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J Eval Clin Pract. 2010 Feb;16(1):69-75. doi: 10.1111/j.1365-2753.2008.01116.x.

GPs' perceptions of multiple-medicine use in older patients.

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1
Department of Pharmacy, Uppsala University, Uppsala, Sweden and NEPI Foundation, Stockholm, Sweden. moen.janne@gmail.com

Abstract

RATIONALE, AIM AND OBJECTIVE:

Multiple-medicine use (polypharmacy) is a growing problem for older patients, prescribers and health policy makers. The general practitioner (GP) is most often the main professional care provider; hence, improvements of treatment can only be carried out in concordance with GPs. The aim of this study was, therefore, to explore GPs' perspectives of treating older users of multiple medicines, using a qualitative approach.

METHOD:

Six focus groups, with four private GPs and 27 county-employed GPs, were analysed by using the framework method.

RESULTS:

In contrast to definitions in most epidemiologic studies, the GPs gave a spontaneous definition of polypharmacy as 'the administration of more medicines than are clinically indicated'. They had problems stating both a cut-off number and which medicines should be included. Clinical practice guidelines were thought of as 'medicine generators', having an ambiguous effect on the GPs, who both trust them and find them difficult to apply. There was a perceived lack of communication between GPs and hospital specialists concerning their patients' medicines, which was further perceived to reduce treatment quality. The influence of patient pressure was acknowledged by the GPs as a factor contributing to the development of multiple-medicine use.

CONCLUSIONS:

The GPs felt insecure although surrounded by clinical practice guidelines. There is a need for policy makers to appreciate this paradox, as the problem is likely to grow in size and proportion. GPs must be empowered to handle the increasing proportion of older users of multiple medicines with individual agendas, receiving care from multiple specialists.

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