Supporting Older People Living With Frailty to Self-Manage Multiple Medicines: An Experience-Based Co-Design of a Complex Intervention Developed in UK Primary Care

Background Older people face numerous challenges when managing multiple medicines. They are required to cope with complicated and changing medicines regimens and coordinate input from multiple health and social care professionals. When not well managed, medicines can cause harm, and older people are more susceptible to the impact of errors. Nevertheless, there is a lack of interventions addressing the multiple tasks required for them to manage polypharmacy at home. Objective To develop a complex behaviour-change intervention to support medicines self-management for older people living with frailty and polypharmacy using Experience-based Co-design (EBCD). Design EBCD was used to create a prototype of a resilient healthcare-informed complex intervention with the potential to improve the safety of, and confidence in, medicines self-management for older people who live at home. Extracts from recordings of interviews about people's experiences of polypharmacy were edited into a short film and shown at meetings to determine priorities. Older people taking 5 or more medicines living with mild-to-moderate frailty, their family members and healthcare professionals then participated in co-design workshops to develop these identified priorities into components of a complex intervention. Two focus groups with healthcare staff, older people, and carers explored potential barriers to implementation. Results Shared priorities identified were to support change in the following areas: day-to-day practical medicines management; understanding medicines management systems; and communicating with healthcare teams. A logic model was designed to make explicit the intervention's underpinning theory of change. A five-part complex intervention was developed which addresses behaviours with potential to increase safety in medicines management. Intervention content was mapped to relevant behaviour change techniques to aid clarity, precision and specificity in reporting its characteristics. Conclusions Using EBCD we were able to co-develop a novel support intervention to improve safety in medicines management at home for older people living with frailty which incorporated: (1) knowledge of medicines and checking medicines received; (2) organising medicines supply; (3) adherence and self-monitoring when taking multiple medicines; (4) dealing with changes in medicines; and (5) knowledge of help available and how, where and when to seek it. Patient or Public Contribution A member of the public with lived experience of managing medicines in older age was co-applicant and co-author in this study, supported by an advisory group of older people taking multiple medicines or with experience of supporting family members. Their contribution played a key role in shaping a relevant and respectful complex intervention for this population.