Advertisement

International Journal of Clinical Pharmacy

, Volume 38, Issue 1, pp 107–118 | Cite as

An exploration of health professionals’ experiences of medicines management in elderly, hospitalised patients in Abu Dhabi

  • Saeed Al Shemeili
  • Susan Klein
  • Alison Strath
  • Saleh Fares
  • Derek StewartEmail author
Research Article

Abstract

Background Given the multiplicity of issues relating to medicines in the elderly, the structures and processes of medicines management should be clearly defined and described to optimise patient outcomes. There is a paucity of research which provides an in-depth exploration of these elements of medicines management for elderly patients. Objectives This study explored health professionals’ experiences of medicines management for elderly, hospitalised patients in Abu Dhabi. Setting The research was conducted in five major hospitals in Abu Dhabi, the United Arab Emirates. Method Responses to an online sampling questionnaire were used to purposively select nurses, pharmacists and physicians for interview. A semi-structured interview schedule was developed with reference to normalization process theory (NPT) and the theoretical domains framework (TDF) to explore issues of medicines management structures, processes and outcomes. Face-to-face interviews of 20–30 min were audio-recorded, transcribed verbatim and analysed using the Framework Approach. Main outcome measures Health professionals’ in-depth experiences of structures, processes and outcomes relating to medicines management. Results Saturation of themes was deemed to occur at interview 27 (7 nurses, 13 pharmacists, 7 physicians). Six key themes and several subthemes emerged from the qualitative analysis, which pertained to the need for: appropriate polypharmacy; a systematic approach to medicines history taking; improved communication and documentation; improved patients’ adherence to medicines; guidelines and policies to support medicines selection, and an educated and trained multidisciplinary team. The most dominant TDF behavioural determinants were issues around: professional role and identity; beliefs about capabilities; beliefs about consequences; environmental context and resources; knowledge, and goals. NPT construct identified little evidence of coherence, cognitive participation, collective action and reflexive monitoring. Conclusion The key themes identified in this research indicate the need to develop a more structured approach to medicines management in elderly hospitalised patients in Abu Dhabi. The NPT constructs and the TDF behavioural determinants can be utilised as part of service development and implementing change.

Keywords

Abu Dhabi Interviews Normalization process theory Qualitative Theoretical domains framework 

Notes

Acknowledgments

We acknowledge the participation of all interviewees.

Funding

Funding was provided by Embassy of the United Arab Emirates.

Conflicts of interest

The authors have no conflicts of interest to declare.

