Health professional perspectives on the management of multimorbidity and polypharmacy for older patients in Australia

McNamara, Kevin Peter, Breken, Bianca Daphne, Alzubaidi, Hamzah Tariq, Bell, J. Simon, Dunbar, James A., Walker, Christine and Hernan, Andrea 2017, Health professional perspectives on the management of multimorbidity and polypharmacy for older patients in Australia, Age and ageing, vol. 46, no. 2, pp. 291-299, doi: 10.1093/ageing/afw200.

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Title Health professional perspectives on the management of multimorbidity and polypharmacy for older patients in Australia
Author(s) McNamara, Kevin PeterORCID iD for McNamara, Kevin Peter
Breken, Bianca Daphne
Alzubaidi, Hamzah Tariq
Bell, J. Simon
Dunbar, James A.ORCID iD for Dunbar, James A.
Walker, Christine
Hernan, AndreaORCID iD for Hernan, Andrea
Journal name Age and ageing
Volume number 46
Issue number 2
Start page 291
End page 299
Total pages 9
Publisher Oxford University Press
Place of publication Oxford, Eng.
Publication date 2017-03-01
ISSN 1468-2834
Keyword(s) care coordination
older patients
primary care
Summary BACKGROUND: delivering appropriate care for patients with multimorbidity and polypharmacy is increasingly challenging. Challenges for individual healthcare professions are known, but only little is known about overall healthcare team implementation of best practice for these patients.

OBJECTIVE: to explore current approaches to multimorbidity management, and perceived barriers and enablers to deliver appropriate medications management for community-dwelling patients with multimorbidity and polypharmacy, from a broad range of healthcare professional (HCP) perspectives in Australia.

METHODS: this qualitative study used semi-structured interviews to gain in-depth understanding of HCPs' perspectives on the management of multimorbidity and polypharmacy. The interview guide was based on established principles for the management of multimorbidity in older patients. HCPs in rural and metropolitan Victoria and South Australia were purposefully selected to obtain a maximum variation sample. Twenty-six HCPs, from relevant medical, dentistry, nursing, pharmacy and allied health backgrounds, were interviewed between October 2013 and February 2014. Fourteen were prescribers and 12 practiced in primary care. Interviews were digitally audio-taped, transcribed verbatim and analysed using a constant comparison approach.

RESULTS: most participants did not routinely use structured approaches to incorporate patients' preferences in clinical decision-making, address conflicting prescriber advice, assess patients' adherence to treatment plans or seek to optimise care plans. Most HCPs were either unaware of medical decision aids and measurements tools to support these processes or disregarded them as not being user-friendly. Challenges with coordination and continuity of care, pressures of workload and poorly defined individual responsibilities for care, all contributed to participants' avoiding ownership of multimorbidity management. Potential facilitators of improved care related to improved culture, implementation of electronic health records, greater engagement of pharmacists, nurses and patients, families in care provision, and the use of care coordinators.

CONCLUSION: extensive shortcomings exist in team-based care for the management of multimorbidity. Delegating coordination and review responsibilities to specified HCPs may support improved overall care.
Language eng
DOI 10.1093/ageing/afw200
Field of Research 119999 Medical and Health Sciences not elsewhere classified
1103 Clinical Sciences
1701 Psychology
1117 Public Health And Health Services
Socio Economic Objective 929999 Health not elsewhere classified
HERDC Research category C1 Refereed article in a scholarly journal
ERA Research output type C Journal article
Copyright notice ©2016, The Authors
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