Is patient activation in the form of a practice mail-out to older people with high-risk prescribing acceptable and useful to patients and doctors?

Problem

High-risk prescribing, adverse drug events, and avoidable adverse drug event hospital admissions in older people are common, costing health systems billions of dollars every year. Avoidable adverse drug event admissions can be minimised by safer prescribing in primary care. The most effective, cost-effective, and practical approach to safer prescribing in everyday practice is not yet known.

We propose testing the effectiveness of a multi-faceted intervention designed to promote medicines review and support safer prescribing in general practice. The intervention comprises a practice audit to identify patients with high-risk prescribing, an outreach visit by a community pharmacist to provide education and patient-specific feedback to doctors, and patient activation through a practice mail-out to patients with high-risk prescribing containing information about their medicines and a letter encouraging them to discuss their medicines when they next see their doctor.

It is not known whether patients and doctors find such patient activation acceptable or useful.

Approach

We feasibility tested the intervention in two general practices in Auckland, New Zealand, one large and one small. Participants were all doctors working in participating practices, patients with high-risk prescribing, and one community pharmacist employed. We conducted semi-structured interviews with 11 patients, 7 doctors, and a community pharmacist. Interviews were digitally recorded, transcribed verbatim, and analysed to identify themes using the general inductive approach.

Findings

Patients reported that the mail-out made them feel special and cared about; none were made anxious. Most said they trusted their doctor to know what was best for them. Most patients said that they would take the letter with them to their next appointment to help them raise the topic of their medicines. Some patients reported that their time with their doctor was already pressured and there might not be enough time to also discuss their medicines. A few patients were confused by the information brochure; some thought it did not apply to them or were not sure which medicines they were on.

In general, doctors supported patient activation via mail-out. Some were concerned that the mail-out might be upsetting for some patients, but were reassured by having control over which patients were and were not sent the mail-out. Most doctors liked the one-on-one feedback sessions with the pharmacist, although some said it was time-consuming.

The pharmacist liked the intervention, reporting that it gave her a foot in the door with doctors and a useful format for delivering education.

Consequences

The intervention appears acceptable and useful. The patient information brochure needs clarification before the intervention is rolled out and its effectiveness tested in a trial.