References

  1. 1.
    World Health Organization. The world health report 2008. Primary health care—now more than ever. New York: The World Health Report; 2008. ISBN: 978 92 4 156373 4.Google Scholar
  2. 2.
    Ornstein SM, Nietert PJ, Jenkins RG, Litvin CB. The prevalence of chronic diseases and multimorbidity in primary care practice: a PPRNet report. J Am Board Fam Pract. 2013;26(5):518–24.CrossRefGoogle Scholar
  3. 3.
    Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B. Epidemiology of multimorbidity and implications for healthcare, research, and medical education: a cross sectional study. Lancet. 2012;380:37–43.CrossRefPubMedGoogle Scholar
  4. 4.
    Payne RA, Avery AJ. Polypharmacy: one of the greatest prescribing challenges in general practice. Brit J Gen Prac. 2011;61:83–4.CrossRefGoogle Scholar
  5. 5.
    Patterson SM, Hughes C, Kerse N, Cardwell CR, Bradley MC. Interventions to improve the appropriate use of polypharmacy for older people. Cochrane Db Syst Rev. 2012;5(5):CD008165.Google Scholar
  6. 6.
    Payne RA, Avery AJ, Duerden M, Saunders CL, Simpson CR, Abel GA. Prevalence of polypharmacy in a Scottish primary care population. Eur J Clin Pharm. 2014;70(5):575–81.CrossRefGoogle Scholar
  7. 7.
    Dwyer LL, Han B, Woodwell DA, Rechtsteiner EA. Polypharmacy in nursing home residents in the United States: results of the 2004 National Nursing Home Survey. Am J Geriatr Pharmac. 2010;1:63–72.CrossRefGoogle Scholar
  8. 8.
    Gurwitz JH, Field TS, Harrold LR, Rothschild J, Debellis K, Seger AC, et al. Incidence and preventability of adverse drug events among older persons in the ambulatory setting. JAMA. 2003;289(9):1107–16.CrossRefPubMedGoogle Scholar
  9. 9.
    Routledge PA, O’Mahony MS, Woodhouse KW. Adverse drug reactions in elderly patients. Brit J C Pharm. 2004;57(2):121–6.CrossRefGoogle Scholar
  10. 10.
    Spinewine A, Schmader KE, Barber N, Hughes C, Lapane KL, Swine C, et al. Appropriate prescribing in elderly people: how well can it be measured and optimised? Lancet. 2007;370(9582):173–84.CrossRefPubMedGoogle Scholar
  11. 11.
    Kaufmann CP, Tremp R, Hersberger KE, Lampert ML. Inappropriate prescribing: a systematic overview of published assessment tools. Eur J Clin Pharmacol. 2014;70:1–11.CrossRefPubMedGoogle Scholar
  12. 12.
    The American Geriatrics Society 2012 Beers Criteria Update Expert Panel. American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2012;60(4):616–31.CrossRefGoogle Scholar
  13. 13.
    O’Mahony D, O’Sullivan D, Byrne S, O’Connor MN, Ryan C, Gallagher P. STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age Ageing. 2014;0:1–6.Google Scholar
  14. 14.
    Vrijens B, De Geest S, Hughes DA, Przemyslaw K, Demonceau J, Ruppar T, et al. A new taxonomy for describing and defining adherence to medications. Brit J Clin Pharm. 2012;73:691–705.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Kardas P, Lewek P, Matyjaszczyk M. Determinants of patient adherence: a review of systematic reviews. Front Pharmac. 2013;4:91. doi: 10.3389/fphar.2013.00091
  16. 16.
    Audit Commission (United Kingdom). A spoonful of sugar Medicines management in NHS hospitals. London: Audit Commission; 2001. ISBN: 1 86240 321 X.Google Scholar
  17. 17.
    National Prescribing Centre. Modernising medicines management—a guide to achieving benefits for patients, professionals and the NHS. Liverpool: National Prescribing Centre; 2002. http://www.nice.org.uk/about/nice-communities/medicines-and-prescribing [cited May 2015].
  18. 18.
    National Institute for Health and Care Excellence. Medicines optimisation: scope consultation. Available from http://www.nice.org.uk/guidance/gid-cgwave0676/documents/medicines-optimisation-scope-consultation [cited May 2015].
  19. 19.
    Donabedian A. Explorations in quality assessment and monitoring: the definition of quality and approaches to its assessment. MI: Health Administration Press; 1980.Google Scholar
  20. 20.
    SEHA Annual Report 2012. The changing face of healthcare. Abu Dhabi: Abu Dhabi Health Services Co. http://www.seha.ae/SEHA/Annual%20Report/AR%202012/chairmans_statement.html# [cited May 2015].
  21. 21.
    Marshall MN. Sampling for qualitative research. Fam Prac. 1996;13(6):522–5.CrossRefGoogle Scholar
  22. 22.
    Francis JJ, Johnston M, Robertson C, Glidewell L, Entwistle V, Eccles MP, et al. What is an adequate sample size? Operationalising data saturation for theory-based interview studies. Psychol Health. 2010;25(10):1229–45.CrossRefPubMedGoogle Scholar
  23. 23.
    May C, Finch T. Implementing, embedding, and integrating practices: an outline of normalization process theory. Sociology. 2009;43(3):535–54.CrossRefGoogle Scholar
  24. 24.
    Michie S, Johnston M, Abraham C, Lawton R, Parker D, Walker A. Making psychological theory useful for implementing evidence based practice: a consensus approach. Qual Safe Health Care. 2005;14(1):26–33.CrossRefGoogle Scholar
  25. 25.
    Ritchie J, Spencer L. Qualitative data analysis for applied policy research. In: Huberman M, Miles MB, editors. The qualitative researcher’s companion. UK: Sage Publications; 2002. p. 305–329.Google Scholar
  26. 26.
    Vogelsmeier A, Pepper G, Oderda L, Weir C. Medication reconciliation: a qualitative analysis of clinicians’ perceptions. Res Soc Adm Pharm. 2013;9(4):419–30.CrossRefGoogle Scholar
  27. 27.
    Skoglund I, Segesten K, Bjorkelund C. GPs’ thoughts on prescribing medication and evidence-based knowledge: the benefit aspect is a strong motivator: A descriptive focus group study. Scand J Prim Health Care. 2007;25(2):98–104.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Cullinan S, Fleming A, O’Mahony D, Ryan C, O’Sullivan D, Gallagher P, et al. Physicians’ perspectives on the barriers to appropriate prescribing in older hospitalized patients: a qualitative study. Brit J Clin Pharm. 2014;79(5):860–9.CrossRefGoogle Scholar
  29. 29.
    Guthrie B, Payne K, Alderson P, McMurdo ME, Mercer SW. Adapting clinical guidelines to take account of multimorbidity. BMJ (Clin Res Ed). 2012;345:e6341.Google Scholar
  30. 30.
    Hughes LD, McMurdo ME, Guthrie B. Guidelines for people not for diseases: the challenges of applying UK clinical guidelines to people with multimorbidity. Age Ageing. 2013;42(1):62–9.CrossRefPubMedGoogle Scholar
  31. 31.
    Francis JJ, O’Connor D, Curran J. Theories of behavior change synthesised into a set of theoretical groupings: introducing a thematic series on the theoretical domains framework. Implement Sci. 2012;7(1):35.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie 2015

Authors and Affiliations

  • Saeed Al Shemeili
    • 1
  • Susan Klein
    • 1
  • Alison Strath
    • 2
  • Saleh Fares
    • 3
  • Derek Stewart
    • 2
    Email author
  1. 1.Institute for Health and Wellbeing ResearchRobert Gordon UniversityAberdeenUK
  2. 2.School of Pharmacy and Life SciencesRobert Gordon UniversityAberdeenUK
  3. 3.Zayed Military HospitalAbu DhabiUAE

Personalised recommendations