JMIR Publications

ABSTRACT

Background:

Older adults with multiple chronic conditions (MCC) and polypharmacy often face challenges with medication adherence. Non-adherence can lead to suboptimal treatment outcomes, adverse drug events, and poor quality of life.

Objective:

To facilitate medication adherence among older adults with MCC and polypharmacy in primary care, we are adapting a technology-enabled intervention previously implemented in a specialty clinic. The original intervention routinely monitored medication adherence using patient reported outcomes submitted monthly through a patient portal questionnaire; results categorized adherence concerns into one of six domains and notified the clinic for the deployment of existing resources (medication reconciliation, coupons, etc.) to appropriately address each concern. The objective of this study was to obtain multilevel feedback to inform the adaptation of the proposed intervention.

Methods:

We conducted a formative qualitative study among patients, clinicians, and clinic administrators affiliated with a large academic health center in Chicago, IL. Patient eligibility included being aged 65 and older, living with MCC, and contending with polypharmacy. Eligibility criteria for clinicians and administrators included being employed by any primary care clinic affiliated with the participating health center. Individual semi-structured interviews were conducted remotely by a trained member of the study team using interview guides informed by the Exploration, Preparation, Implementation, Sustainment (EPIS) Framework. Thematic analysis of interview audio recordings drew from the Rapid Identification of Themes from Audio Recordings (RITA) procedures.

Results:

In total, we conducted 25 interviews, including 12 with clinicians and administrators and 13 with patients. Thematic analysis revealed participants largely found the intervention idea to be acceptable and appropriate for use with the target population in primary care, though several concerns were raised: 1) some older adult patients may have challenges accessing and using the portal; 2) questionnaires need to be thoughtfully worded so as not to offend patients concerned about loss of independence; 3) monthly delivery of questionnaires may be too frequent a cadence for primary care patients; 4) and without a slower cadence, adherence notifications have the potential to overwhelm busy clinicians.

Conclusions:

Our medication adherence monitoring intervention, adapted from specialty care, will be implemented in primary care. Formative interviews, informed by the EPIS Framework, and conducted among patients, clinicians, and administrators have identified intervention adaptation needs. Results from this study could inform other interventions utilizing the patient portal with older adults. Clinical Trial: NCT05766423