Optimising medication therapy management for polymedicated home-dwelling older adults with multiple chronic conditions: the ME@HOME study
Optimal medication therapy management is a basic condition to enable polymedicated, home-dwelling older adults, with multiple chronic conditions, to remain at home and preserve their quality of life. A multi-stakeholder approach including older adults, health professionals, informal caregivers and primary health-care institutions is essential to ensure the best possible medication therapy management and prevent medication related problems. The reasons for high numbers of emergency department visits and significant rates of hospitalisation due to medication-related problems have been poorly explored.
To reveal the current state and practices of medication therapy management for polymedicated, home-dwelling older adults with multiple chronic conditions, as well as the roles of the different actors involved and coordination activities between them.
To develop an innovative, integrated model to optimise medication therapy management and prevent medication-related problems by promoting coordination between older adults, their informal caregivers and healthcare professionals.
This explanatory, mixed-method design involves two major phases conducted sequentially. The quantitative phase will retrospectively explore the last three years of electronic patient records from a local hospital (N ≈ 50,000) to identify the different patient profiles—made up of medication and environment-related factors—of polymedicated, home-dwelling older adults with multiple chronic conditions and an increased risk of hospitalisation, emergency department visits, hospital readmission, institutionalisation or early death. Regional profiles will be compared with national data from similar acute hospitals. The profiles identified in the retrospective investigation will be used to select participants for the qualitative investigation. The prospective qualitative phase will investigate the medication management practices and experiences of the older adults presenting with the profiles identified in the first phase (N ≈ 30), as well as the perspectives of the formal (N ≈ 30) and informal caregivers (N ≈ 30) involved in their medication management at home. A systematic review will examine the existence and effectiveness of medication management models and interventions for polymedicated, home-dwelling older adults with multiple chronic conditions.