Beliefs about prescribed medication among older patients with polypharmacy: a mixed methods study in primary care

Abstract

BackgroundPolypharmacy (≥5 medications) is common in older patients and is associated with adverse outcomes. Patients’ beliefs about medication can influence their expectations for medication, adherence, and willingness to deprescribe. Few studies have examined beliefs about prescribed medication among older patients with polypharmacy in primary care.AimTo explore medication-related beliefs in older patients with polypharmacy and factors that might influence beliefs.Design and settingA mixed methods study utilising data from a randomised controlled trial aiming to decrease potentially inappropriate prescribing in older patients (≥70 years) in Ireland.MethodBeliefs were assessed quantitatively and qualitatively. Participants completed the Beliefs about Medicines Questionnaire by indicating their degree of agreement with individual statements about medicines on a 5-point Likert scale. Semi-structured qualitative interviews were conducted with a purposive sample of participants. Interviews were transcribed verbatim and a thematic analysis conducted. Quantitative and qualitative data were analysed separately and triangulated during the interpretation stage.ResultsIn total, 196 patients were included (mean age 76.7 years, SD 4.9, 54% male), with a mean of 9.5 (SD 4.1) medications per patient. The majority (96.3%) believed strongly in the necessity of their medication, while 33.9% reported strong concerns. Qualitative data confirmed these coexisting positive and negative attitudes to medications and suggested the importance of patients’ trust in GPs in establishing positive beliefs and potential willingness to deprescribe.ConclusionParticipants reported strong beliefs in medications with coexisting positive and negative attitudes. The doctor–patient relationship may have influenced beliefs and attitudes towards medicines, highlighting the importance of strong doctor–patient relationships, which need to be considered in the context of deprescribing.

Deprescribing medications for older adults in the primary care context: A mixed studies review

“…Patients assumed, as their doctor had more medical knowledge than they did, that it must be appropriate to continue their medication, otherwise, their doctor would stop writing repeat prescriptions . Poor health literacy may also be a factor that influences deprescribing decision making . General practitioners in Clyne et al earlier study thought that they may be able to negotiate with patients to motivate them to consider deprescribing if they could give their patients more information about their medications.…”

“…In comparison, older adults hold conflicting ideas around medication use, often expressing concurrent positive and negative beliefs . These conflicting beliefs are clearly illustrated in the 3 quantitative studies that used the Patient's Attitudes Toward Deprescribing survey.…”

“…However, in practice, those who reported higher trust were less likely to have experienced deprescribing . Older adults reported that their trust in the prescribing practices of their GP was based on the perceived clinical knowledge of their GP, a belief that their GP would make decisions with their best interests in mind, and on the strength of the relationship established between themselves and their GP based on mutual respect, good communication, and knowledge of their preferences . Sometimes, this level of trust meant that they did not ask for important medication information .…”

“…Some older adults did qualify their trust, suggesting that they needed to find information for themselves in order to maintain responsibility for their own health , . Others remarked on the paternalistic nature of their relationship with their GP, although they were generally accepting of this, that it was wise not to argue, and preferred to follow their doctor's advice . Weir et al compared attitudes of older adults across 3 groups and noted that those who were frailer and/or lacked an understanding of their medications were happy to abdicate decision making about their medications, including deprescribing, to their doctor.…”

“…The majority of the studies (n = 28) used qualitative methods, eg, focus groups, semistructured interviews, and Delphi approach; one used mixed methods, 41 and 9 used quantitative methods. 44,48,51,52,57,58,65,68,69…”