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

Abstract

Annette Eidam,1 Anja Roth,1 Eduard Frick,2 Michael Metzner,2 Anette Lampert,2,3 Hanna M Seidling,2,3 Walter E Haefeli,2,3 Jürgen M Bauer1,4 1Center for Geriatric Medicine, Heidelberg University, AGAPLESION Bethanien Hospital Heidelberg, Heidelberg, Germany; 2Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University, Heidelberg, Germany; 3Cooperation Unit Clinical Pharmacy, Heidelberg University, Heidelberg, Germany; 4Network Aging Research (NAR), Heidelberg University, Heidelberg, GermanyCorrespondence: Annette Eidam, Center for Geriatric Medicine, Heidelberg University, AGAPLESION Bethanien Hospital Heidelberg, Heidelberg, Germany, Tel [phone], Fax [phone], Email [email protected]: 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

Keywords

• geriatric pharmacotherapy
• medication priorities
• multimorbidity
• multiple chronic conditions
• patient-centered
• preference assessment