Previdoli Giorgia, Simms-Ellis Ruth, Silcock Jonathan, Alldred David Phillip, Cheong V-Lin, Tyndale-Biscoe Savi, Tomlinson Justine, Fylan Beth
Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK.
NIHR Yorkshire and Humber Patient Safety Research Collaboration, Bradford, UK.
Health Expect. 2025 Oct;28(5):e70364. doi: 10.1111/hex.70364.
Older people face numerous challenges when managing multiple medicines. They are required to cope with complicated and changing medicines regimens and coordinate input from multiple health and social care professionals. When not well managed, medicines can cause harm, and older people are more susceptible to the impact of errors. Nevertheless, there is a lack of interventions addressing the multiple tasks required for them to manage polypharmacy at home.
To develop a complex behaviour-change intervention to support medicines self-management for older people living with frailty and polypharmacy using Experience-based Co-design (EBCD).
EBCD was used to create a prototype of a resilient healthcare-informed complex intervention with the potential to improve the safety of, and confidence in, medicines self-management for older people who live at home. Extracts from recordings of interviews about people's experiences of polypharmacy were edited into a short film and shown at meetings to determine priorities. Older people taking 5 or more medicines living with mild-to-moderate frailty, their family members and healthcare professionals then participated in co-design workshops to develop these identified priorities into components of a complex intervention. Two focus groups with healthcare staff, older people, and carers explored potential barriers to implementation.
Shared priorities identified were to support change in the following areas: day-to-day practical medicines management; understanding medicines management systems; and communicating with healthcare teams. A logic model was designed to make explicit the intervention's underpinning theory of change. A five-part complex intervention was developed which addresses behaviours with potential to increase safety in medicines management. Intervention content was mapped to relevant behaviour change techniques to aid clarity, precision and specificity in reporting its characteristics.
Using EBCD we were able to co-develop a novel support intervention to improve safety in medicines management at home for older people living with frailty which incorporated: (1) knowledge of medicines and checking medicines received; (2) organising medicines supply; (3) adherence and self-monitoring when taking multiple medicines; (4) dealing with changes in medicines; and (5) knowledge of help available and how, where and when to seek it.
A member of the public with lived experience of managing medicines in older age was co-applicant and co-author in this study, supported by an advisory group of older people taking multiple medicines or with experience of supporting family members. Their contribution played a key role in shaping a relevant and respectful complex intervention for this population.
老年人在管理多种药物时面临诸多挑战。他们需要应对复杂多变的用药方案，并协调多名健康和社会护理专业人员的意见。如果管理不善，药物可能会造成伤害，而老年人更容易受到用药错误的影响。然而，目前缺乏针对老年人在家中管理多重用药所需的多项任务的干预措施。
采用基于经验的协同设计（EBCD）方法，开发一种复杂的行为改变干预措施，以支持体弱且患有多重用药问题的老年人进行药物自我管理。
运用EBCD方法创建了一个基于医疗保健知识的复杂干预措施原型，该原型有潜力提高居家老年人药物自我管理的安全性和信心。将关于人们多重用药经历的访谈录音片段剪辑成一部短片，并在会议上播放以确定优先事项。然后，患有轻度至中度体弱且正在服用5种或更多药物的老年人、他们的家庭成员以及医疗保健专业人员参加了协同设计研讨会，将这些确定的优先事项发展为复杂干预措施的组成部分。与医护人员、老年人和护理人员进行的两个焦点小组讨论探讨了实施过程中的潜在障碍。
确定的共同优先事项是在以下方面支持改变：日常实际的药物管理；理解药物管理系统；以及与医疗团队沟通。设计了一个逻辑模型，以明确干预措施的潜在变革理论。开发了一个由五个部分组成的复杂干预措施，该措施针对有可能提高药物管理安全性的行为。将干预内容映射到相关的行为改变技术上，以帮助清晰、准确和具体地描述其特征。
通过EBCD，我们能够共同开发一种新颖的支持性干预措施，以提高体弱居家老年人在家中药物管理的安全性，该措施包括：（1）药物知识和核对收到的药物；（2）组织药物供应；（3）服用多种药物时的依从性和自我监测；（4）应对药物变化；以及（5）了解可获得的帮助以及如何、在何处和何时寻求帮助。
一位有老年人用药管理生活经验的公众是本研究的共同申请人和共同作者，由一个服用多种药物或有支持家庭成员经验的老年人咨询小组提供支持。他们的贡献在为该人群塑造一个相关且尊重人的复杂干预措施方面发挥了关键作用。
