Healthcare Provider Perspectives on Digital and Interprofessional Medication Management in Chronically Ill Older Adults of Turkish Descent in Germany: A Qualitative Structuring Content Analysis

Abstract

Medication management for chronically ill older adults with a history of migration can be associated with specific challenges, for instance language barriers. This study examined healthcare provider perspectives on interprofessional cooperation and digital medication management tools as approaches for increasing medication safety for chronically ill older adults of Turkish descent in Germany. Semi-structured interviews were conducted with 11 healthcare providers, including general practitioners, pharmacists, a geriatric consultant, a hospital social worker, and an expert on digitalization in nursing care. The interviews were analyzed by means of qualitative structuring content analysis. This article presents selected results of the analysis relating to medication management, barriers to optimal medication management, interprofessional cooperation, and digital tools. Compliance was perceived to be high among chronically ill older adults of Turkish descent and the involvement of family members in medication management was rated positively by respondents. Barriers to medication management were identified in relation to health literacy and language barriers, systemic problems such as short appointments and generic substitution, and racism on behalf of healthcare providers. Additionally, the respondents highlighted structural barriers to interprofessional communication in the German healthcare system. Furthermore, two technology acceptance models presented in this article to illustrate the respondents' perspectives on a) a digital application for medication management to be used by chronically ill older adults of Turkish descent and b) a digital tool for interprofessional communication. The discussion highlights the implications of the results for medication management within the German healthcare system.

Racism against racialized migrants in healthcare in Europe: a scoping review

“…The qualitative studies recruited participants via purposive sampling [ 42 – 46 ], quota sampling [ 47 ], and convenience sampling, which was typically followed by snowballing. Convenience sampling involved the acquisition of participants from various clusters, including healthcare and nursing institutions [ 48 – 55 ], immigrant associations, non-governmental organizations, religious institutions, or community centers [ 54 , 56 – 63 ], specific illness support groups or workshops [ 64 , 65 ], specific cities or geographical areas [ 66 – 68 ], and/or universities [ 69 ]. The mixed-method study employed convenience sampling within cluster sampling by inviting women amongst three public maternity units to partake in the study [ 70 ].…”

“…Another two studies focused on the care for persons living with HIV/AIDS [ 64 ]. Further studies examined racism in care for chronically ill adults [ 66 ], care for elders [ 52 ], and palliative care [ 46 ].…”

“…The most common region of origin for racialized migrants in the included studies was Africa, with a total of 10 articles, including two articles that studied healthcare for migrants from African countries broadly [ 63 , 65 ], six articles on migrants from Sub-Saharan Africa, [ 51 , 54 , 60 , 61 , 64 , 70 ], one article including migrants from Ethiopia [ 62 ], and one article including migrants from Morocco [ 67 ]. Three studies focused on migrants from European and Middle Eastern countries, including one on migrants from Eastern European countries broadly [ 73 ], one on migrants from Syria [ 42 ], one on migrants from Turkey [ 58 , 66 ], and one on migrants from Turkey and Portugal [ 58 ]. The study looking at migrants from Eastern Europe also looked at migrants of Afro-Caribbean descent [ 73 ].…”

“…In a study conducted in Ireland, for instance, maternity service providers described interactions that they felt to be “unacceptable and racist” from both other staff and patients in the hospital [ 53 ]. In a German study, several physicians caring for chronically ill Turkish adults reported witnessing incidents of racism toward older adults of Turkish descent in the healthcare system [ 66 ].…”

“…That’s really a lot of work for me. And when I feel stressed, it makes me aggressive” [ 66 ]. The statement exemplifies interlocking levels of discrimination, as the concept of the “hysterical migrant patient” has a clearly gendered undertone intersecting with its racist connotation.…”