Beliefs About Prescribed Medication Among Older Patients with Polypharmacy: a Mixed Methods Study in Primary Care

Overview

Journal Br J Gen Pract

Specialty Public Health

Date 2017 May 24

PMID 28533200

Citations 36

Authors

Barbara Clyne

Janine A Cooper

Fiona Boland

Carmel M Hughes

Tom Fahey

Susan M Smith

Affiliations

Soon will be listed here.

Abstract

Background: Polypharmacy (≥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.

Aim: To explore medication-related beliefs in older patients with polypharmacy and factors that might influence beliefs.

Design And Setting: A mixed methods study utilising data from a randomised controlled trial aiming to decrease potentially inappropriate prescribing in older patients (≥70 years) in Ireland.

Method: Beliefs 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.

Results: In 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.

Conclusion: Participants 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.

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References

Patterson S, Cadogan C, Kerse N, Cardwell C, Bradley M, Ryan C . Interventions to improve the appropriate use of polypharmacy for older people. Cochrane Database Syst Rev. 2014; (10):CD008165. DOI: 10.1002/14651858.CD008165.pub3. View

Hajjar E, Cafiero A, Hanlon J . Polypharmacy in elderly patients. Am J Geriatr Pharmacother. 2008; 5(4):345-51. DOI: 10.1016/j.amjopharm.2007.12.002. View

Noel P, Frueh B, Larme A, Pugh J . Collaborative care needs and preferences of primary care patients with multimorbidity. Health Expect. 2005; 8(1):54-63. PMC: 5060269. DOI: 10.1111/j.1369-7625.2004.00312.x. View

Spinewine A, Schmader K, Barber N, Hughes C, Lapane K, Swine C . Appropriate prescribing in elderly people: how well can it be measured and optimised?. Lancet. 2007; 370(9582):173-184. DOI: 10.1016/S0140-6736(07)61091-5. View

Horne R, Chapman S, Parham R, Freemantle N, Forbes A, Cooper V . Understanding patients' adherence-related beliefs about medicines prescribed for long-term conditions: a meta-analytic review of the Necessity-Concerns Framework. PLoS One. 2013; 8(12):e80633. PMC: 3846635. DOI: 10.1371/journal.pone.0080633. View

Sorensen K, Pelikan J, Rothlin F, Ganahl K, Slonska Z, Doyle G . Health literacy in Europe: comparative results of the European health literacy survey (HLS-EU). Eur J Public Health. 2015; 25(6):1053-8. PMC: 4668324. DOI: 10.1093/eurpub/ckv043. View

Reeve E, Shakib S, Hendrix I, Roberts M, Wiese M . Review of deprescribing processes and development of an evidence-based, patient-centred deprescribing process. Br J Clin Pharmacol. 2014; 78(4):738-47. PMC: 4239968. DOI: 10.1111/bcp.12386. View

Loffler C, Kaduszkiewicz H, Stolzenbach C, Streich W, Fuchs A, Bussche H . Coping with multimorbidity in old age--a qualitative study. BMC Fam Pract. 2012; 13:45. PMC: 3403868. DOI: 10.1186/1471-2296-13-45. View

Cullinan S, OMahony D, Fleming A, Byrne S . A meta-synthesis of potentially inappropriate prescribing in older patients. Drugs Aging. 2014; 31(8):631-8. DOI: 10.1007/s40266-014-0190-4. View

10.

Menckeberg T, Bouvy M, Bracke M, Kaptein A, Leufkens H, Raaijmakers J . Beliefs about medicines predict refill adherence to inhaled corticosteroids. J Psychosom Res. 2007; 64(1):47-54. DOI: 10.1016/j.jpsychores.2007.07.016. View

11.

Modig S, Kristensson J, Ekwall A, Hallberg I, Midlov P . Frail elderly patients in primary care--their medication knowledge and beliefs about prescribed medicines. Eur J Clin Pharmacol. 2008; 65(2):151-5. DOI: 10.1007/s00228-008-0581-8. View

12.

Schuling J, Gebben H, Veehof L, Haaijer-Ruskamp F . Deprescribing medication in very elderly patients with multimorbidity: the view of Dutch GPs. A qualitative study. BMC Fam Pract. 2012; 13:56. PMC: 3391990. DOI: 10.1186/1471-2296-13-56. View

13.

Mohammed M, Moles R, Chen T . Medication-related burden and patients' lived experience with medicine: a systematic review and metasynthesis of qualitative studies. BMJ Open. 2016; 6(2):e010035. PMC: 4746464. DOI: 10.1136/bmjopen-2015-010035. View

14.

Reeve E, Wiese M, Hendrix I, Roberts M, Shakib S . People's attitudes, beliefs, and experiences regarding polypharmacy and willingness to Deprescribe. J Am Geriatr Soc. 2013; 61(9):1508-14. DOI: 10.1111/jgs.12418. View

15.

Clyne B, Cooper J, Hughes C, Fahey T, Smith S . A process evaluation of a cluster randomised trial to reduce potentially inappropriate prescribing in older people in primary care (OPTI-SCRIPT study). Trials. 2016; 17(1):386. PMC: 4973100. DOI: 10.1186/s13063-016-1513-z. View

16.

Moriarty F, Hardy C, Bennett K, Smith S, Fahey T . Trends and interaction of polypharmacy and potentially inappropriate prescribing in primary care over 15 years in Ireland: a repeated cross-sectional study. BMJ Open. 2015; 5(9):e008656. PMC: 4577876. DOI: 10.1136/bmjopen-2015-008656. View

17.

Krska J, Morecroft C, Poole H, Rowe P . Issues potentially affecting quality of life arising from long-term medicines use: a qualitative study. Int J Clin Pharm. 2013; 35(6):1161-9. DOI: 10.1007/s11096-013-9841-5. View

18.

Anthierens S, Tansens A, Petrovic M, Christiaens T . Qualitative insights into general practitioners views on polypharmacy. BMC Fam Pract. 2010; 11:65. PMC: 2945967. DOI: 10.1186/1471-2296-11-65. View

19.

Wallace E, Salisbury C, Guthrie B, Lewis C, Fahey T, Smith S . Managing patients with multimorbidity in primary care. BMJ. 2015; 350:h176. DOI: 10.1136/bmj.h176. View

20.

Calnan M, Rowe R . Researching trust relations in health care: conceptual and methodological challenges--introduction. J Health Organ Manag. 2006; 20(5):349-58. DOI: 10.1108/14777260610701759. View