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Optimising medication management for polymedicated home-dwelling older adults with multiple chronic conditions - ME@home

English title Optimising medication management for polymedicated home-dwelling older adults with multiple chronic conditions - ME@home
Applicant Verloo Henk
Number 183434
Funding scheme NRP 74 Smarter Health Care
Research institution Institut Santé & Social HES-SO/Valais
Institution of higher education University of Applied Sciences and Arts Western Switzerland - HES-SO
Main discipline Medico-Social Problems of the Elderly
Start/End 01.02.2019 - 31.01.2022
Approved amount 322'371.00
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All Disciplines (2)

Discipline
Medico-Social Problems of the Elderly
Health

Keywords (12)

Medication management; Retrospective quantitative analysis ; Multidimensional; Multi-stakeholder approach; Prospective qualitative analysis; Polymedication; Resident Assessement Instrument; Multiple chronic conditions; Home dwelling older adults; Frailty; Patient centred research; Medication related problems

Lay Summary (French)

Lead
L’utilisation de plusieurs médica-ments peut entraîner des effets indésirables et des situations dan-gereuses pour les personnes âgées atteintes de maladies chroniques qui vivent à domicile. L’étude exa-mine comment la gestion des mé-dicaments peut être rendue plus sûre pour ce groupe de personnes.
Lay summary
Titre: Une gestion des médicaments plus sûre pour les personnes âgées vivant à domicile

Les personnes âgées souffrant de maladies chroniques prennent souvent un nombre important de médicaments en même temps. Une bonne gestion de la médication est un défi majeur, en particulier pour les personnes vivant à domicile. Cependant, les expériences des personnes âgées elles-mêmes et de leurs proches aidants (p. ex. membres de la famille, amis, voisins) en matière de gestion des médicaments n’ont fait l’objet que de peu de recherches.

L’objectif de l’étude est, en premier lieu, d’identifier les facteurs qui peuvent conduire à des effets indésirables ou à des situations dangereuses liés à la prise d’un nombre important de médicaments chez les personnes âgées vivant à domicile. En deuxième lieu, l’expérience de ces personnes en matière de gestion des médicaments sera étudiée. Enfin, les rôles de leurs soignants, professionnels et proches aidants seront analysés.

Dans un premier temps, environ 50 000 dossiers électroniques de personnes âgées vivant à domicile avec des maladies chroniques ayant été hospitalisées à l’Hôpital du Valais seront étudiés. Cette analyse vise à fournir des résultats probants sur les facteurs de risque amenant à des effets indésirables ou à des situations dangereuses associés à la prise de médicaments chez les personnes âgées vivant à domicile. Dans un deuxième temps, 30 personnes âgées et leurs soignants, professionnels et proches aidants respectifs seront interrogés sur leur expérience de gestion des médicaments à la maison. Les personnes âgées interrogées seront sélectionnées en fonction des profils de risque établis dans la première étape de la recherche.   

Sur la base des résultats de la recherche, des recommandations seront formulées sur la façon de rendre plus sûre la gestion des médicaments pour les personnes âgées vivant à domicile avec des maladies chroniques. Il s’agit ainsi d’éviter les effets indésirables et les situations dangereuses associés à une mauvaise gestion des médicaments, qui peuvent conduire à terme à l’hospitalisation ou à l’admission dans les maisons de retraite, voire à un décès prématuré.
Direct link to Lay Summary Last update: 31.01.2019

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Abstract

Current demographic transitions indicate that a significant proportion of old (over 65) and very old adults in the future will have crippling chronic diseases or unstable multimorbidity that requires several treatment components involving complex medication regimens. This frail population may experience health-related problems, hospitalisations or readmissions due to the acute symptoms of their illnesses, often resulting in medication-related problems (MRPs). Accurate management of their medication treatment is a real challenge for frail older adults with multiple chronic conditions (OAMCC), especially when living at home. The literature in this area currently focuses on health care professionals’ perspectives, to which patients’ and informal caregivers’ perspectives and experiences are often secondary. It is essential to identify OAMCC and the greatest risks they face with polymedication. Their experiences and specific medication treatment practices at home, in addition to the implications of these for their various professional and non-professional caregivers, must be further understood.Three main objectives will guide this project. The first is to carry out a retrospective analysis of patients’ hospital records, their medication and environment-related factors in order to identify those that increase the risks of hospitalisation, emergency department (ED) visits, readmissions (notably due to MRPs), institutionalisation or early death among polymedicated, home-dwelling OAMCC, whether they are non-frail, frail or dependent. The second objective is to use a prospective qualitative study to explore and better understand the medication experiences and practices of the different profiles of home-dwelling OAMCC. We will seek to identify the skills and strategies they have developed to manage polymedication within their social contexts and health trajectories, despite possible cognitive impairments and particularly after recent hospitalisation. The third objective is to better understand the roles and coordination of the different caregivers involved in the medication management of home-dwelling OAMCC. We will investigate the perspectives of both professional caregivers (community health care nurses, pharmacists, GPs or specialist physicians) and non-professional/informal caregivers (family members, friends or neighbours). A mixed methods study will address the medication management of polymedicated, home-dwelling OAMCC. This will involve two major phases conducted sequentially over time: a quantitative data collection phase followed by a qualitative investigative phase. To fulfil the first objective, a quantitative phase will consist of retrospectively exploiting the last five years of electronic patient records from the Valais Hospital in order to identify the different profiles-made up of medication and environment-related factors-of the polymedicated, home-dwelling OAMCC at risk of hospitalisation, ED visits, hospital readmission (notably for MRPs), institutionalisation or early death. All home-dwelling OAMCC with somatic and/or mental health disorders who were hospitalised, rehospitalised or consulted the Valais Hospital’s ED between 2013 and 2017 (estimated N = 50,000) will be included. To respond to our second and third objectives, a qualitative study will draw upon a feasibility study which is currently in progress and was approved by the CER-VD as of 5 July 2017 (2017-01025). Its findings have been accepted for publication in Patient Preference and Adherence. This qualitative study will involve: - obtaining and understanding the medication management practices and experiences of the identified profiles of OAMCC extracted from the hospital data, which will allow us to make a purposive sample of patients-of those polymedicated, home-dwelling OAMCC who present with the most risk factors. The older adults will be interviewed at home (N = about 30 polymedicated OAMCC, until saturation of data) on two separate occasions. This methodology will allow us to analyse the evolution of their medication practices and experiences. The data collection tools include a walking-interview based on a medication journal. This will allow us to focus on the concrete practices of OAMCC and contextualise them within the private spaces of their daily lives. - collecting and analysing the perspectives of the formal and informal caregivers involved in medication management at home in order to cross-reference perspectives about this important dimension of care at home. These participants will be designated by the OAMCC themselves. Informal caregivers will be interviewed in a joint interview with the OAMCC to confront their experiences. Formal caregivers will be interviewed on their point of view on the OAMCC's medication management at home. The research results will allow us to then develop an innovative, integrated model for supporting this frail population. Concrete, interprofessional recommendations will be established, integrating the retrospective analysis of the electronic data of hospitalised older patients, the direct perspectives of this population and those of the parties involved in the management of their medication treatment at home. These recommendations will aim to support treatment management and avoid potentially harmful consequences, including falls, acute confusion, rehospitalisation and/or institutionalisation, or early death.The collaboration between researchers from different disciplines and institutions, and their cooperation with clinicians at the Valais Hospital and Sion’s Community Healthcare Centre, as well as members of the Valais Medical Society and the Valais Pharmacists’ Association, will ensure that this research project is based on real-world situations and needs and is optimally integrated and supported throughout its implementation.
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