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

Mikkelsen, Thorbjørn Hougaard; Søndergaard, Jens; Kjær, Niels Kristian; Nielsen, Jesper Bo; Ryg, Jesper; Kjeldsen, Lene Juel; Mogensen, Christian Backer

doi:10.1186/s12877-023-04131-6

Cited by 3 publications

(7 citation statements)

References 42 publications

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“…Patients with dementia were excluded. The participating patients and relatives have previously participated in focus group interviews (FGI) reported elsewhere [ 23 ] and were subsequently invited to participate in the participatory design process. The inclusion of patients invited to the FGIs was based on consecutive sampling among patients admitted to the Emergency Department at Hospital Sønderjylland.…”

Section: Methodsmentioning

confidence: 99%

“…The inclusion of patients invited to the FGIs was based on consecutive sampling among patients admitted to the Emergency Department at Hospital Sønderjylland. The patients were invited while admitted to the department during ten days in April, May and June 2021 [ 23 ]. Overall 31 patients were eligible for the FGIs.…”

Section: Methodsmentioning

confidence: 99%

“…A total of 10 patients, here of three with a spouse, accepted the invitation to the FGIs. One died before the FGI and another did not show up [ 23 ]. Patients and relatives participating in the FGIs were invited to participate in the making process.…”

Section: Methodsmentioning

confidence: 99%

“…Older patients often use five or more prescription medications daily [ 8 , 9 ], but polypharmacy is not always beneficial for the patient [ 10 – 15 ], and some older patients experience severe side effects [ 16 – 20 ] often due to drug-drug interactions [ 21 , 22 ]. In addition, previous parts of this study have shown that older patients are often concerned about drug-drug interactions and side effects as well as confused about aspects such as names, labels, and when to take the medication [ 23 ]. Therefore, the discharge of elderly patients from the hospital is a complex process where robust tools are needed to support the correct medication at the correct time.…”

Section: Introductionmentioning

confidence: 99%

“…This knowledge is important to understand some of the results of this study. Despite these systems enabling sharing of information improvements are needed to ensure the right medication for older patients [ 23 ].…”

Section: Introductionmentioning

confidence: 99%

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Designing a tool ensuring older patients the right medication at the right time after discharge from hospital– the first step in a participatory design process

Mikkelsen,

Søndergaard,

Kjær

et al. 2024

BMC Health Serv Res

Self Cite

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Background On average, older patients use five or more medications daily, increasing the risk of adverse drug reactions, interactions, or medication errors. Healthcare sector transitions increase the risk of information loss, misunderstandings, unclear treatment responsibilities, and medication errors. Therefore, it is crucial to identify possible solutions to decrease these risks. Patients, relatives, and healthcare professionals were asked to design the solution they need. Methods We conducted a participatory design approach to collect information from patients, relatives, and healthcare professionals. The informants were asked to design their take on a tool ensuring that patients received the correct medication after discharge from the hospital. We included two patients using five or more medications daily, one relative, three general practitioners, four nurses from different healthcare sectors, two hospital physicians, and three pharmacists. Results The patients’ solution was a physical location providing a medication overview, including side effects and interactions. Healthcare professionals suggested different solutions, including targeted and timely information that provided an overview of the patient’s diagnoses, treatment and medication. The common themes identified across all sub-groups were: (1) Overview of medications, side effects, and diagnoses, (2) Sharing knowledge among healthcare professionals, (3) Timely discharge letters, (4) Does the shared medication record and existing communication platforms provide relevant information to the patient or healthcare professional? Conclusion All study participants describe the need for a more concise, relevant overview of information. This study describes elements for further elaboration in future participatory design processes aimed at creating a tool to ensure older patients receive the correct medication at the correct time.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Designing a tool ensuring older patients the right medication at the right time after discharge from hospital– the first step in a participatory design process

Mikkelsen,

Søndergaard,

Kjær

et al. 2024

BMC Health Serv Res

Self Cite

View full text Add to dashboard Cite

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‘It's a job to be done’. Managing polypharmacy at home: A qualitative interview study exploring the experiences of older people living with frailty

Previdoli,

Alldred,

Silcock

et al. 2024

Health Expectations

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IntroductionMany 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.MethodsBetween 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.FindingsFive 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.ConclusionFrail 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.Patient and Public InvolvementAn 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.

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Improving discharge summaries from hospital with a brief recommendation text box: results from a nationwide survey

Mikkelsen,

Nielsen,

Storsveen

et al. 2024

BJGP Open

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BackgroundDanish hospital physicians are obliged to mark the discharge summaries addressing whether the patient’s GP is recommended to follow up, as well as to state suggested follow-up actions in a recommendation text box.AimThis study aims to investigate the GP’s experiences with the recommendation text box.Design & settingA questionnaire sent to a representative sample of general practitioners in Denmark.MethodA questionnaire was prepared for GPs based on background material, focus group interviews and discussions with GPs and hospital physicians. It was subsequently pilot-tested by fellow researchers and GPs and revised prior to the survey.ResultsAlmost ¾ of the general practitioners (72%) ‘totally or partly agree’ that the recommendation text box is easy to find. In addition, our results show significant differences between software used by the GPs. Almost 2/3 (63%) ‘totally agree’ or ‘partly agree’ that the recommendation text box provides brief and precise information about the recommended follow-up.ConclusionGPs generally find that the recommendation text box provides them with brief and precise information about the recommended follow-up. In addition, the software used by the GPs has a significant influence on how the recommendation text box is presented.

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

Cited by 3 publications

References 42 publications

Designing a tool ensuring older patients the right medication at the right time after discharge from hospital– the first step in a participatory design process

Designing a tool ensuring older patients the right medication at the right time after discharge from hospital– the first step in a participatory design process

‘It's a job to be done’. Managing polypharmacy at home: A qualitative interview study exploring the experiences of older people living with frailty

Improving discharge summaries from hospital with a brief recommendation text box: results from a nationwide survey

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