'I just take them because I know the people that give them to me': A theory‐informed interview study of community‐dwelling people with dementia and carers' perspectives of medicines management. (10th January 2021)

• Record Type: Journal Article
• Authors: Barry, Heather E.; McGrattan, Máiréad; Ryan, Cristín; Passmore, A. Peter; Robinson, A. Louise; Molloy, Gerard J.; Darcy, Carmel M.; Buchanan, Hilary; Hughes, Carmel M.
• Is Part Of: International journal of geriatric psychiatry. Volume 36:Number 6(2021)
• Page Start: 883
• Page End: 891
• Publication Date: 2021-01-10
• Subjects: beliefs about medicines -- carers -- dementia -- medicines management -- primary health care -- qualitative research -- theoretical domains framework; Geriatric psychiatry -- Periodicals; Geriatric Psychiatry -- Periodicals; 618.97689
• DOI: 10.1002/gps.5488
• Languages: English
• ISSNs: 0885-6230

Abstract

Abstract: Objective: Identify facilitators and barriers to successful medicines management for people with dementia (PwD) in primary care from the perspectives of community‐dwelling PwD and carers. Methods: Semi‐structured interviews conducted with PwD and carers in Northern Ireland. The 14‐domain Theoretical Domains Framework guided data collection and analysis. Interviews explored participants' experiences and perceptions of medicines management. PwD also completed the Beliefs about Medicines Questionnaire indicating their level of agreement with statements about medicines. Qualitative data were analysed using the framework method and content analysis. Quantitative data were analysed descriptively. Results: Eighteen PwD and 15 carers were interviewed. PwD believed they were competent with medicines management ('beliefs about capabilities'). Most PwD reported having strategies to prompt them to take their medicines ('memory, attention and decision processes'). Carers played an important role in supporting PwD with medicines management ('social influences') and monitoring adherence ('behavioural regulation') and anticipated having to take on a greater role as patients' cognitive impairment worsened ('beliefs about consequences'). Participants highlighted assistance provided by community pharmacies with medicines acquisition and delivery ('environmental context and resources') and placed great trust in primary healthcare professionals ('social influences'). PwD had positive attitudes towards medication and believed strongly in the necessity of their medicines. Conclusions: This is the first study to use a theoretical approach to explore medicines management for community‐dwelling PwD. The findings provide new insights into the critical role of carers in facilitating optimal medicines management and will inform future intervention development, in which carers' needs assessment and involvement will be key. Key Points: This study used qualitative methods to explore the experiences of community‐dwelling people with dementia (PwD) and their carers about medicines management. The beliefs of PwD about medicines were also determined using a validated questionnaire PwD generally did not perceive medicines management to be an issue for them at the time of interview and they displayed positive beliefs about medicines. All of the PwD interviewed had carer assistance with medicines. Carers were concerned about the future and how medicines management may become more problematic as the PwD's cognitive and functional abilities declined These findings are in contrast with the views of primary healthcare professionals and other findings previously reported in the literature, where issues and concerns about adherence to medication in particular are highlighted Carers will be a fundamental part of any future intervention that is developed to improve medicines management for PwD. Understanding how PwD, and especially those living alone, manage their medicines at different stages of the disease trajectory is needed to inform future interventions