MEMORABLE: MEdication Management in Older people: Realist Approaches Based on Literature and Evaluation

Abstract

BackgroundOlder people are major users of medication. As people get age, the balance between benefits and harms for medication changes. Medication management by healthcare practitioners (for example, pharmacists, doctors, and nurses) is designed to help older people take the appropriate medication. Current evidence indicates that medication management is a complex process that is not easy to do well.AimThe aim of MEMORABLE, funded by the NIHR, is to understand how medication management works and how it might be implemented effectively.MethodMEMORABLE uses realism to understand how, why, for whom, and in what circumstances medicines management works. Realism is a theory-driven approach using primary and secondary data to make sense of complex interventions (for example medicines management), where outcomes are context sensitive. This is the first-time worldwide that realism has been used for this long-standing problem. MEMORABLE uses the literature (secondary data) and interviews (primary data). Data will be synthesised across datasets to set out and refine programme theories, about how medication management works, and develop a framework to improve practice.ResultsThree candidate programme theories (older people, informal carers, and practitioners) were identified from the literature and interviews. These programme theories will be explored against a 5-stage medication management process, conceived as a framework for analysis of the data. Emerging mechanisms of interest, burden, capacity, and needs/concerns are being explored.ConclusionMEMORABLE, which ended in December 2018, is using an innovative methodology, applied collaboratively, to develop an outcome-focused, evidence-based framework enhance medication management.