Exploring the Determinants of Polypharmacy Prescribing and Dispensing Behaviors in Primary Care for the Elderly-Qualitative Study.

Polypharmacy is particularly prevalent in the elderly. The interest in this issue is growing, and many interventions exist to improve the appropriate use of polypharmacy for older people. However, evidence of their effectiveness is still limited. Thus, the aim of this study, based on a qualitative approach, was to identify the key elements perceived to influence the prescribing and dispensing of appropriate polypharmacy to older people in primary care. Semistructured interviews were conducted with general practitioners and community pharmacists practicing in the region of Nouvelle-Aquitaine (France). Pre-existing topic guides based on the 12 TDF domains have been adapted and used. Data were analyzed using the framework method and content analysis. A focus group of healthcare professionals was conducted, and behavior change techniques (BCTs) were used to select the intervention components. Seventeen interviews were convened. A wide range of determinants were identified as barriers and/or facilitators. Nine domains were selected as key domains to target for intervention. Five intervention components (behavior change techniques-BCTs) to include in an intervention were finally selected. The results of this study will serve as a starting point for the design of a theory-based intervention targeting healthcare professionals to improve appropriate prescribing and dispensing of polypharmacy for older people in primary care.

Exploring the Determinants of Polypharmacy Prescribing and Dispensing Behaviours in Primary Care for the Elderly-Protocol for a Qualitative Study.

Polypharmacy is becoming increasingly common, especially among the elderly. It often has a negative connotation, but is sometimes necessary or even desirable, and needed to categorize polypharmacy as appropriate or inappropriate. The challenge is in ensuring that this is considered appropriate when necessary. We aimed to develop an evidence-based intervention to reduce the risks associated with using a systematic approach, involving key stakeholders in prescribing and dispensing drugs to the elderly in primary care. The purpose of this study is to identify the key components which are perceived as influencing these behaviours. It is a qualitative study of general practitioners (GPS) and community pharmacists involved in the care of the elderly. The main inclusion criterion is the geographic location. Qualitative data will be generated from one-on-one, semi-structured interviews and processed for thematic content analysis. Our approach integrates the patient pathway in primary care. It considers the fact that GP and pharmacist behaviours are far from being independent. This study represents the first step in the process of developing an intervention theory which involves a crossover between data from the literature and the knowledge of experts, allowing us to interrogate hypotheses about the influences and mechanisms associated with prescribing and dispensing drugs to the elderly in primary care.

Failure to Reach a Consensus in Polypharmacy Definition: An Obstacle to Measuring Risks and Impacts-Results of a Literature Review.

INTRODUCTION: The risk of polypharmacy is on the rise in most industrialized countries, threatening to burden their health systems. Although many definitions exist and numerous concepts are found in literature as synonyms, the phenomenon of polypharmacy remains poorly defined. The aim of this literature review is to provide an overview of available definitions of polypharmacy, to analyse their convergences and divergences and to discuss the consequences on the assessment of the problem. METHODS: A literature review was conducted to identify all published systematic reviews on definitions of polypharmacy available via Scopus and Pubmed databases. The Assessment of Multiple Systematic Reviews (AMSTAR) tool was used to appraise the methodological quality of the selected reviews. Available definitions and other characteristics were extracted; summarised in a table and analysed. RESULTS: Six systematic reviews were identified. They were published between 2000 and 2018. Three focussed on definitions of polypharmacy in the elderly; two in the general population and one in children. The strategy adopted in reviews is more rigorous in the most recent ones. However, they remain, at best, partially exhaustive. The definitions found in the literature used two main approaches, either (i) quantitative, applying varying thresholds and types of polypharmacy based on the number of medications being taken by the patient (ii) qualitative, based on the clinical indications and effects of a given drug regimen, with a growing number of characteristics to describe polypharmacy. The term "inappropriate" is increasingly associated with polypharmacy especially in studies that aimed to use this definition to identify possible solutions for healthcare providers in the field related to aging. CONCLUSION: This review confirms a high variability and an evolution in the approaches defining "polypharmacy" in the absence of a consensus following standardized criteria. That makes it very difficult to estimate and measure the outcomes associated with this phenomenon.