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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.

Background The rapid diffusion of wearable electronic health monitoring devices (wearable devices or wearables) among lay populations shows that self-tracking and self-monitoring are pervasively expanding, while influencing health-related practices. General practitioners are confronted with this phenomenon, since they often are the expert-voice that patients will seek. Objective This article aims to explore general practitioners’ perceptions of the role of wearable devices in family medicine and of their benefits, risks, and challenges associated with their use. It also explores their perceptions of the future development of these devices. Methods Data were collected during a medical conference among 19 Swiss general practitioners through mind maps. Maps were first sketched at the conference and their content was later compared with notes and reports written during the conference, which allowed for further integration of information. This tool represents an innovative methodology in qualitative research that allows for time-efficient data collection and data analysis. Results Data analysis highlighted that wearable devices were described as user-friendly, adaptable devices that could enable performance monitoring and support medical research. Benefits included support for patients’ empowerment and education, behavior change facilitation, better awareness of personal medical history and body functioning, efficient information transmission, and connection with the patient’s medical network; however, general practitioners were concerned by a lack of scientific validation, lack of clarity over data protection, and the risk of stakeholder-associated financial interests. Other perceived risks included the promotion of an overly medicalized health culture and the risk of supporting patients’ self-diagnosis and self-medication. General practitioners also feared increased pressure on their workload and a compromised doctor–patient relationship. Finally, they raised important questions that can guide wearables’ future design and development, highlighting a need for general practitioners and medical professionals to be involved in the process. Conclusions Wearables play an increasingly central role in daily health-related practices, and general practitioners expressed a desire to become more involved in the development of such technologies. Described as useful information providers, wearables were generally positively perceived and did not seem to pose a threat to the doctor–patient relationship. However, general practitioners expressed their concern that wearables may fuel a self-monitoring logic, to the detriment of patients’ autonomy and overall well-being. While wearables can contribute to health promotion, it is crucial to clarify the logic underpinning the design of such devices. Through the analysis of group discussions, this study contributes to the existing literature by presenting general practitioners’ perceptions of wearable devices. This paper provides insight on general practitioners’ perception to be considered in the context of product development and marketing.

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BackgroundSwitzerland’s aging population raises pressing questions about maintaining older adults in their home environments and the problems associated with managing complex treatments requiring medication in such contexts. Few studies have examined older adults’ experiences of changes in their medication on discharge home following hospitalization for illness or an accident. Similarly, few studies have evaluated the involvement of informal and professional caregivers in the medication practices used with older adults living at home. However, medication practices are complex and understanding them requires an interest in their underlying logic and the interactions that constitute them. This study will explore the feasibility of recruiting older adults and then collecting and analyzing data on their medication practices and their experiences of discharge home after hospitalization for an illness or following an accident. Furthermore, it will describe the involvement of informal caregivers and homecare professionals in these processes.Design and methodsThe study will use a qualitative methodology. The first phase will be developed in the general medicine and surgery wards of Sion hospital and in the town’s community healthcare center. This phase will aim to build a close collaboration between the research team and the health care professionals of Valais hospitals and the community healthcare center. It will enable data collection from professional caregivers to identify the tools, and potentially the interventions, which are used to prepare older adults for hospital discharge and return home, particularly with regard to the medication prescribed to them. In the second phase, semi-structured interviews will be conducted with eight patients aged 75 years old or more who have returned home after hospitalization. Interviews will also be conducted with their informal and professional caregivers.ConclusionThis feasibility study will enable the identification of tools that leverage improved adhesion to a medical treatment that has been adjusted and stabilized following discharge home from hospital. It will incorporate the points of view of older adults and the different stakeholders involved in the management of their medication and the development of tangible solutions to encourage treatment adhesion on discharge home. This study’s findings will enable us to design a much larger future study.

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Qualitative research today must develop tools to better clarify the processes of data interpretation. Studies on reflexivity have made inroads in this direction by stressing the engagement of the researcher's subjectivity: the researcher is no longer "outside," no longer a neutral observer who is affectively and politically detached, but is rather an instrument in the research process. However, reflexivity frequently remains no more than a general attitude whose practical modalities lack clear definition. Using the concept of resonances, originally developed in the field of constructivist systemic therapy (Elkaïm 1989), the present article proposes a tool to account for reflexive and self-reflexive processes more comprehensively. The practical application of the resonances technique is illustrated by the example of a research interview.

Alfred Schütz original contribution to the social sciences refers to his analysis of the structure of the "life-world". This article aims to invigorate interest in the work of this author, little known in the field of health psychology. Key concepts of Schütz' approach will be presented in relation to their potential interest to the understanding of the experience of illness. In particular, we develop the main characteristics of the everyday life and its cognitive style, that is, its finite province of meaning. We propose to adopt this notion to define the experience of chronic or serious illness when the individual is confronted to the medical world. By articulating this analysis with literature in health psychology, we argue that Schütz's perspective brings useful insight to the field, namely because of its ability to study meaning constructions by overcoming the trap of solipsism by embracing intersubjectivity. The article concludes by outlining both, the limitations and research perspectives brought by this phenomenological analysis of the experiences of health and illness.