Abstract
BackgroundMedication adherence is vital to ensuring optimal patient outcomes, particularly amongst multimorbid older people prescribed multiple medications. Interventions targeting adherence often lack a theoretical underpinning and this may impact on effectiveness. The theoretical domains framework (TDF) of behaviour can aid intervention development by systematically identifying key determinants of medication adherence.ObjectivesThis study aimed to (i) identify determinants (barriers, facilitators) of adherence to multiple medications from older people's perspectives; (ii) identify key domains to target for behaviour change; and (iii) map key domains to intervention components [behaviour change techniques (BCTs)] that could be delivered in an intervention by community pharmacists.MethodFocus groups were conducted with older people (>65 years) receiving ≥4 medications. Questions explored the 12 domains of the TDF (eg “Knowledge,” “Emotion”). Data were analysed using the framework method and content analysis. Identification of key domains and mapping to intervention components (BCTs) followed established methods.ResultsSeven focus groups were convened (50 participants). A wide range of determinants were identified as barriers (eg forgetfulness, prioritization of medications) and facilitators (eg social support, personalized routines) of adherence to multiple medications. Eight domains were identified as key targets for behaviour change (eg “Social influences,” “Memory, attention and decision processes,” “Motivation and goals”) and mapped to 11 intervention components (BCTs) to include in an intervention [eg “Social support or encouragement (general),” “Self‐monitoring of the behaviour,” “Goal‐setting (behaviour)”].ConclusionThis study used a theoretical underpinning to identify potential intervention components (BCTs). Future work will incorporate the selected BCTs into an intervention that will undergo feasibility testing in community pharmacies.
Highlights
Medication adherence is vital to ensuring optimal patient outcomes, amongst multimorbid older people prescribed multiple medications
The objectives of this study were to (i) identify determinants of adherence to multiple medications from the viewpoint of older adults; (ii) select key theoretical domains framework (TDF) domains to target to achieve desired changes; and (iii) map key domains to appropriate behaviour change techniques (BCTs) that could be included in an intervention that could feasibly be delivered by community pharmacists
This study formed part of a multiphase research project that aimed to improve treatment outcomes in older patients by targeting health-care professionals (HCPs)’ clinical behaviours [ie appropriate prescribing and dispensing of polypharmacy (≥4 medications5) by general practitioners (GPs) and community pharmacists]20,21 and patients’ medication adherence behaviours. It was intended at the outset of the project that any intervention to improve adherence to multiple medications in older people in primary care would be delivered by community pharmacists
Summary
Medication adherence is vital to ensuring optimal patient outcomes, amongst multimorbid older people prescribed multiple medications. The theoretical domains framework (TDF) of behaviour can aid intervention development by systematically identifying key determinants of medication adherence. Non-adherence to prescribed regimens can result in negative clinical outcomes for older patients, as well as increased use of health- care resources (eg increased contact with primary health-care teams, emergency department visits, hospitalizations) and higher associated costs (eg medication wastage).[1,6] Globally, it is estimated that medication non-adherence results in annual avoidable costs of approximately US$270 billion.[7] The scale of the problem is considered to be equivalent to a major disease epidemic and continues to be a key priority for policymakers, researchers and health-care professionals (HCPs) worldwide.[6,8] Despite variation in estimated rates of non- adherence in older adults (range 25%-75%),[9] it is clear that there is considerable potential for improvement in this population group
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