title: GPs' perceptions of multiple-medicine use in older patients.
abstract: OBJECTIVE
  Multiple-medicine use (polypharmacy) is a growing problem for older patients, prescribers and health policy makers. The general practitioner (GP) is most often the main professional care provider; hence, improvements of treatment can only be carried out in concordance with GPs. The aim of this study was, therefore, to explore GPs' perspectives of treating older users of multiple medicines, using a qualitative approach.
  
  
  METHODS
  Six focus groups, with four private GPs and 27 county-employed GPs, were analysed by using the framework method.
  
  
  RESULTS
  In contrast to definitions in most epidemiologic studies, the GPs gave a spontaneous definition of polypharmacy as 'the administration of more medicines than are clinically indicated'. They had problems stating both a cut-off number and which medicines should be included. Clinical practice guidelines were thought of as 'medicine generators', having an ambiguous effect on the GPs, who both trust them and find them difficult to apply. There was a perceived lack of communication between GPs and hospital specialists concerning their patients' medicines, which was further perceived to reduce treatment quality. The influence of patient pressure was acknowledged by the GPs as a factor contributing to the development of multiple-medicine use.
  
  
  CONCLUSIONS
  The GPs felt insecure although surrounded by clinical practice guidelines. There is a need for policy makers to appreciate this paradox, as the problem is likely to grow in size and proportion. GPs must be empowered to handle the increasing proportion of older users of multiple medicines with individual agendas, receiving care from multiple specialists.
authors.affiliation: Department of Pharmacy, Uppsala University, Uppsala, Sweden and NEPI Foundation, Stockholm, Sweden. moen.janne@gmail.com
authors.forename: Janne
authors.initials: J
authors.lastname: Moen
authors.forename: Sara
authors.initials: S
authors.lastname: Norrgård
authors.forename: Karolina
authors.initials: K
authors.lastname: Antonov
authors.forename: J Lars G
authors.initials: JL
authors.lastname: Nilsson
authors.forename: Lena
authors.initials: L
authors.lastname: Ring
mesh_terms: D000328:Adult; D000368:Aged; D003266:Continuity of Patient Care; D005194:Family Practice; D005260:Female; D017144:Focus Groups; D015577:Geriatric Assessment; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D019338:Polypharmacy; D010818:Practice Patterns, Physicians'; D013548:Sweden