Optimising medication management for polymedicated home-dwelling older adults with multiple chronic conditions: a mixed-methods study protocol

Abstract

IntroductionOptimal medication management is one of the basic conditions necessary for home-dwelling older adults living with multiple chronic conditions (OAMCC) to be able to remain at home and preserve their quality of life. Currently, the reasons for such high numbers of emergency department visits and the very significant rate of hospitalisations for OAMCC, due to medication-related problems (MRPs), is poorly explored. This study aims to reveal the current state of the medication management practices of polymedicated, home-dwelling OAMCC and to make proposals for improving clinical and medication pathways through an innovative and integrated model for supporting medication management and preventing adverse health outcomes.Methods and analysisA mixed-methods study will address the medication management of polymedicated, home-dwelling OAMCC. Its explanatory sequential design will involve two major phases conducted sequentially over time. The quantitative phase will consist of retrospectively exploiting the last 5 years of electronic patient records from a local hospital (N ≈ 50 000) in order to identify the different profiles—made up of patient-related, medication-related and environment-related factors—of the polymedicated, home-dwelling OAMCC at risk of hospitalisation, emergency department visits, hospital readmission (notably for MRPs), institutionalisation or early death. The qualitative study will involve: (a) obtaining and understanding the medication management practices and experiences of the identified profiles extracted from the hospital data of OAMCC who will be interviewed at home (N ≈ 30); (b) collecting and analysing the perspectives of the formal and informal caregivers involved in medication management at home in order to cross-reference perspectives about this important dimension of care at home. Finally, the mixed-methods findings will enable the development of an innovative, integrated model of medication management based on the Agency for Clinical Innovation framework and Bodenheimer and Sinsky’s quadruple aim.Ethics and disseminationEthical approval has been obtained from the Human Research Ethics Committee of the Canton Vaud (2018-02196). Findings will be disseminated in peer-reviewed journals, professional conferences and other knowledge transfer activities with primary healthcare providers, hospital care units, informal caregivers’ and patients’ associations.

Unplanned nursing home admission among discharged polymedicated older inpatients: a single-centre, registry-based study in Switzerland

“…This registry continues to be analysed as part of a larger project. 20 Our study defined ‘unplanned nursing home admission’ as the impossibility for a formerly home-dwelling older adult inpatient to return there after hospital discharge, and this included any new admission to a nursing home following an acute care admission. 2 All the patients included in the study followed a home to hospital to nursing home pathway.…”

Beliefs about Polypharmacy among Home-Dwelling Older Adults Living with Multiple Chronic Conditions, Informal Caregivers and Healthcare Professionals: A Qualitative Study

“…Semi-structured individual interviews were conducted with OAs and their HPs, and semi-structured joint interviews were conducted with them and their ICs, when available. The present study is rooted in an interdisciplinary approach mixing health psychology and the nursing sciences, and it forms a part of a larger research project whose protocol has been published elsewhere [ 41 ]. The present qualitative study followed the COnsolidated criteria for REporting Qualitative research (COREQ) [ 42 ].…”

Transforming a Patient Registry Into a Customized Data Set for the Advanced Statistical Analysis of Health Risk Factors and for Medication-Related Hospitalization Research: Retrospective Hospital Patient Registry Study

“…Another limitation to our study was that the sample was restricted to inpatients aged 65 years or older. Because this retrospective, register-based study was part of a larger project [50] focused on medication management among polymedicated, home-dwelling older adults with multiple chronic conditions, we did not have the ethics committee's approval to extend our extraction of data from the hospital register to all hospitalized adults. Furthermore, our analysis did not consider medicines prescribed before hospital admissions due to a lack of data accuracy and validity.…”