428f-93bc-b443504013f1

License:

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 15 February 2023

Date accepted : 24 June 2023

Funding

Funded by: University Library of Southern Denmark

Open Access :

Open access funding provided by University Library of Southern Denmark

Custom metadata

ScienceOpen disciplines: Geriatric medicine

Keywords: polypharmacy,older people,non-adherence,adverse drug interactions,medication errors,experiences,continuity of care,focus group interviews,qualitative research

Data availability:

ScienceOpen disciplines: Geriatric medicine

Keywords: polypharmacy, older people, non-adherence, adverse drug interactions, medication errors, experiences, continuity of care, focus group interviews, qualitative research

Handling polypharmacy –a qualitative study using focus group interviews with older patients, their relatives, and healthcare professionals

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Abstract

Background

Methods

Results

Conclusion

Supplementary Information

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Hearing Loss and Restoration

Most cited references 40

Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups.

Systematic text condensation: a strategy for qualitative analysis.

Patient barriers to and enablers of deprescribing: a systematic review.

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