Patients’ experiences of a patient-centred polypharmacy medication review intervention: a mixed-methods study

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Abstract
Background: People prescribed multiple medications need regular review to optimise medication and improve health outcomes. Although the most effective method to improve inappropriate polypharmacy remains unclear, medication reviews incorporating patient-centred care and shared decision making are believed to be key to achieving optimal outcomes. Aim: To explore patients’ experiences of an intervention to deliver patient-centred polypharmacy medication review in primary care. Design and setting: A mixed-methods process evaluation was undertaken within the Improving Medicines use in People with Polypharmacy in Primary Care (IMPPP) randomised controlled trial conducted in the Bristol and West Midlands regions of England. Method: Participants receiving the intervention were invited to complete a patient experience survey. Additionally, participants were purposively sampled and invited to participate in an interview and/or audio-recording of their medication review, to explore views and experiences. Results: Survey response rate was 72.5% ( n = 556/767); 28 patients were interviewed, 27 reviews were recorded. Overall, 73.2% ( n = 407) were satisfied with their review, strongly associated with shared decision making, and 79.9% ( n = 444) expressed satisfaction with how the review was delivered (primarily pharmacist-led telephone consultations). Most audio-recordings of reviews demonstrated collaborative decision making. Patients valued reviews when they felt well-informed, prepared, and received clear follow-up. Pharmacist-led delivery was acceptable, although unfamiliarity with the reviewer and concerns about prescribing authority were perceived negatively. Conclusion: Participants were satisfied with their review, although this may be contingent on preparation and support. Findings highlight the importance of communication throughout, and how the clinician role and familiarity shape patient experience. A person-centred review approach has the potential to improve patient experience, satisfaction, and engagement.

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