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GPs' perceptions of multiple-medicine use in older patients
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmacy. (The Pharmaceutical Outcomes Research Group)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmacy. (The Pharmaceutical Outcomes Research Group)
The Swedish Association of the Pharmaceutical Industry.
NEPI Foundation.
Show others and affiliations
2010 (English)In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 16, no 1, 69-75 p.Article in journal (Refereed) Published
Abstract [en]

Rationale, aim and objective: Multiple-medicine use (polypharmacy) is a growing problem for older patients, prescribers and health policy makers. The general practitioner (GP) is most often the main professional care provider; hence, improvements of treatment can only be carried out in concordance with GPs. The aim of this study was, therefore, to explore using a qualitative approach GPs' perspectives of treating older users of multiple medicines. Method: Six focus groups, with four private GPs and 27 county-employed GPs, were analysed by using the framework method. Results: In contrast to definitions in most epidemiologic studies, the GPs gave a spontaneous definition of polypharmacy as 'the administration of more medicines than are clinically indicated'. They had problems stating both a cut-off number and which medicines should be included. Clinical practice guidelines were thought of as 'medicine generators', having an ambiguous effect on the GPs, who both trust them and find them difficult to apply. There was a perceived lack of communication between GPs and hospital specialists concerning their patients' medicines, which was further perceived to reduce treatment quality. The influence of patient pressure was acknowledged by the GPs as a factor contributing to the development of multiple-medicine use. Conclusions: The GPs felt insecure although surrounded by clinical practice guidelines. There is a need for policy makers to appreciate this paradox, as the problem is likely to grow in size and proportion. GPs must be empowered to handle the increasing proportion of older users of multiple medicines with individual agendas, receiving care from multiple specialists.

Place, publisher, year, edition, pages
2010. Vol. 16, no 1, 69-75 p.
Keyword [en]
clinical practice guidelines, focus groups, general practitioner, multiple-medicine use, older people, polypharmacy
National Category
Pharmaceutical Sciences
Identifiers
URN: urn:nbn:se:uu:diva-104551DOI: 10.1111/j.1365-2753.2008.01116.xISI: 000274486200010PubMedID: 20367817OAI: oai:DiVA.org:uu-104551DiVA: diva2:219941
Available from: 2009-05-28 Created: 2009-05-28 Last updated: 2010-12-21Bibliographically approved
In thesis
1. Multiple Medicine Use: Patients’ and general practitioners’ perceptions and patterns of use in relation to age and other patient characteristics
Open this publication in new window or tab >>Multiple Medicine Use: Patients’ and general practitioners’ perceptions and patterns of use in relation to age and other patient characteristics
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

There are widespread concerns about the increasing use of multiple medicines. The aims of this thesis were to identify older patients' and general practitioners' (GPs) attitudes to and experiences of multiple medicine use, as well as to describe patterns of multiple medicine use in different age groups in association with patient-related factors. An additional aim was to contribute to scientific methodological development by providing an empirical example of the application of the Lehoux, Poland, & Daudelin template for the analysis of interaction in focus groups. Data were collected via qualitative focus group discussions and from a cross-sectional community-based population survey conducted during 2001-2005.

The patients revealed co-existing accounts of both immediate gratitude that medicines exist and problems with using multiple medicines such as worrying whether multiple medicine use is 'good' for the body. The patient-doctor relationship coloured their attitudes towards their treatment and care.

The GPs at times felt insecure, though surrounded by treatment guidelines. Lack of communication with hospital specialists was perceived to reduce treatment quality, while influence of patient pressure was thought to contribute to the development of multiple medicine use. An interaction analysis helped in appreciating and clarifying the contexts in which results from the content analysis were created. Further discussion is needed on how to best report these results.

Different cut-offs are useful in defining multiple medicine use in different age groups. Vast majorities of users of multiple medicines were found to have unique medicine combinations. Multiple medicine use was found to be associated with morbidity and poor self-rated health across all age groups.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2009. 77 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Pharmacy, ISSN 1651-6192 ; 102
Keyword
Age groups, Focus group interaction analysis, General practitioners, Multiple medicine use, Patient-doctor communication, Patient-related factors, Polypharmacy
National Category
Social and Clinical Pharmacy
Research subject
Social Pharmacy
Identifiers
urn:nbn:se:uu:diva-106349 (URN)978-91-554-7564-2 (ISBN)
Public defence
2009-09-25, Auditorium Minus, Gustavianum, Akademigatan 3, Uppsala, 09:15 (English)
Opponent
Supervisors
Available from: 2009-09-02 Created: 2009-06-19 Last updated: 2009-09-02Bibliographically approved

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