By Dr Iuri Marques and Dr Daisy Payne
In our autumn newsletter (http://yhpstrc.org/newsletter/) we discussed our work on improving the management of medicines by optimising the process of stopping problematic medicines in primary care. Here we move our focus to how we are capturing patient views about reducing the number of medicines they take.
As people get older and develop health conditions, many are prescribed long-term medicines. With time, more health conditions may develop, more medicines are prescribed and patients risk experiencing medicines-related problems as well as decreased quality of life or frequent unplanned hospital admissions. Patients may also be treated by multiple healthcare professionals in both primary and secondary care at different times. For example, if a patient is admitted to hospital, a consultant may decide to stop one or more medicines, and when the patient is discharged into primary care, the GP may decide to restart them. Consequently, managing medicines is a complex process, and one that can be quite confusing and upsetting for the patient.
The Safe Use of Medicines theme for the NIHR Yorkshire and Humber PSTRC is investigating how we can improve the process of stopping medicines for patients, ensuring the patient understands the reasons behind any decision being made, and takes an active role in the discussions about their care and medicines. We believe that since the process of stopping medicines is so complex, it is important to hear the voices of everyone involved. The first step we took was to engage with patients and members of the public in the development of our study, to ensure we focused on the important aspects of the process and asked the right questions. They were instrumental in identifying research priorities and co-designing all participant documents so that they were patient friendly. Now, we are interviewing patients who have recently had a medicine stopped, their supporting peers (i.e. friends or relatives who play an active role in the management of patients’ medicines and conditions) and healthcare professionals, to understand their views and experiences.
The healthcare professionals we have interviewed have given us invaluable insight into the process of reducing medicines, including the purpose, usefulness and clinical justification for stopping a medicine and how they communicate this to their patients. However, whilst they are able to reflect on this process, only the patients themselves can provide insight into what it is like to live with these decisions. It is crucial therefore that we speak to patients, since they can provide insights and relate experiences that healthcare professionals cannot.
As well as talking to patients, we are talking to supporting peers – people who are not part of the formal health and care team yet have some involvement in managing patients’ medicines. Supporting peers add a unique and currently unexplored insight into the experiences of patients when medicines are stopped. Their views about what is best for the patient, and their care priorities may differ from the priorities of the patient themselves.
Stopping medicines is and will continue to be a complex process. The best way to improve it is by including everyone who is directly or even indirectly involved, understand their views and experiences, and ultimately give them a voice in how care is delivered in the future.
This research is funded by the National Institute for Health Research (NIHR) Yorkshire and Humber Patient Safety Translational Research Centre (NIHR Yorkshire and Humber PSTRC). The views expressed in this article / presentation are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care