Health professional perspectives on the management of multimorbidity and polypharmacy for older patients in Australia.
delivering appropriate care for patients with multimorbidity and polypharmacy is increasingly challenging. Challenges for individual healthcare professions are known, but only little is known about overall healthcare team implementation of best practice for these patients.



to explore current approaches to multimorbidity management, and perceived barriers and enablers to deliver appropriate medications management for community-dwelling patients with multimorbidity and polypharmacy, from a broad range of healthcare professional (HCP) perspectives in Australia.



this qualitative study used semi-structured interviews to gain in-depth understanding of HCPs' perspectives on the management of multimorbidity and polypharmacy. The interview guide was based on established principles for the management of multimorbidity in older patients. HCPs in rural and metropolitan Victoria and South Australia were purposefully selected to obtain a maximum variation sample. Twenty-six HCPs, from relevant medical, dentistry, nursing, pharmacy and allied health backgrounds, were interviewed between October 2013 and February 2014. Fourteen were prescribers and 12 practiced in primary care. Interviews were digitally audio-taped, transcribed verbatim and analysed using a constant comparison approach.



most participants did not routinely use structured approaches to incorporate patients' preferences in clinical decision-making, address conflicting prescriber advice, assess patients' adherence to treatment plans or seek to optimise care plans. Most HCPs were either unaware of medical decision aids and measurements tools to support these processes or disregarded them as not being user-friendly. Challenges with coordination and continuity of care, pressures of workload and poorly defined individual responsibilities for care, all contributed to participants' avoiding ownership of multimorbidity management. Potential facilitators of improved care related to improved culture, implementation of electronic health records, greater engagement of pharmacists, nurses and patients, families in care provision, and the use of care coordinators.



extensive shortcomings exist in team-based care for the management of multimorbidity. Delegating coordination and review responsibilities to specified HCPs may support improved overall care.
Deakin Rural Health, School of Medicine, Deakin University, Waurn Ponds, Victoria, Australia.|School of Health and Social Development, Faculty of Health, Deakin University, Burwood, Victoria, Australia.|Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia.
Kevin Peter
KP
Mc Namara
School of Pharmacy, University of Utrecht, Utrecht, the Netherlands.
Bianca Daphne
BD
Breken
Sharjah Institute for Medical Research and College of Pharmacy, University of Sharjah, Sharjah, United Arab Emirates.
Hamzah Tariq
HT
Alzubaidi
Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia.
J Simon
JS
Bell
Faculty of Health, Deakin University,Burwood, Victoria, Australia.
James A
JA
Dunbar
Chronic Illness Alliance, Surrey Hills, Victoria, Australia.
Christine
C
Walker
Deakin Rural Health, Deakin University, Warrnambool, Victoria, Australia.
Andrea
A
Hernan
D000328:Adult; D000367:Age Factors; D001291:Attitude of Health Personnel; D000066491:Clinical Decision-Making; D015897:Comorbidity; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D011307:Drug Prescriptions; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D033183:Interdisciplinary Communication; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team / Q000458:organization & administration*; D057240:Patient Preference; D010465:Perception; D019338:Polypharmacy; D010818:Practice Patterns, Physicians'; D036301:Qualitative Research; D013021:South Australia; D014739:Victoria; D055815:Young Adult
care coordination; multimorbidity; older patients; polypharmacy; primary care