Abstract
Background: Population ageing and improvements in healthcare mean the number of people living with two or more chronic conditions, or ‘multimorbidity’, is rapidly increasing. This presents a challenge to current disease-specific care delivery models. Adherence to prescribed medications appears particularly challenging for individuals living with multimorbidity, given the often-complex drug regimens required to treat multiple conditions. Poor adherence is associated with increased mortality, as well as wasted healthcare resources. Supporting medication adherence is a key priority for general practitioners (GPs) and practice nurses as they are responsible for much of the disease counselling and medication prescribing associated with chronic illnesses. Despite this, practical resources and training for health practitioners on how to promote adherence in practice is currently lacking. Informed by the principles of patient and public involvement (PPI), the aim of this research was to develop a patient informed e-learning resource to help GPs and nurses support medication adherence. Method: Utilising collective intelligence (CI) and scenario-based design (SBD) methodology, input was gathered from 16 stakeholders to gain insights into barriers to supporting people with multimorbidity who are receiving polypharmacy, strategies for overcoming these barriers, and user needs and requirements to inform the design of the e-learning tool. Results: In total, 67 barriers to supporting people who are taking multiple medications were identified across 8 barrier categories. 162 options for overcoming the identified barriers were then generated. This data was used in the design of a short and flexible e-learning tool for continuous professional development, that has been integrated into general practice and clinical education programmes as a supportive tool. Conclusions: Using CI and SBD methodology was an effective way of facilitating collaboration, idea-generation, and the co-creation of design solutions amongst a diverse group of stakeholders. This approach could be usefully applied to address other complex healthcare-related challenges.
Highlights
Healthcare utilisation and cost in both primary and secondary care is significantly increased with multimorbidity
The current research project brought together general practitioners, practice nurses, pharmacists, medical educators, psychologists, learning technologists, as well as members of the public living with multimorbidity and receiving polypharmacy
In the final stage of the workshop, focused on scenario-based specification of user needs to inform the design of an e-learning tool for health practitioners, a broad range of information and knowledge needs, communication needs, decision-making support needs, behavioural support needs, relational needs, and ‘other’ needs were identified (see Tables 10 and 11 (extended data (Hanlon et al, 2020))
Summary
Healthcare utilisation and cost in both primary and secondary care is significantly increased with multimorbidity (i.e., co-occurrence of two or more chronic conditions). Each additional chronic condition leads to near-exponential increases in both service usage and financial costs (McPhail, 2016) This effect on primary care consultations, hospital outpatient visits and admissions and total healthcare costs occurs independently of age, gender and socioeconomic status (Glynn et al, 2011). Population ageing and improvements in healthcare mean the number of people living with two or more chronic conditions, or ‘multimorbidity’, is rapidly increasing. This presents a challenge to current disease-specific care delivery models. This data was used in the design of a short and flexible e-learning tool for continuous professional development, that has been integrated version 2
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