'It's a job to be done'. Managing polypharmacy at home: A qualitative interview study exploring the experiences of older people living with frailty.
frailty
medications management
medications self‐management
older people
polypharmacy
qualitative study
Journal
Health expectations : an international journal of public participation in health care and health policy
ISSN: 1369-7625
Titre abrégé: Health Expect
Pays: England
ID NLM: 9815926
Informations de publication
Date de publication:
Feb 2024
Feb 2024
Historique:
revised:
11
12
2023
received:
02
09
2023
accepted:
14
12
2023
medline:
5
8
2024
pubmed:
5
8
2024
entrez:
5
8
2024
Statut:
ppublish
Résumé
Many older people live with both multiple long-term conditions and frailty; thus, they manage complex medicines regimens and are at heightened risk of the consequences of medicines errors. Research to enhance how people manage medicines has focused on adherence to regimens rather than on the wider skills necessary to safely manage medicines, and the older population living with frailty and managing multiple medicines at home has been under-explored. This study, therefore, examines in depth how older people with mild to moderate frailty manage their polypharmacy regimens at home. Between June 2021 and February 2022, 32 patients aged 65 years or older with mild or moderate frailty and taking five or more medicines were recruited from 10 medical practices in the North of England, United Kingdom, and the CARE 75+ research cohort. Semi-structured interviews were conducted face to face, by telephone or online. The interviews were recorded, transcribed verbatim and analysed using reflexive thematic analysis. Five themes were developed: (1) Managing many medicines is a skilled job I didn't apply for; (2) Medicines keep me going, but what happened to my life?; (3) Managing medicines in an unclear system; (4) Support with medicines that makes my work easier; and (5) My medicines are familiar to me-there is nothing else I need (or want) to know. While navigating fragmented care, patients were expected to fit new medicines routines into their lives and keep on top of their medicines supply. Sometimes, they felt let down by a system that created new obstacles instead of supporting their complex daily work. Frail older patients, who are at heightened risk of the impact of medicines errors, are expected to perform complex work to safely self-manage multiple medicines at home. Such a workload needs to be acknowledged, and more needs to be done to prepare people in order to avoid harm from medicines. An older person managing multiple medicines at home was a core member of the research team. An advisory group of older patients and family members advised the study and was involved in the first stages of data analysis. This influenced how data were coded and themes shaped.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e13952Subventions
Organisme : National Institute for Health and Care Research (NIHR)
ID : NIHR201056
Organisme : National Institute for Health and Care Research (NIHR) Yorkshire and Humber Patient Safety Translational Research Centre
Informations de copyright
© 2024 The Authors. Health Expectations published by John Wiley & Sons Ltd.
Références
Donaldson LJ, Kelley ET, Dhingra‐Kumar N, Kieny MP, Sheikh A. Medication without harm: WHO's third global patient safety challenge. Lancet. 2017;389(10080):1680‐1681. doi:10.1016/S0140-6736(17)31047-4
World Health Organization. Medication without harm strategic framework. 2023. Accessed August 30, 2023. https://www.who.int/initiatives/medication-without-harm
World Health Organization. WHO calls for urgent action by countries for achieving medication without harm. September 16, 2022. Accessed August 30, 2023. https://www.who.int/news/item/16-09-2022-who-calls-for-urgent-action-by-countries-for-achieving-medication-without-harm
World Health Organization. Strategic framework. 2018. Accessed August 30, 2023 https://cdn.who.int/media/docs/default-source/patient-safety/strategic-framework-medication-without-harm86c06fafdf0b4294bd23ec9667dfb95d.pdf?sfvrsn=b5cb2d66_2
Chowdhury SR, Chandra Das D, Sunna TC, Beyene J, Hossain A. Global and regional prevalence of multimorbidity in the adult population in community settings: a systematic review and meta‐analysis. EClinicalMedicine. 2023;57:101860. doi:10.1016/j.eclinm.2023.101860
