How do Pakistani patients experience polypharmacy in multimorbidity? A qualitative interview study

Problem

Polypharmacy is the co-prescription of four or more medications. The patient experience and possible ‘burden’ of being on multiple medications is poorly understood. Up to half of all medications prescribed are never taken and medicines wastage is estimated to cost the NHS £150 million a year. High-quality knowledge to inform prescribing and ‘de-prescribing’ in multimorbidity is needed. Crucially, this knowledge needs to consider the needs of the UK’s progressively superdiverse population. London’s South Asian population, including those of Pakistani origin, are at the receiving end of higher levels of prescribing and experience higher levels of multimobidity compared to other ethnicities. Urdu is the third most common spoken immigrant language in England and Urdu-speaking Pakistani patients form a significant ethnic group in London. Most existing research on medication behavior in this community is concerned with ‘compliance’ rather than patient experience. This study aims to explore how Pakistani patients with multimorbidity: • Experience polypharmacy in multimorbidity• Manage medicines in the context of their daily lives• Describe their relationships with professionals involved in their medicines management

Approach

12-15 patients will be recruited from GP practices in East London; patients must be Pakistani, aged>50 and be on>10 regular medications (identified as ‘high risk’ polypharmacy). Patients will complete an in-depth interview with a bilingual researcher in Urdu at home, using a Biographical Narrative Interview Method (BNIM) style interview. BNIM interviews start with a Single Narrative Interview Question (SQUIN). This SQUIN is designed to induce a narrative of patient’s experience of polypharmacy in the context of their wider health and life story; thus their ‘lived experience’ of polypharmacy. The initial response to the SQUIN is used by the interviewer to identify a sequence of topics to elicit further narratives as the interview progresses.

Findings

We have recruited 3 practices and conducted pilot interviews and 1 formal interview to date. This is a hard-to-reach population and recruitment has had to accommodate this. BNIM was developed within the Western population and its application in a non-Western population comes with challenges. By using this methodology we hope to explore with richness possible considerations and complexities when managing polypharmacy in Pakistani patients.

Consequences

The constant flux in the ethnic and cultural make-up of the British patient population is identifying an increasing need for healthcare providers to be able to place an individual’s healthcare needs in the context of their wider socio-cultural background. It is thought that patients from different backgrounds make sense of their medicines in a different way and this research will allow us to reflect upon these assumptions more critically. This is a population that is under-researched and over-represented in terms of polypharmacy and multimorbidity. The research will provide new knowledge that can inform professional practices and improve care.