General Practitioners’ Barriers Toward Medication Reviews in Polymedicated Multimorbid Patients

Abstract

Purpose:The aim of this study was to explore whether general practitioners (GPs) experienced barriers toward medication reviews in polymedicated, multimorbid patients, and how a clinical pharmacologist with a focus on pharmacotherapy can support the GPs in an outpatient clinic.Design:The study was descriptive and exploratory and had a qualitative design with a phenomenological/hermeneutic orientation for the interviews.Participants:The study comprised 14 interviews with 14 different GPs from the Capital Region of Denmark.Results:Three themes emerged from the interviews: (1) The care of patients With polypharmacy is challenged by the lack of professional dialogue and collaboration between GPs and hospital-based clinical pharmacologists, (2) the relationship between the patients with polypharmacy and the GP is characterized by care and individual considerations, and (3) the culture encourages adding medication and inhibits dialogue about medication withdrawal even for patients with polypharmacy.Conclusion and implications for practice:This study found that the primary barriers toward multimorbid patients with polypharmacy were the need for communication and teamwork with specialists (cardiologists, neurologists, endocrinologists, etc). Often, GPs felt that the specialists at the hospitals were more concerned about following standards and guidelines regarding specific diseases instead of a more holistic patient approach. To improve management of polypharmacy patients, the GPs suggest that a joint force is necessary, a partner-like relationship with greater transparency regarding information transfer, feedback, and shared decision-making, but also more education in the pharmacological field is essential.

Risk of drug interactions and prescription appropriateness in elderly patients

“…A recent survey conducted in Denmark has shown that general practitioners are often left alone in the management of polypharmacy set up in hospitals [8]. Also in our study, it emerged that it is unfortunately common that the specialist prescribes following the guidelines without considering the patient's age, the comorbidities and the risks associated with polypharmacy.…”

General practitioner strategies for managing patients with multimorbidity: a systematic review and thematic synthesis of qualitative research

“…Fourteen individual countries were represented across the 33 studies: Netherlands [48][49][50][51][52][53][54], England [55][56][57][58][59], Australia [60][61][62][63], Denmark [64][65][66][67], Norway [50,[67][68][69], Ireland [70][71][72], New Zealand [73][74][75], Canada [76,77], Wales [50,69], Sweden [67,78], Finland [67], Iceland [67], Portugal [79] and Scotland [80]. Together these studies included a total of 593 unique GP participants (range: 4-74 GPs).…”

“…Studies focused on multimorbidity were usually oriented towards a particular aspect of multimorbidity care. Some used the broad lens of 'patient management,' [48,53,55,59,63,67,72,[77][78][79][80] while others focused on medication management [51,52,60,62,66,70,71,73,74]; clinical practice guidelines [49,58,61,68]; GP decision making [50,69,75]; care goals [54,76]; patient selfcare [57,64]; disease management programs [65]; and health service orientation [56].…”

General Practitioners' Propensity to Cooperate With Other Health Professionals in the Management of Patients With Multimorbidity and Polypharmacy: A Cross-sectional Study.

“…Combined with a lack of communication between physicians, this may lead to increase harm from polypharmacy [7,15]. In these qualitative studies, many GPs call for better interprofessional communication and a fair balance between them and specialists when sharing prescribing activity [15,16]. Our quantitative study con rmed that cooperation and con dence between physicians is not obvious for a majority of GPs (moderate and low cooperation pro les).…”

“…Accordingly, health policies in several countries encourage interprofessional cooperation and multiprofessional practices (e.g., multidisciplinary or multiprofessional group practices and healthcare networks) [12][13][14]. Several qualitative studies have addressed these professionals' experiences and perceptions of such cooperation [7,15,16]. But little is known about how and the extent to which GPs cooperate with other healthcare professionals (medical specialists and non-physician professionals as pharmacists, nurses, physical therapists etc) and in managing patients with multimorbidity and polypharmacy, and whether their propensity to cooperate may in uence their own practices.…”