Improving medication management for patients with multimorbidity in primary care: a qualitative feasibility study of the MY COMRADE implementation intervention

Abstract

Background: For the majority of patients with multimorbidity, the prescription of multiple long-term medications (polypharmacy) is indicated. However, polypharmacy poses a risk of adverse drug events, drug interactions and excessive treatment burdens. To help general practitioners (GPs) conduct more comprehensive medication reviews for patients with multimorbidity, we developed the theoretically-informed MultimorbiditY COllaborative Medication Review And DEcision Making (MY COMRADE) implementation intervention. In this study, we assessed the feasibility and acceptability of MY COMRADE by GPs.

Methods: A non-randomised feasibility study using a qualitative framework approach was conducted. General practices were recruited by purposively sampling from interested GPs attending continuing professional development meetings (CPD) in southwest Ireland. Participating practices were instructed on the MY COMRADE implementation intervention which has five components: (i) action planning; (ii) allocation of protected time; (iii) peer-supported medication review; (iv) use of a prescribing checklist and (v) self-incentives (allocation of CPD points). GPs in participating practices agreed to conduct medication reviews on multimorbid patients from their own caseload using the MY COMRADE approach. After completing these reviews, qualitative interviews were conducted to evaluate GPs' experiences of the intervention and were analysed using the framework method.

Results: GPs from ten practices participated in the study. The GPs reported that MY COMRADE was an acceptable approach to implementing medication review in general practice, especially for complex patients with multimorbidity. Action plans for the medication reviews varied between practices, but all reviews led to recommendations for optimising medications and patient safety. Many GPs felt that using the MY COMRADE approach would ultimately lead to more efficient use of their time, but a minority felt that the time and cost implications of using two GPs to review medications would not be sustainable unless greater incentives were used.

Conclusions: This study demonstrates that MY COMRADE is an acceptable and feasible approach to supporting comprehensive medication reviews for patients with multimorbidity. These findings indicate that a large scale trial of the effectiveness of MY COMRADE is now required to fully evaluate its potential to change prescribing behaviour and improve downstream outcomes such as prescribing appropriateness and treatment burden.

Trial registration: ISRCTN registry: ISRCTN34837446.

Fig. 1

Key steps in the development and feasibility testing of the MY COMRADE intervention, following stages of the UK Medical Research Council guidance on the development and evaluation of complex interventions in healthcare [30]