What Is a Medication-Related Problem? A Qualitative Study of Older Adults and Primary Care Clinicians

  • Francesca M. NicosiaEmail author
  • Malena J. Spar
  • Marilyn Stebbins
  • Rebecca L. Sudore
  • Christine S. Ritchie
  • Kirby P. Lee
  • Kevin Rodondi
  • Michael A. Steinman
Original Research



Older adults often take multiple medications, leading to a myriad of medication-related problems. Addressing these problems requires thoughtful approaches that align with patients’ perspectives and experiences.


To (1) identify and categorize medication-related problems from the patient perspective and (2) understand patient and clinician attitudes toward these problems and experiences with addressing these problems.


Qualitative, semi-structured interviews with patients and focus groups with physicians and pharmacists.


Twenty older adults recruited from an academic medical center and from a community senior center; 14 primary care physicians and 6 pharmacists affiliated with an academic medical center.


Hybrid deductive-inductive thematic analysis.

Key Results

Older adults identified a variety of medication-related problems that could be classified into four broad categories: (1) obtaining medications (e.g., problems with cost and insurance coverage); (2) taking medications (e.g., organization and remembering to take pills); (3) medication effects, including side effects and concerns over lack of effectiveness; and (4) communication and care coordination, including information related to medications. Many of the problems described by older adults were framed within the person’s socioemotional context, including the impact of medications on interpersonal relationships, emotional wellbeing, and activities that add meaning and quality to life. In contrast, clinicians almost exclusively focused on discrete medication issues without reference to this larger context and expressed relatively little interest in learning more about their patients’ perspectives.


Older adults experience medication-related problems as inseparable from their broader life context. Incorporating the social and emotional context of medications and related communication into a problem-focused framework can guide clinicians in specific actions and interventions to address medication-related problems from the patient perspective.


geriatrics primary care qualitative research medication medication-related problems 



Drs. Steinman and Ritchie: Tideswell at UCSF. Dr. Steinman: National Institute on Aging, National Institutes of Health (P30 AG044281, K24AG049057, and R24AG064025). Dr. Sudore is funded in part by the National Institute on Aging, National Institutes of Health (K24AG054415).

Compliance with Ethical Standards

The study was approved by the institutional review boards (IRBs) of the University of California, San Francisco and the San Francisco VA Medical Center.

Conflict of Interest

Dr. Steinman served as a consultant for, an internet startup company focused on collecting and sharing patient-reported information on medication effectiveness and harms. Dr. Rodondi is an advisor to, a medication therapy management company. All remaining authors declare that they do not have a conflict of interest

Supplementary material

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ESM 1 (DOCX 18 kb)


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Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  • Francesca M. Nicosia
    • 1
    • 2
    • 3
    Email author
  • Malena J. Spar
    • 1
    • 2
  • Marilyn Stebbins
    • 4
  • Rebecca L. Sudore
    • 1
    • 2
  • Christine S. Ritchie
    • 1
    • 5
  • Kirby P. Lee
    • 4
  • Kevin Rodondi
    • 4
  • Michael A. Steinman
    • 1
    • 2
    • 5
  1. 1.Division of GeriatricsUniversity of California, San FranciscoSan FranciscoUSA
  2. 2.San Francisco Veterans Affairs Medical CenterSan FranciscoUSA
  3. 3.Institute for Health & AgingUniversity of California, San FranciscoSan FranciscoUSA
  4. 4.Department of Clinical Pharmacy, School of PharmacyUniversity of California, San FranciscoSan FranciscoUSA
  5. 5.San Francisco Campus for Jewish Living Center for Research in AgingSan FranciscoUSA

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