How can shared decision making be enacted in polypharmacy medication reviews in primary care? A mixed-methods study

The problem

The number of people who take multiple medicines regularly is increasing. These medicines need to be carefully monitored by healthcare professionals and patients to check that the medicines are not causing problems. It is important that people
taking multiple medicines can share their concerns and discuss their medicines with healthcare professionals. Medication reviews are carried out in primary care by doctors and clinical pharmacists. NHS guidelines state that decisions about any
changes to prescribing should be made with patient involvement. We do not currently know much about how medication reviews are carried out or how people taking multiple medicines are involved in making shared decisions with the person
leading their review.

Aim

To understand how decision making in medication reviews is shared between the healthcare professional leading the review and the patient.

How will we do this

In this study we will:
1) Review academic literature to see if there is any guidance about how to involve patients in making decisions in complex
situations where multiple decisions need to be made.
2) Investigate what happens in medication reviews by re-visiting transcripts of the 27 reviews that were carried out as part of the Improving Medicines use in People with Polypharmacy in Primary care (IMPPP) study. These have been transcribed (typed up) and made available for other researchers to use. We will explore how decisions are made in these reviews and what role the patient has in making decisions about their medicines. We will do this by coding the transcripts each time we identify an element from a standardised ‘shared decision-making’ framework. This will help us to identify what happens and what is missing.

Why?

We want to do this work to help us to make improvements to the way decisions are made in medication reviews for people
who take multiple medications.

What next?

This work is an important first step in understanding how decisions are made during medication reviews for people who take multiple medications. Our results will be used to suggest ways to improve shared decision making in medication reviews for
people who take multiple medications. We will produce an accessible version of our results to share widely with people who take multiple medications.