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Addressing the Polypharmacy Challenge in Older People

The Polypharmacy Challenge Blog

Living with Polypharmacy - part 2

The second session of our Living with Polypharmacy panel at the Chronic Living: quality, vitality and health in the 21st Century conference continued with presentations using a variety of methods to make the work of polypharmacy visible.

I presented data from Video Reflexive Ethnography (VRE) workshops with GPs to show a hidden side of medicines talk focusing on the emotions primary care staff feel when faced with stopping or starting a patient's medicines. The VRE method invites professionals to view and reflect on video clips of their practice. One emotion featured heavily in professional talk: fear. Particular drugs were entangled with fear concerning how the drug works, harmful side effects it may cause, the patient’s history with the drug, the clinician’s past encounters with the drug, and future prescribing trends which reach media and public attention. The entanglement of emotional work in prescribing raises questions about interventions to reduce polypharmacy which rely solely on one kind of knowledge: scientific evidence and clinical safety.

We then welcomed Olga Kits - speaking as dawn was breaking from Halifax Nova Scotia, Canada - who took us through her research journey to redefine polypharmacy. Olga was initially inspired to research polypharmacy after seeing mainstream medical journals describe polypharmacy ‘as a necessary evil’ or requiring a war-like attitude to beat it. Olga’s research site was a long-term care facility where she spent a year following the medication; where the medication ‘doings’ and ’sayings’ took place. Focusing on the practices individuals were engaged in, enabled a move away from the portrayal of polypharmacy as a side effect of poor prescribing habits by individuals to consider the everyday institutional practices which allow polypharmacy to exist. Given the pervasive growth of polypharmacy globally, Olga argued that we cannot explain it away through individual behaviours.

Next up was Sarah Spencer, a GP and Academic Clinical Fellow, who presented her detailed work on how informal carers experience polypharmacy in the home. Sarah spent time with eight carers from a carer support group, interviewing them about their role in the daily lives of medicines facilitation. Carers' experience of managing medicines has largely been omitted from the literature and without the carer’s perspective, we fail to fully understand polypharmacy. Through the interviews, Sarah showed the daily struggles and moral dilemmas informal carers faced in order to encourage independence, foster normality, and maintain relationships. This is turn, shaped medicine practices in the home. While the carers in this study, were very careful about prioritising medication, this was not at the expense of relationships with their loved ones or their desire for a living a normal life.

Finally, Vas Papageorgiou, Kathryn Jones, and Richard Mindham (patient contributor) gave a fascinating talk about a novel trial to investigate whether patients who had recovered from dilated cardiomyopathy (DCM) could withdraw treatments. It’s often the case that patients with recovered DCM do not have symptoms yet are told they need to remain on medication for life. As part of a process evaluation running alongside the trial, Vas and Kathryn interviewed trial staff and patient participants to explore their perspectives of being part of a trial to reduce medication. The trial provided a safe space for patients and professionals to experiment experimenting with reducing medication - trying things out. The trial allowed the opportunity for participants to take ownership of their health by balancing the risks and benefits of taking medication to make an informed decision in relation to their care.

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