What are the experiences of carers supporting individuals taking multiple medications?

Problem

Polypharmacy is a complex area, involving not only clinicians’ decision to prescribe, but also individual patients’ perspectives on medicine taking, their capacity to fit medicine-taking into their daily lives and the support that is available to facilitate this. Approximately a third of all prescribed medicines in the United Kingdom are not taken as prescribed (WHO 2003). This study aimed to extend our understanding of carers’ perspectives and priorities in relation to medicine-taking and to develop an appreciation of how this affects medication practices in the home.

Approach

This was a narrative study using semi-structured interviews and ethnographic observation. Eight participants who provided regular informal care to individuals prescribed five or more medications were recruited from a carers support group. Interviews were transcribed verbatim and analysis was guided by a discursive approach which generated four inter-related themes: Medication Facilitation, Relationships, Prioritising the Normal and Information Gathering.

Findings

Carers’ perspectives affect the care that they provide in the home environment. Clinicians should be cautious when discussing the needs of the carer or patient as individuals. In this study, their needs were very much entwined. Carers were acutely aware of the dangers of medicine taking. This often resulted in increased workload in the form of safety netting and increased emotional burden. Carers had good relations with their doctors but were often uncertain about the boundaries of their responsibilities regarding medication taking. This occasionally resulted in covert monitoring and information gathering from the internet, support groups and other non-medical means.

Consequences

There is recognition within government that the health and social care system should be adapted to support the needs of carers. They recommend that informal carers’ expertise should be recognised and that their views ought to be considered in decision making. The results of this study suggest this should go further, by encouraging healthcare professionals to understand the importance of the prior relationship and to establish carer/patient priorities in medicine taking. Neglecting to do so may inhibit carers from seeking support when they need it and result in medication regimes being covertly adapted.