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Medication management strategy for older people with polypharmacy: the GP's perspective.

Sinnige, J., Korevaar, J.C., Lieshout, J. van, Westert, G.P., Schellevis, F.G., Braspenning, J.C.C. Medication management strategy for older people with polypharmacy: the GP's perspective. Abstract. In: Abstractbook 21st WONCA Europe Conference. 15-18 juni 2016, Kopenhagen. OP47.1
Background
For older patients with polypharmacy medication management is a process of careful deliberation that needs periodic adjustment based on treatment effects and changing conditions.

Aim
The aim of this study is to gain insight into the GP's medication management strategy for patients with polypharmacy, and to explore the GP's perspectives and needs on decision making support to facilitate this medication management.

Method
For this qualitative study, two focus group meetings were organized with experienced Dutch GPs. Questions about medication management of four representative clinical case vignettes with multimorbidity and polypharmacy were answered individually. The strategy chosen in each case was discussed plenary. Analysis followed a Framework approach.

Results
Twelve GPs described a similar strategy regarding the patients' management, namely:
1) Defining treatment goals;
2) Determining the primary goal(s);
3) Adjusting medications based on the treatment effect, GP's and patient's preferences, and patient characteristics.
There was variation in the execution of this strategy between the GPs. for example, GPs differed in their focus on clinical values versus the reason for encounter, and some GPs determined one primary goal while others focused on several goals simultaneously. The GPs liked to discuss their choices with the other professionals. Furthermore, they valued structured medication reviews with the patient, and quick and practical tools that worked on demand.

Conclusions
To facilitate decision making a more extensive and structured collaboration between health care professionals is desired, as well as support to execute structured medication reviews with eligible patients.