Daunt R, Curtin D, O'Mahony D. Polypharmacy stewardship: a novel approach to tackle a major public health crisis. Lancet Healthy Longev. 2023;4(5):e228‐e235. doi:10.1016/S2666-7568(23)00036-3
World Health Organization. Integrated Health Services, Medication without Harm. Medication Safety in Polypharmacy. 2019. Accessed August 30, 2023 https://www.who.int/publications/i/item/WHO-UHC-SDS-2019.11
Wastesson JW, Morin L, Tan ECK, Johnell K. An update on the clinical consequences of polypharmacy in older adults: a narrative review. Expert Opin Drug Saf. 2018;17(12):1185‐1196. doi:10.1080/14740338.2018.1546841
Zazzara MB, Palmer K, Vetrano DL, Carfì A, Onder G. Adverse drug reactions in older adults: a narrative review of the literature. Eur Geriatr Med. 2021;12(3):463‐473. doi:10.1007/s41999-021-00481-9
Wimmer BC, Bell JS, Fastbom J, Wiese MD, Johnell K. Medication regimen complexity and polypharmacy as factors associated with all‐cause mortality in older people: a population‐based cohort study. Ann Pharmacother. 2016;50(2):89‐95. doi:10.1177/1060028015621071
Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet. 2013;381(9868):752‐762. doi:10.1016/S0140-6736(12)62167-9
Age UK. What is frailty? Age UK. July 21, 2020. Accessed November 3, 2023. https://www.ageuk.org.uk/our-impact/policy-research/frailty-in-older-people/understanding-frailty/
England NHS. NHS England—identifying frailty. 2023. Accessed November 3, 2023. https://www.england.nhs.uk/ourwork/clinical-policy/older-people/frailty/frailty-risk-identification/
Bonaga B, Sánchez‐Jurado PM, Martínez‐Reig M, et al. Frailty, polypharmacy, and health outcomes in older adults: the frailty and dependence in albacete study. J Am Med Dir Assoc. 2018;19(1):46‐52. doi:10.1016/j.jamda.2017.07.008
Toh JJY, Zhang H, Soh YY, Zhang Z, Wu XV. Prevalence and health outcomes of polypharmacy and hyperpolypharmacy in older adults with frailty: a systematic review and meta‐analysis. Ageing Res Rev. 2023;83:101811. doi:10.1016/j.arr.2022.101811
Eriksen CU, Kyriakidis S, Christensen LD, et al. Medication‐related experiences of patients with polypharmacy: a systematic review of qualitative studies. BMJ Open. 2020;10(9):e036158. doi:10.1136/bmjopen-2019-036158
Mikkelsen TH, Søndergaard J, Kjaer NK, et al. Handling polypharmacy—a qualitative study using focus group interviews with older patients, their relatives, and healthcare professionals. BMC Geriatr. 2023;23(1):477. doi:10.1186/s12877-023-04131-6
Howell EH, Senapati A, Hsich E, Gorodeski EZ. Medication self‐management skills and cognitive impairment in older adults hospitalized for heart failure: a cross‐sectional study. SAGE Open Med. 2017;5:2050312117700301. doi:10.1177/2050312117700301
Previdoli G, Cheong VL, Alldred D, et al. A rapid review of interventions to improve medicine self‐management for older people living at home. Health Expect. 2023;26(3):945‐988. doi:10.1111/hex.13729
Mira JJ, Lorenzo S, Guilabert M, Navarro I, Pérez‐Jover V. A systematic review of patient medication error on self‐administering medication at home. Expert Opin Drug Saf. 2015;14(6):815‐838. doi:10.1517/14740338.2015.1026326
Aldila F, Walpola RL. Medicine self‐administration errors in the older adult population: a systematic review. Res Soc Adm Pharm. 2021;17(11):1877‐1886. doi:10.1016/j.sapharm.2021.03.008
Hollnagel E, Wears RL, Braithwaite J. From safety‐I to safety‐II: a white paper Australia The resilient health care net. University of Southern Denmark, University of Florida, USA, and Macquarie University. 2015. http://www.qpsolutions.vn/cgi-bin/Document/Safety%20II%20WhitePaper.pdf
Braithwaite J, Churruca K, Ellis LA, et al. Complexity Science in Healthcare: Aspirations, Approaches, Applications and Accomplishments. Macmillan Education Australia; 2017.
Tomlinson J, Silcock J, Smith H, Karban K, Fylan B. Post‐discharge medicines management: the experiences, perceptions and roles of older people and their family carers. Health Expect. 2020;23(6):1603‐1613. doi:10.1111/hex.13145
Heaven A, Brown L, Young J, et al. Community ageing research 75+ study (CARE75+): an experimental ageing and frailty research cohort. BMJ Open. 2019;9(3):e026744. doi:10.1136/bmjopen-2018-026744
Hollnagel E. Epilogue: RAG–the resilience analysis grid. In: Erik H, Jean P, David DW, John W, eds. Resilience Engineering in Practice. Ashgate; 2011:275‐296.
