Medication-related experiences of patients with polypharmacy: a systematic review of qualitative studies

Abstract

BackgroundWe aimed to synthesise qualitative studies exploring medication-related experiences of polypharmacy among patients with multimorbidity.MethodsWe systematically searched PubMed, Embase and Cumulative Index to Nursing and Allied Health Literature in February 2020 for primary, peer-reviewed qualitative studies about multimorbid patients’ medication-related experiences with polypharmacy, defined as the use of four or more medications. Identified studies were appraised for methodological quality by applying the Critical Appraisal Skills Programme checklist for qualitative research, and data were extracted and synthesised by the meta-aggregation approach.ResultsWe included 13 qualitative studies, representing 499 patients with polypharmacy and a wide range of chronic conditions. Overall, most Critical Appraisal Skills Programme items were reported in the studies. We extracted 140 findings, synthesised these into 17 categories, and developed five interrelated syntheses: (1) patients with polypharmacy are a heterogeneous group in terms of needing and appraising medication information; (2) patients are aware of the importance of medication adherence, but it is difficult to achieve; (3) decision-making about medications is complex; (4) multiple relational factors affect communication between patients and physicians, and these factors can prevent patients from disclosing important information; and (5) polypharmacy affects patients’ lives and self-perception, and challenges with polypharmacy are not limited to practical issues of medication-taking.DiscussionPolypharmacy poses many challenges to patients, which have a negative impact on quality of life and adherence. Thus, when dealing with polypharmacy patients, it is crucial that healthcare professionals actively solicit individual patients’ perspectives on challenges related to polypharmacy. Based on the reported experiences, we recommend that healthcare professionals upscale communicative efforts and involve patients’ social network on an individualised basis to facilitate shared decision-making and treatment adherence in multimorbidpatients with polypharmacy.

What can we learn from patients’ experiences of polypharmacy?

“…For all these reasons, researchers in Denmark sought to evaluate patients' perspectives of multimorbidity and polypharmacy through a systematic review of studies of medication-related experiences published since 1988. 3 Looking for qualitative studies in adults with two or more co-morbidities (excluding palliative care) who were taking at least four medicines, they identified 13 publications involving a total of 499 patients. Eleven used semi-structured interview or focus groups and two use unstructured interviews; methodological quality was generally high.…”

The Effect of a Comprehensive, Interdisciplinary Medication Review on Quality of Life and Medication Use in Community Dwelling Older People with Polypharmacy

“…There is extensive literature on polypharmacy showing complex and often conflicting effects on clinical outcomes due to variability in definitions of polypharmacy and outcome measures used with the strongest evidence for hospitalization and inappropriate prescribing [ 5 ]. Qualitative work suggests that polypharmacy poses a substantial treatment burden and affects quality of life and adherence [ 6 ].…”

Home medicines reviews: a national survey of Australian accredited pharmacists’ health service time investment

“… 27 - 31 Other tasks that could impact on time investment include motivational interviewing, understanding patient medicines goals as part of shared health decision-making, exploring patients’ concerns and lived experiences with medicines and their level of health and medicines literacy to better plan individualized care plans to understand problems and challenges faced by polypharmacy comorbid patients. 32 - 34 …”