Patient-perceived barriers and facilitators to the implementation of a medication review in primary care: a qualitative thematic analysis - PubMed (original) (raw)

Patient-perceived barriers and facilitators to the implementation of a medication review in primary care: a qualitative thematic analysis

Mirella Carolin Uhl et al. BMC Fam Pract. 2018.

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: Multimorbidity; Multiple chronic conditions; Patients; Polypharmacy; Primary health care.

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Conflict of interest statement

The Institutional Review Board of the University Hospital Frankfurt/Main approved the study protocol in January, 2016 (No 443/15). Participants received written information, and provided written consent to participate in the study.

Not applicable.

Competing interests

CM and BSM received grants from the German Statutory Health Insurance Company “Techniker Krankenkasse (TK)” for the study. However, the “TK” had no involvement in study design; collection, analysis and interpretation of data; writing of the study report; and in the decision to submit the article for publication. The other authors declare no conflict of interest.

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