Brown MEL, Dueñas AN. A medical science educator's guide to selecting a research paradigm: building a basis for better research. Med Sci Educ. 2020;30(1):545‐553. doi:10.1007/s40670-019-00898-9
Braun V, Clarke V. Reflecting on reflexive thematic analysis. Qual Res Sport Exerc Health. 2019;11(4):589‐597. doi:10.1080/2159676X.2019.1628806
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77‐101. doi:10.1191/1478088706qp063oa
Braun V, Clarke V. Is thematic analysis used well in health psychology? A critical review of published research, with recommendations for quality practice and reporting. Health Psychol Rev. 2023;19:1‐24. doi:10.1080/17437199.2022.2161594
Carli Lorenzini G, Bell A, Olsson A. “You need to be healthy to be sick”: exploring older people's experiences with medication packaging at home. Age Ageing. 2022;51(3):afac050. doi:10.1093/ageing/afac050
Vandermause R, Neumiller JJ, Gates BJ, et al. Preserving self: medication‐taking practices and preferences of older adults with multiple chronic medical conditions. J Nurs Scholarsh. 2016;48(6):533‐542. doi:10.1111/jnu.12250
Swinglehurst D, Fudge N. Organising polypharmacy: unpacking medicines, unpacking meanings—an ethnographic study. BMJ Open. 2021;11(8):e049218. doi:10.1136/bmjopen-2021-049218
Bell C, Appel CW, Frølich A, Prior A, Vedsted P. Improving health care for patients with multimorbidity: a mixed‐methods study to explore the feasibility and process of aligning scheduled outpatient appointments through collaboration between medical specialties. Int J Integr Care. 2022;22(1):17. doi:10.5334/ijic.6013
Maidment I, Lawson S, Wong G, et al. Towards an understanding of the burdens of medication management affecting older people: the MEMORABLE realist synthesis. BMC Geriatr. 2020;20(1):183. doi:10.1186/s12877-020-01568-x
Lyson HC, Sharma AE, Cherian R, et al. A qualitative analysis of outpatient medication use in community settings: observed safety vulnerabilities and recommendations for improved patient safety. J Patient Saf. 2021;17(4):e335‐e342. doi:10.1097/PTS.0000000000000590
Secchi A, Booth A, Maidment I, Sud D, Zaman H. Medication management in minority, Asian and Black ethnic older people in the United Kingdom: a mixed‐studies systematic review. J Clin Pharm Ther. 2022;47(9):1322‐1336. doi:10.1111/jcpt.13735
Chaplin S. What can we learn from patients' experiences of polypharmacy? Prescriber. 2021;32(4):21‐22. doi:10.1002/psb.1909
Ajayi (Sotubo) O. A perspective on health inequalities in BAME communities and how to improve access to primary care. Future Healthc J. 2021;8(1):36‐39. doi:10.7861/fhj.2020-0217
Wade C, Malhotra AM, McGuire P, Vincent C, Fowler A. Action on patient safety can reduce health inequalities. BMJ. 2022;376:e067090. doi:10.1136/bmj-2021-067090
Fylan B, Armitage G, Naylor D, Blenkinsopp A. A qualitative study of patient involvement in medicines management after hospital discharge: an under‐recognised source of systems resilience. BMJ Qual Safe. 2018;27(7):539‐546. doi:10.1136/bmjqs-2017-006813
Fylan B, Marques I, Ismail H, et al. Gaps, traps, bridges and props: a mixed‐methods study of resilience in the medicines management system for patients with heart failure at hospital discharge. BMJ Open. 2019;9(2):e023440. doi:10.1136/bmjopen-2018-023440
Lang A, Macdonald M, Marck P, et al. Seniors managing multiple medications: using mixed methods to view the home care safety lens. BMC Health Serv Res. 2015;15:548. doi:10.1186/s12913-015-1193-5
Mohammed MA, Moles RJ, Chen TF. Medication‐related burden and patients' lived experience with medicine: a systematic review and metasynthesis of qualitative studies. BMJ Open. 2016;6(2):e010035. doi:10.1136/bmjopen-2015-010035
Mair FS, May CR. Thinking about the burden of treatment. BMJ. 2014;349:g6680. doi:10.1136/bmj.g6680
Maidment I, Huckerby C, Shukla D. Medication management in older people—a hidden burden. Prescriber. 2020;31(11‐12):30‐33. doi:10.1002/psb.1881
van Merode T, van de Ven K, van den Akker M. Patients with multimorbidity and their treatment burden in different daily life domains: a qualitative study in primary care in the Netherlands and Belgium. J Comorb. 2018;8(1):9‐15. doi:10.15256/joc.2018.8.119
