Medication (Mis)management: Community perspectives

Medication mismanagement is a growing public health concern, especially among older adults. Annually, it is a major contributor to emergency hospitalization and nursing home placement. Despite their central role in this issue, relatively little is known about what elders and caregivers perceive as acceptable and feasible solutions to medication mismanagement. In order to describe their perspective, 9 focus groups (N=65, mean age=71) were conducted with caregivers or elders from 5 northeastern urban and rural communities. Participants were recruited by key informants with snowball sampling. Several themes emerged from the participant recommended solutions. The first was improved communication/coordination between healthcare providers; participants strongly expressed desire for providers to utilize electronic medical records to facilitate between-practice coordination of care. The second was the need for regular review, by doctors or pharmacists, of all medications taken to evaluate effectiveness, medication interactions, and the reduction/elimination of medications. The third was implementing community-driven support systems, such as phone trees or regular visits from neighbors, for elders who do not have social resources. Finally, both elders and caregivers suggested implementing a medical advocate: someone who is knowledgeable about health and medicine, but has no financial stake in the healthcare system, to advise them about medication and facilitate communication with providers. Overwhelmingly, elders and caregivers recognized community-wide issues with medication management and were eager to offer solutions they thought would work in their communities. These solutions resonated across focus groups and can lend credibility to strategies currently being developed/utilized and offer innovative recommendations for future interventions.