“I must, and I can live with that”: a thematic analysis of patients’ perspectives on polypharmacy and a digital decision support system for GPs

Brünn, Robin; Müller, Beate S.; Flaig, Berthold Bodo; Kellermann-Mühlhoff, Petra; Karbach, Ute; Söling, Sara; Muth, Christiane; Akker, Marjan van den; Düvel, Lara; Beckmann, Till; Hammerschmidt, Reinhard; Jachmich, Julia; Leicher, Eva; Brandt, Benjamin; Richard, Johanna; Meyer, Frank; Flume, Mathias; Müller, Thomas; Gerlach, Ferdinand M.; González‐González, Ana Isabel; Dinh, Truc Sophia; Chapidi, Kiran; Ihle, Peter; Meyer, Ingo; Timmesfeld, Nina; Trampisch, Hans J.; Klaaßen-Mielke, Renate; Basten, Jale; Greiner, Wolfgang; Surmann, Bastian; Pfaff, Holger; Köberlein-Neu, Juliane; Piotrowski, Alexandra; Beifuß, Karolina; Meyer, Sarah L.; Grandt, Daniel; Grandt, Simone

doi:10.1186/s12875-021-01517-6

Cited by 4 publications

(5 citation statements)

References 19 publications

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“…The involvement of pharmacists was not part of this intervention, but their support in conducting medication reviews would appear to be plausible, especially in view of the discussed implementation barriers, and existing literature, which indicates benefits in terms of both medication appropriateness [34] and patient-relevant outcomes such as quality of life [35]. Qualitative studies conducted in the AdAM trial suggest that the expertise of pharmacists is also appreciated by GPs [36] and patients [37]. In addition, as the AdAM intervention comprised only one voluntary two-hour education session, with accompanying online videos and FAQs, it is quite possible that better results could have been generated if training in polypharmacy and use of the software had been better, as can be seen in comparable trials [32,38,39].…”

Section: Our Findings In the Context Of Existing Researchmentioning

confidence: 99%

Use of an Electronic Medication Management Support System in Patients with Polypharmacy in General Practice: A Quantitative Process Evaluation of the AdAM Trial

Brünn

Lemke²,

Basten³

et al. 2022

Pharmaceuticals

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Polypharmacy is associated with a risk of negative health outcomes. Potentially inappropriate medications, interactions resulting from contradicting medical guidelines, and inappropriate monitoring, all increase the risk. This process evaluation (PE) of the AdAM study investigates implementation and use of a computerized decision-support system (CDSS). The CDSS analyzes medication appropriateness by including claims data, and hence provides general practitioners (GPs) with full access to patients’ medical treatments. We based our PE on pseudonymized logbook entries into the CDSS and used the four dimensions of the Medical Research Council PE framework. Reach, which examines the extent to which the intended study population was included, and Dose, Fidelity, and Tailoring, which examine how the software was actually used by GPs. The PE was explorative and descriptive. Study participants were representative of the target population, except for patients receiving a high level of nursing care, as they were treated less frequently. GPs identified and corrected inappropriate prescriptions flagged by the CDSS. The frequency and intensity of interventions documented in the form of logbook entries lagged behind expectations, raising questions about implementation barriers to the intervention and the limitations of the PE. Impossibility to connect the CDSS to GPs’ electronic medical records (EMR) of GPs due to technical conditions in the German healthcare system may have hindered the implementation of the intervention. Data logged in the CDSS may underestimate medication changes in patients, as documentation was voluntary and already included in EMR.

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Section: Our Findings In the Context Of Existing Researchmentioning

confidence: 99%

Use of an Electronic Medication Management Support System in Patients with Polypharmacy in General Practice: A Quantitative Process Evaluation of the AdAM Trial

Brünn

Lemke²,

Basten³

et al. 2022

Pharmaceuticals

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“…This data has already been published. 14,15 However, there are some limitations to consider. The process evaluation relies on proper documentation by GPs since log data only show changes made in the system and may not display real life consequences.…”

Section: Discussionmentioning

confidence: 99%

“…The primary aim of the AdAM study is to determine whether a yearly medication review supported by eMMa effectively reduces the combined endpoint of all-cause hospital admissions and allcause mortality in adult patients with five or more chronic prescriptions in primary care. The evaluation of eMMa assesses cost-effectiveness, physicians' 14 and patients' 15 perspectives on the intervention, a sustainability assessment, a qualitative comparative analysis of contextual and implementation process factors, and the process evaluation described in this paper. Design, setting and population.…”

Section: The Adam Studymentioning

confidence: 99%

Use of an electronic medication management support system in patients with polypharmacy in general practice: study protocol of a quantitative process evaluation of the AdAM trial

