A qualitative study to understand multimorbidity and polypharmacy through engaging an underserved minority elderly group
Introduction: Having multiple chronic medications increases the risk of adverse drug events (ADE) among elderly patients, particularly those residing in medically underserved communities. A gap still exists about medication-related problems (MRP) and intervention strategies for minority older adults, which is highly relevant to advance pharmacy practice in providing culturally appropriate services and reduce health disparities.
Research Question or Hypothesis: What is the perception of MRP by minority elderly patients with polypharmacy? What are the potential strategies to improve medication management?
Study Design: A qualitative study with a multi-disciplinary patient centered focus group
Methods: Patients were engaged based on the Patient-Centered Outcomes Research Institute (PCORI) engagement rubric for research. Patients (age 65 years or older) taking five or more medications were recruited from a historically Black community in Houston, Texas. Structured open-ended questions were adapted from the principles of the Asset-Based Community Development (ABCD) process to guide discussion on research questions. Meetings were recorded and transcribed verbatim. Codes were developed based on the socioecological model. The content analysis in Altas ti, Inc. Responses were categorized into codes by two investigators independently, cross-matched, and discussed to resolve discrepancies.
Results: The workgroup consisted of three patients, one caregiver, one physician, one nurse, three pharmacists, three health educators, and one social worker (n=13; 92% African Americans). The workgroup spent two one-hour sessions to discuss the research questions. Patient-level problems reported were medication complexity, forgetfulness, and lack of organization. A common theme related to health-system level problem was confusion regarding excessive prescriptions from multiple providers. Patients suggested creating medication list, medication wallet cards, using a medication reminder app, and bingo games related to standard labels on prescription bottles.
Conclusion: This study provides important insights into MRP experienced by minority elderly patients and ideas for potential strategies for future interventions.