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

Kevin Peter McNamara, Bianca Daphne Breken, Hamzah Tariq Alzubaidi, J Simon Bell, James A Dunbar, Christine Walker, Andrea Hernan

Research output: Contribution to journalArticleResearchpeer-review

30 Citations (Scopus)

Abstract

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 abroad range of healthcare professional (HCP) perspectives in Australia.
Methods: this qualitative study used semi-structured interviews to gain in-depth understanding of HCPs’ perspectives onthe 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 careplans. 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.
Original languageEnglish
Pages (from-to)291–299
Number of pages9
JournalAge and Ageing
Volume46
Issue number2
DOIs
Publication statusPublished - 2017

Keywords

  • Care coordination
  • Multimorbidity
  • Older patients
  • Polypharmacy
  • Primary care

Cite this