Title: Understanding and enhancing medicines management resilience in home-dwelling older people living with frailty.
Funder: Department of Health and Social Care

Abstract: Background: It is an NHS priority to support people to age well. For people living with frailty, the focus of support where possible should be provide tools to self-manage conditions (NHS England, 2019). Patients with frailty are already sensitive to minor stressors and complex medicines regimens can result in further instability and deterioration (Schoonover et al., 2014). Increased complexity of medication regimens is associated with non-adherence and medication errors (Ingersoll et al., 2008), increased risk of hospitalisation and a subsequent disruption in the stability of medication regimen. Aims and objectives: This research aims to explore and improve how older people with mild and moderate frailty and their carers self-manage their medicines using the theory of resilience in healthcare. Specifically our research objectives are to: (i) conduct qualitative research to map the range of strategies used to self-manage medicines of mild and moderately frail older patients and their support networks; (ii) understand how patients and their support networks might anticipate potential system failure, respond to problems they encounter with their medicines or when they perceive deterioration and require support; (iii) critically appraise how the overall medicines management system facilitates older people living with frailty to self-manage their medicines at home; (iv) conduct a rapid review of self-management of medicines intervention components that might enhance healthcare resilience; (v) co-design with patients and primary care staff a resilience-based intervention to support effective self-management of medicines that is flexible to cope with changes in type and quantity of medicines for varying and fluctuating conditions; (vi) iteratively prototype the intervention by assessing potential barriers and facilitators to its use. Methods: We will use a mixed-methods process of qualitative research and co-design, with each stage building on the previous one. The research setting will be primary care in eight GP practices in Yorkshire and Humber. We will use resilience in healthcare as an underpinning theoretical framework. Step one comprises qualitative interviews with 32 patients and carers and 16 healthcare professionals. Data will be mapped onto a resilience analysis grid and then analysed thematically. Step 2 comprises a rapid review of interventions that might contribute to resilience in medicines self-management followed by an adapted experience-based co-design of an intervention with staff and patients. Co-design will comprise a 'trigger film' of patient experiences, a prioritisation event, intervention development workshops and a celebration event. Step 3 is a prototyping stage where potential barriers and facilitators to embedding the intervention in the primary care context are explored qualitatively in four focus groups with healthcare staff (2) and patients (2). Groups will comprise 6-8 participants each. Project delivery will be over 24 months. Anticipated impact and dissemination: We anticipate that the outputs of this research will be an intervention and implementation guidance ready to be evaluated with the target population. We will produce journal articles and conference presentations and work with our patient groups to plan dissemination activities with members of the public. We also intend our co-design film to offer broad insight into how patients manage their medicines at home.

Lay abstract: For older people living at home, managing medicines can be complicated and challenging. They need to organise supplies, cope with changes to their medicine and routines, and take action when they think there have been mistakes or when they feel unwell. Poorly managed medicines may result in falls and being admitted to hospital which could lead to reduced activity and the ability to lead a normal life. Aim To work with older people and their carers to understand: The routines that people use to help them manage their medicines. How they might recognise when they need help or if their health is getting worse. And together develop skills and tools to self-manage medicines and access help from healthcare professionals when it is needed. Our work understand the positive steps people can take to stay safe. We hope that this will reduce harm from medicines and help people stay well. Our focus will be on people who are mildly or moderately frail which means they are at risk of falls, needing to go into hospital or into long-term care. Patient and public involvement Our patient team member has guided and reviewed our plans. We ran a workshop with patients and carers to inform our ideas and spoke with a patient panel. They told us that many older people work hard to manage their medicines safely at home and the work they do should be shared with others so that they can learn from it. We will also set up a patient group to guide this research. What we will do &bull; We will interview 32 older people and their carers to find out about how they manage medicines, how they get help, their strategies and routines, and what they are able to do to overcome problems. We will invite them via their GP practice. We will also interview 16 healthcare professionals in primary and community care to understand how they support patients. &bull; We will then work with groups of patients, carers and healthcare staff in workshops to create tools that patients and their carers can use to manage medicines. We will aim to have 4 patients / carers and two staff members in each workshops and run at least two workshops in each of four areas. &bull; We will ask patients, carers and healthcare staff to assess what has been developed and to see if others would benefit. We will do this by running two focus groups with patients and two with staff members. Dissemination We will present our results to patients, carers and healthcare staff at events and conferences. We will write articles for journals and also for patients and members of the public.

Research activity codes: 7.1 INDIVIDUAL CARE NEEDS
Health categories: GENERIC HEALTH RELEVANCE