Brünn

Lemke

Chapidi

et al. 2022

Therapeutic Advances in Drug Safety

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Background: Interventional studies on polypharmacy often fail to significantly improve patient-relevant outcomes, or confine themselves to measuring surrogate parameters. Interventions and settings are complex, with many factors affecting results. The AdAM study’s aim is to reduce hospitalization and death by requiring general practitioners (GPs) to use a computerized decision-support system (CDSS). The study will undergo a process evaluation to identify factors for successful implementation and to assess whether the intervention was implemented as intended. Objective: To evaluate our complex intervention, based on the Medical Research Council’s guideline dimensions. Research Questions: We will assess implementation (reach, fidelity, dose, tailoring) by asking: (1) Who took part in the intervention (proportion of GPs using the CDSS, proportion of patients enrolled in them)? Information on GPs’ and patients’ characteristics will also be collected. (2) How many and which medication alerts were dealt with? (3) Was the intervention implemented as intended? (4) On what days did GPs use the intervention tool? Methods: The process evaluation is part of a stepped-wedge cluster-randomized controlled trial. Characteristics of practices, GPs and patients using the CDSS will be compared with the non-participating population. CDSS log data will be analyzed to evaluate how the number of medication alerts changed between baseline and 2 months later, and to identify the kind of alerts that were dealt with. Comparison of enrolled patients on weekdays versus weekends will shed light on GPs’ use of the CDSS in the absence or presence of patients. Outcomes will be presented using descriptive statistics, and significance tests will be used to identify associations between them. We will conduct subgroup analyses, including time effects to account for software improvements. Discussion: This study protocol is the basis for conducting analyses of the quantitative process evaluation. By providing insight into how GPs conduct medication reviews, the evaluation will provide context to the trial results and support their interpretation. The evaluation relies on the proper documentation by GPs, potentially limiting its explanatory power.

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“…The gradually aging population brings increased number of chronic diseases together and thereby multi-drug use. So, most of the previous studies in this issue have been conducted with patients above 65 years of age (7)(8)(9)(10)(11)(12). Differently from most previous studies, we have evaluated multi-drug use in all patients above 18 years.…”

Section: Discussionmentioning

confidence: 99%

“…The excessive branching in medical practice creates a disadvantage for the use of multiple drugs and makes the management of these patients difficult (9,10).…”

Section: Introductionmentioning

confidence: 99%

Determination of Social Support Status and Risk of Mental Illness in Patients Using Multiple Drugs in Primary Care

Özer¹,

Topal²,

Gereklioğlu³

et al. 2021

ejhh

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Aim: Multiple drug use (polypharmacy) increases the risk of numerous negative health consequences. The aim of this study was to examine the factors that may lead to polypharmacy in adult patients followed in primary care and to determine the social support status and anxiety-depression risk in patients using multiple drugs. Methods: This cross-sectional study was conducted with 3 family medicine units in the Adana province. A total of 393 adult patients who were receiving two or more drugs daily were included. Sociodemographic data were recorded and risk factors for polypharmacy were questioned. The Multidimensional Scale of Perceived Social Support (MSPSS) and the Hospital Anxiety Depression Scale (HADS) were applied. Results: Out of 393 participants, 52.9% were female and the mean age was 60.1±11.0 years. The mean number of chronic diseases was 2.7±.2. The mean number of drugs used was 4.7±2.2. Of the participants, 31.3% had risk of depression and 24.2% had risk of anxiety. The number of drugs used increased as age, body mass index (BMI), waist circumference and number of chronic diseases increased. The MSPSS total score decreased as age increased. The risk of anxiety and depression was significantly greater in women, participants with low education and those who had no partner. Conclusions: Significant physical and mental problems occur in individuals who use multiple drugs, especially in the elderly. The present study revealed that predictors of polypharmacy include age, BMI, waist circumference and number of chronic diseases. Primary care physicians should be aware of these predictors when prescribing additional medication.

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“I must, and I can live with that”: a thematic analysis of patients’ perspectives on polypharmacy and a digital decision support system for GPs

Cited by 4 publications

References 19 publications

Use of an Electronic Medication Management Support System in Patients with Polypharmacy in General Practice: A Quantitative Process Evaluation of the AdAM Trial

Use of an Electronic Medication Management Support System in Patients with Polypharmacy in General Practice: A Quantitative Process Evaluation of the AdAM Trial

Use of an electronic medication management support system in patients with polypharmacy in general practice: study protocol of a quantitative process evaluation of the AdAM trial

Determination of Social Support Status and Risk of Mental Illness in Patients Using Multiple Drugs in Primary Care

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