Addressing the polypharmacy challenge v1
Research type
Research Study
Full title
Addressing the polypharmacy challenge in older people with multimorbidity: an in-depth ethnographic study of experiences and practices to inform medicines optimisation in primary care
IRAS ID
205517
Contact name
Deborah Swinglehurst
Contact email
Sponsor organisation
Queen MaryUniversity of London
Duration of Study in the UK
4 years, 4 months, 28 days
Research summary
Older people with multimorbidity (co-presence of at least two ongoing medical conditions) are often prescribed four or more medications (‘polypharmacy’). Polypharmacy may be burdensome to patients, is a common source of error and is sometimes harmful. Polypharmacy is also expensive and wasteful, with many prescribed medicines remaining unused. \nThe aim of this research is to improve patient care through building an in-depth understanding of the experiences of 30 patients with multimorbidity who are prescribed ten or more medicines (indicating a relatively high risk of adverse events). An ethnographic approach will involve observations over 18-24 months, building longitudinal ‘case narratives’, exploring patients’ understandings and beliefs, medicines routines and encounters with health professionals. It will also explore how polypharmacy is sustained and/or challenged within lay and professional networks, identifying elements of safe high quality prescribing and those that may lead to harmful or wasteful polypharmacy.\nFindings will inform development of evidence-based resources to increase clinicians’ skill/confidence in managing polypharmacy, and patient resources to promote public understanding. \nThere are four aspects to the study:\nUnderstanding patients’ experience: 6-8 interviews in patients’ homes encouraging them to ‘tell their story’; photographs; accompanying and observational notes of patients’ encounters with the health service; document review.\nUnderstanding professional behaviours: Interviews with key professionals involved in selected case study patients’ care; shadowing key staff; observing organisational routines; document review; video-recording and analysis of ‘medication review’ consultations.\nExploring professional concerns: Video-elicited feedback from individual clinicians on their recorded consultations identifying ‘key moments’ in medicines decision-making; video-reflexive ethnography (VRE) i.e. the study clinicians collectively watch video excerpts prompting inter-professional discussion about polypharmacy challenges.\nDeveloping e-learning materials and patient resources: Work with patients/professionals/key stakeholders to co-design e-learning resources for professionals. Work with patients to co-design patient engagement resources and raise public awareness of polypharmacy issues\n
REC name
Yorkshire & The Humber - Leeds West Research Ethics Committee
REC reference
16/YH/0462
Date of REC Opinion
24 Nov 2016
REC opinion
Favourable Opinion