Learning to think differently about polypharmacy
By Deborah Swinglehurst
E-learning resources are one way to share knowledge from research discoveries and to encourage professionals to rethink the way they deliver care. Here, Deborah Swinglehurst takes us through a new module to encourage a different way of thinking about polypharmacy and multimorbidity.
When I applied for my research Fellowship, it was always my intention to share with health care professionals what we had discovered through our ethnographic study on living with many medicines and health conditions. Polypharmacy (when people are prescribed many medicines) is a challenging and complex problem. Yet it is a problem that receives relatively little attention. Dealing with polypharmacy often leaves GPs feeling perplexed. What should they do when faced with a patient who has a very long list of medicines? Tackling polypharmacy may involve difficult decisions around reducing or stopping medicines when the evidence to support this is missing. GPs have to use their clinical judgment and be willing to engage in careful negotiation with their patient to work out what to do.
We wanted to develop e-learning materials that enable GPs to recognise this challenge whilst also finding ways of introducing changes to their practice which are feasible within an already overcrowded schedule. The modules we have developed with the Royal College of General Practitioners (RCGP) are not prescriptive. There is no simple ‘to do’ list when it comes to polypharmacy. Instead, we invite learners to think differently about polypharmacy and multimorbidity. We hope that in doing so this opens up possibilities for GPs to re-imagine how they approach polypharmacy.
The course consists of three 30-minute modules and two five-minute ‘screencasts’ which give a taster of the three longer modules. The course focuses on dealing with polypharmacy in community settings.
- Module 1 – Polypharmacy, multimorbidity and the treatment burden
This module introduces the concept of ‘burden of treatment’ with a particular focus on how it impacts patients affected by multimorbidity and polypharmacy. We invite clinicians to reflect on how the burden of treatment plays out in the lives of patients and their social networks. We ask clinicinas to consider how they might apply this concept to improve their care of older patients with multimorbidity. - Module 2 – Polypharmacy, multimorbidity and the medication review
This module asks clinicians to reflect on how they go about doing a medication review. Many factors shape how medication reviews play out in practice. Practitioners taking this module will reflect on the purpose of medication reviews, what makes a good medication review, how to approach conversations about medicines with patients and some of the factors which influence how a medication review proceeds. - Module 3 – Medicines: whose knowledge counts?
This module introduces the concept of epistemic injustice – a form of prejudice that arises from a wrong done to someone in their capacity as a ‘knower’. Using polypharmacy as a case example, GPs will learn how the circulation of epistemic injustice within the health care system disempowers people and can lead to inertia. This module will equip GPs with tools on how to challenge epistemic injustice in the context of polypharmacy.