Background

Patients with polypharmacy are challenged with the management of their daily medication. Medication management strategies for direct oral anticoagulants (DOAC) are especially important to guarantee medication adherence and to prevent thromboembolic events. Patients are often left alone with finding an appropriate strategy.

Objective(s)

To explore medication management strategies, to measure adherence to DOAC with the aim of deducing recommendations for practice.

Methods

Face-to-face semi-structured interviews were conducted at the home of outpatients who were taking ≥4 medications daily including a DOAC, and self-managing their medication. A small electronic device (Time4Med™) was given to record medication intake during the four following weeks. During a second home visit, participants saw a graph of their medication intake as dot chart, and obtained a feedback. Interviews were transcribed verbatim and thematically analysed. Medication adherence was calculated with electronic data.

Results

Eighteen individuals (61.1% female; median age 77.5 years) were interviewed and reported 30 different medication management strategies, together with triggers, advantages and limitations. They combined at least five strategies, composed of internal (memory-based) and external (packaging-based or intake-based) strategies. The number of strategies was neither associated with the number of medications nor with medication adherence. Taking adherence was <100% for eight patients (44.4%). The inability of any medication management strategy to adapt to ageing and cognitive decline emerged as its most dramatic limitation, especially because individuals would fail to notice when their strategy became unsuited.

Conclusions

Elderly patients develop manifold medication management strategies, which can inspire future medication users. Limitations are present such as forgetting medication intake in spite of a management strategy. The moment to adapt the strategy to ageing or cognitive decline is crucial and often goes unnoticed. It is therefore decisive that healthcare professionals regularly re-evaluate the appropriateness of the medication management strategies during counselling or ideally during home visits.

中文翻译：

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老年门诊患者如何管理包括 DOAC 在内的多种药物治疗 - 一项强调咨询需求的定性分析

背景

服用多种药物的患者在日常用药管理方面面临挑战。直接口服抗凝剂 (DOAC) 的药物管理策略对于保证药物依从性和预防血栓栓塞事件尤为重要。患者常常独自寻找合适的策略。

目标

探索药物管理策略，衡量对 DOAC 的依从性，以推导出实践建议。

方法

在门诊患者的家中进行面对面的半结构化访谈，这些患者每天服用≥4 种药物，包括 DOAC，并自行管理药物。一个小型电子设备 (Time4Med™) 被用于记录接下来四个星期的药物摄入量。在第二次家访期间，参与者将他们的药物摄入量图表显示为点状图，并获得了反馈。采访被逐字转录并进行主题分析。使用电子数据计算药物依从性。

结果

18 人（61.1% 女性；中位年龄 77.5 岁）接受了采访，并报告了 30 种不同的药物管理策略，以及触发因素、优势和局限性。他们结合了至少五种策略，由内部（基于记忆）和外部（基于包装或摄入）策略组成。策略的数量既与药物数量无关，也与药物依从性无关。8 名患者 (44.4%) 的依从性低于 100%。任何药物管理策略都无法适应衰老和认知能力下降成为其最大的局限性，特别是因为当他们的策略变得不合适时，个人不会注意到。

结论

老年患者制定了多种药物管理策略，可以激励未来的药物使用者。尽管有管理策略，但仍存在一些限制，例如忘记服药。使策略适应衰老或认知衰退的时刻至关重要，而且往往被忽视。因此，医疗保健专业人员在咨询期间或理想情况下在家访期间定期重新评估药物管理策略的适当性是决定性的。