The online version of this article (https://doi.org/10.1186/s12875-017-0707-0) contains supplementary material, which is available to authorized users.
Although polypharmacy can cause adverse health outcomes, patients often know little about their medication. A regularly conducted medication review (MR) can help provide an overview of a patient’s medication, and benefit patients by enhancing their knowledge of their drugs. As little is known about patient attitudes towards MRs in primary care, the objective of this study was to gain insight into patient-perceived barriers and facilitators to the implementation of an MR.
We conducted a qualitative study with a convenience sample of 31 patients (age ≥ 60 years, ≥3 chronic diseases, taking ≥5 drugs/d); in Hesse, Germany, in February 2016. We conducted two focus groups and, in order to ensure the participation of elderly patients with reduced mobility, 16 telephone interviews. Both relied on a semi-structured interview guide dealing with the following subjects: patients’ experience of polypharmacy, general design of MRs, potential barriers and facilitators to implementation etc. Interviews were audio-recorded, transcribed verbatim, and analysed by two researchers using thematic analysis.
Patients’ average age was 74 years (range 62–88 years). We identified barriers and facilitators for four main topics regarding the implementation of MRs in primary care: patient participation, GP-led MRs, pharmacist-led MRs, and the involvement of healthcare assistants in MRs. Barriers to patient participation concerned patient autonomy, while facilitators involved patient awareness of medication-related problems. Barriers to GP-led MRs concerned GP’s lack of resources while facilitators related to the trusting relationship between patient and GP. Pharmacist-led MRs might be hindered by a lack of patients’ confidence in pharmacists’ expertise, but facilitated by pharmacies’ digital records of the patients’ medications. Regarding the involvement of healthcare assistants in MRs, a potential barrier was patients’ uncertainty regarding the extent of their training. Patients could, however, imagine GPs delegating some aspects of MRs to them.
Our study suggests that patients regard MRs as beneficial and expect indications for their medicines to be checked, and possible interactions to be identified. To foster the implementation of MRs in primary care, it is important to consider barriers and facilitators to the four identified topics.
Additional file 1: Interview guide for telephone interviews and focus groups. (DOCX 22 kb)12875_2017_707_MOESM1_ESM.docx
Additional file 2: Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. (DOCX 19 kb)12875_2017_707_MOESM2_ESM.docx
van Den Akker M, Buntinx F, Knottnerus JA. Comorbidity or multimorbidity: what's in a name? A review of literature. Eur J Gen Pract. 2009;2:65–70. CrossRef
Pötzsch O, Rößger F. Bevölkerung Deutschlands bis 2060–13. koordinierte Bevölkerungsvorausberechnung. 2015. https://www.destatis.de/DE/PresseService/Presse/Pressekonferenzen/2015/bevoelkerung/Pressebroschuere_Bevoelk2060.pdf?__blob=publicationFile. Accessed 24 Mar 2016.
Wehling M, Burkhardt H. Arzneitherapie für Ältere. 2nd ed. Berlin, Heidelberg: Springer-Verlag Berlin Heidelberg; 2011.
Fillit HM, Futterman R, Orland BI, Chim T, Susnow L, Picariello GP, et al. Polypharmacy management in Medicare managed care: changes in prescribing by primary care physicians resulting from a program promoting medication reviews. Am J Manag Care. 1999;5:587–94. PubMed
Shaw J, Seal R, Pilling M. Room for review: a guide to medication review : the agenda for patients, practitioners and managers. London: Task Force on Medicines Partnership; 2002.
Patterson SM, Cadogan CA, Kerse N, Cardwell CR, Bradley MC, Ryan C, Hughes C. Interventions to improve the appropriate use of polypharmacy for older people. Cochrane Database Syst Rev. 2014;(10):CD008165. https://doi.org/10.1002/14651858.CD008165.pub3.
Sheridan J, Butler R, Brandt T, Harrison J, Jensen M, Shaw J. Patients’ and pharmacists' perceptions of a pilot medicines use review service in Auckland, New Zealand. J Pharm Health Serv Res. 2012;3:35–40. CrossRef
Allgemeinmedizin If, Frankfurt. ForN - Forschungsnetzwerk Allgemeinmedizin Frankfurt. 2016. http://www.allgemeinmedizin.uni-frankfurt.de/forschung4/forn.html. Accessed 4 May 2016.
Mayring P. Einführung in die qualitative Sozialforschung: Eine Anleitung zu qualitativem Denken. 5th ed. Beltz: Weinheim; 2002.
dr. dresing & pehl GmbH. f4transkript - Audiodateien schneller abtippen. 2016. https://www.audiotranskription.de/f4.htm. Accessed 9 May 2016.
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3:77–101. CrossRef
Krueger RA, Casey MA. Focus groups: a practical guide for applied research. 5th ed. Thousand Oaks: SAGE; 2015.
VERBI Software. Consult. Sozialforschung. GmbH. MAXQDA 11. 1995-2016. http://www.maxqda.de/produkte/maxqda11/. Accessed 9 May 2016.
Jaski ME, Schwartzberg JG, Guttman RA, Noorani M. Medication review and documentation in physician office practice. Eff Clin Pract. 2000;3:31–4. PubMed
Cromme SK, Whitaker KL, Winstanley K, Renzi C, Smith CF, Wardle J. Worrying about wasting GP time as a barrier to help-seeking: a community-based, qualitative study. Br J Gen Pract. 2016;66:82. CrossRef
Bezreh T, Laws MB, Taubin T, Rifkin DE, Wilson IB. Challenges to physician-patient communication about medication use: a window into the skeptical patient's world. Patient Prefer Adherence. 2012;6:11–8. PubMed
Morgan DL. Focus groups. Annu Rev Sociol. 1996;22:129–52. CrossRef
Rosemann T, Korner T, Wensing M, Gensichen J, Muth C, Joos S, Szecsenyi J. Rationale, design and conduct of a comprehensive evaluation of a primary care based intervention to improve the quality of life of osteoarthritis patients. The PraxArt-project: a cluster randomized controlled trial ISRCTN87252339. BMC Public Health. 2005;5:77. CrossRefPubMedPubMedCentral
Peters-Klimm F, Muller-Tasch T, Schellberg D, Gensichen J, Muth C, Herzog W, Szecsenyi J. Rationale, design and conduct of a randomised controlled trial evaluating a primary care-based complex intervention to improve the quality of life of heart failure patients: HICMan (Heidelberg integrated case management). BMC Cardiovasc Disord. 2007;7:25. CrossRefPubMedPubMedCentral
- Patient-perceived barriers and facilitators to the implementation of a medication review in primary care: a qualitative thematic analysis
Mirella Carolin Uhl
Ferdinand Michael Gerlach
Beate Sigrid Müller
- BioMed Central
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