Development of an Electronic Tool to Assess Patient Preferences in Geriatric Polypharmacy (PolyPref)

Annette Eidam; Anja Roth; Eduard Frick; Michael Metzner; Anette Lampert; Hanna M Seidling; Walter E Haefeli; Jürgen M Bauer

doi:10.2147/PPA.S364681

Development of an Electronic Tool to Assess Patient Preferences in Geriatric Polypharmacy (PolyPref)

Patient Prefer Adherence. 2022 Jul 23:16:1733-1747. doi: 10.2147/PPA.S364681. eCollection 2022.

Authors

Annette Eidam¹, Anja Roth¹, Eduard Frick², Michael Metzner², Anette Lampert^{2

3}, Hanna M Seidling^{2

3}, Walter E Haefeli^{2

3}, Jürgen M Bauer^{1

4}

Affiliations

¹ Center for Geriatric Medicine, Heidelberg University, AGAPLESION Bethanien Hospital Heidelberg, Heidelberg, Germany.
² Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University, Heidelberg, Germany.
³ Cooperation Unit Clinical Pharmacy, Heidelberg University, Heidelberg, Germany.
⁴ Network Aging Research (NAR), Heidelberg University, Heidelberg, Germany.

Abstract

Purpose: Medical decision-making in older adults with multiple chronic conditions and polypharmacy should include the individual patient's treatment preferences. We developed and pilot-tested an electronic instrument (PolyPref) to elicit patient preferences in geriatric polypharmacy.

Patients and methods: PolyPref follows a two-stage direct approach to preference assessment. Stage 1 generates an individual preselection of relevant health outcomes and medication regimen characteristics, followed by stage 2, in which their importance is assessed using the Q-sort methodology. The feasibility of the instrument was tested in adults aged ≥70 years with ≥2 chronic conditions and regular intake of ≥5 medicines. After the assessment with PolyPref, the patients rated the tool with regard to its comprehensibility and usability and assessed the accuracy of the personal result. Evaluators rated the patients' understanding of the task.

Results: Eighteen short-term health outcomes, 3 long-term health outcomes, and 8 medication regimen characteristics were included in the instrument. The final population for the pilot study comprised 15 inpatients at a clinic for geriatric rehabilitation with a mean age of 80.6 (± 6.0) years, a median score of 28 (range 25-30) points on the Mini-Mental State Examination, and a mean of 11.6 (± 3.6) regularly taken medicines. Feedback by the patients and the evaluators revealed ratings in favor of understanding and comprehensibility of 86.7% to 100%. The majority of the patients stated that their final result summarized the most important aspects of their pharmacotherapy (93.3%) and that its ranking order reflected their personal opinion (100%). Preference assessment took an average of 35 (± 8.5) min, with the instrument being handled by the evaluator in 14 of the 15 participants.

Conclusion: Preference assessment with PolyPref was feasible in older adults with multiple chronic conditions and polypharmacy, offering a new strategy for the standardized evaluation of patient priorities in geriatric pharmacotherapy.

Keywords: geriatric pharmacotherapy; medication priorities; multimorbidity; multiple chronic conditions; patient-centered; preference assessment.

Grants and funding

This study was funded by the Baden-Württemberg Ministry of Science, Research and the Arts as part of the project “Medication and circumstances of life in old age” (Verbundvorhaben “Medikation und Lebenssituation im Alter”). The funding source had no role in the design of this study, the collection and interpretation of the data, and the writing of this manuscript.