Nicosia FM, Spar MJ, Stebbins M, et al. What is a medication‐related problem? A qualitative study of older adults and primary care clinicians. J Gen Intern Med. 2020;35(3):724‐731. doi:10.1007/s11606-019-05463-z
Verma A, Saha S, Jarl J, Conlon E, McGuinness B, Trépel D. An overview of systematic reviews and meta‐analyses on the effect of medication interventions targeting polypharmacy for frail older adults. J Clin Med. 2023;12(4):1379. doi:10.3390/jcm12041379
O'Donnell LK, Ibrahim K. Polypharmacy and deprescribing: challenging the old and embracing the new. BMC Geriatr. 2022;22(1):734. doi:10.1186/s12877-022-03408-6
Ulley J, Harrop D, Ali A, Alton S, Fowler Davis S. Deprescribing interventions and their impact on medication adherence in community‐dwelling older adults with polypharmacy: a systematic review. BMC Geriatr. 2019;19(1):15. doi:10.1186/s12877-019-1031-4
Ibrahim K, Cox NJ, Stevenson JM, Lim S, Fraser SDS, Roberts HC. A systematic review of the evidence for deprescribing interventions among older people living with frailty. BMC Geriatr. 2021;21(1):258. doi:10.1186/s12877-021-02208-8
Picton C, Wright H. Keeping Patients Safe when they Transfer between Care Providers—Getting the Medicines Right. Royal Pharmaceutical Society; 2012.
O'Hara JK, Aase K, Waring J. Scaffolding our systems? Patients and families “reaching in” as a source of healthcare resilience. BMJ Qual Safe. 2019;28(1):3‐6. doi:10.1136/bmjqs-2018-008216
O'Hara JK, Canfield C, Aase K. Patient and family perspectives in resilient healthcare studies: a question of morality or logic? Safe Sci. 2019;120:99‐106. doi:10.1016/j.ssci.2019.06.024
Davies N, Kolodin V, Woodward A, et al. Models of care and the role of clinical pharmacists in UK primary care for older adults: a scoping review protocol. PLoS One. 2023;18(7):e0276471. doi:10.1371/journal.pone.0276471
Cheraghi‐Sohi S, Jeffries M, Stevenson F, et al. The influence of personal communities on the self‐management of medication taking: a wider exploration of medicine work. Chronic Illn. 2015;11(2):77‐92. doi:10.1177/1742395314537841
Powell C, Ismail H, Cleverley R, et al. Patients as qualitative data analysts: developing a method for a process evaluation of the “Improving the Safety and Continuity of Medicines management at care Transitions” (ISCOMAT) cluster randomised control trial. Health Expect. 2021;24(4):1254‐1262. doi:10.1111/hex.13257
Mughal F, Khunti K, Mallen C. The impact of COVID‐19 on primary care: insights from the National Health Service (NHS) and future recommendations. J Fam Med Prim Care. 2021;10(12):4345. doi:10.4103/jfmpc.jfmpc_756_21
Khalil‐Khan A, Khan MA. The impact of COVID‐19 on primary care: a scoping review. Cureus. 2023;15(1):e33241. doi:10.7759/cureus.33241
Fraser C, Fisher R. How has the COVID‐19 pandemic impacted primary care? The Health Foundation. May 27, 2021. Accessed August 30, 2023. https://www.health.org.uk/news-and-comment/charts-and-infographics/how-has-the-covid-19-pandemic-impacted-primary-care
Chudasama YV, Gillies CL, Zaccardi F, et al. Impact of COVID‐19 on routine care for chronic diseases: a global survey of views from healthcare professionals. Diabetes Metab Syndr. 2020;14(5):965‐967. doi:10.1016/j.dsx.2020.06.042
Regional ethnic diversity. Ethnicity facts and figures. Government data about the UK's different ethnic groups. December 22, 2022. Accessed August 30, 2023. https://www.ethnicity-facts-figures.service.gov.uk/uk-population-by-ethnicity/national-and-regional-populations/regional-ethnic-diversity/latest
The Law Society. A guide to race and ethnicity terminology and language. The Law Society. June 27, 2023. Accessed August 30, 2023. https://www.lawsociety.org.uk/topics/ethnic-minority-lawyers/a-guide-to-race-and-ethnicity-terminology-and-language
Norman C, Wildman JM, Sowden S. COVID‐19 at the deep end: a qualitative interview study of primary care staff working in the most deprived areas of England during the COVID‐19 pandemic. Int J Environ Res Public Health. 2021;18(16):8689. doi:10.3390/ijerph18168689