https://orcid.org/0000-0002-1490-9456
Abstract
Purpose
The aim of this systematic review was to identify methods used to assess medication preferences in older adults and evaluate their advantages and disadvantages with respect to their applicability to the context of multimorbidity and polypharmacy.
Material and Methods
Three electronic databases (PubMed, Web of Science, PsycINFO) were searched. Eligible studies elicited individual treatment or outcome preferences in a context that involved long-term pharmacological treatment options. We included studies with a study population aged ≥ 65 years and/or with a mean or median age of ≥ 75 years. Qualitative studies, studies assessing preferences for only two different treatments, and studies targeting preferences for life-sustaining treatments were excluded. The identified preference measurement methods were evaluated based on four criteria (time budget, cognitive demand, variety of pharmacological aspects, and link with treatment strategies) judged to be relevant for the elicitation of patient preferences in polypharmacy.
Results
Sixty articles met the eligibility criteria and were included in the narrative synthesis. Fifty-five different instruments to assess patient preferences, based on 24 different elicitation methods, were identified. The most commonly applied preference measurement techniques were “medication willingness” (description of a specific medication with inquiry of the participant’s willingness to take it), discrete choice experiments, Likert scale-based questionnaires, and rank prioritization. The majority of the instruments were created for disease-specific or context-specific settings. Only three instruments (Outcome Prioritization Tool, a complex intervention, “MediMol” questionnaire) dealt with the broader issue of geriatric multimorbidity. Only seven of the identified tools showed somewhat favorable characteristics for a potential use of the respective method in the context of polypharmacy.
Conclusion
Up to now, few instruments have been specifically designed for the assessment of medication preferences in older patients with multimorbidity. To facilitate valid preference elicitation in the context of geriatric polypharmacy, future research should focus on suitable characteristics of existing techniques to develop new measurement approaches for this increasingly relevant population.
Acknowledgments
This work 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” (Verbundprojekt “Medikation und Lebenssituation im Alter”). The funding source had no role in the design of this systematic review, the collection and interpretation of the data, and the writing of this manuscript. In addition, we acknowledge financial support by the Baden-Württemberg Ministry of Science, Research and the Arts and by Ruprecht-Karls-Universität Heidelberg (Open Access Publishing Fund).
Disclosure
Dr Annette Eidam reports grants from the State Ministry of Baden-Wuerttemberg (Germany) for Sciences, Research and Arts, during the conduct of the study. Ms Anja Roth reports grants from the State Ministry of Baden-Wuerttemberg (Germany) for Sciences, Research and Arts, during the conduct of the study.
Dr André Lacroix reports grants from the State Ministry of Baden-Wuerttemberg (Germany) for Sciences, Research and Arts, during the conduct of the study.
Dr Sabine Goisser reports grants from the State Ministry of Baden-Wuerttemberg (Germany) for Sciences, Research and Art, during the conduct of the study.
Dr Hanna M. Seidling reports grants from the State Ministry of Baden-Wuerttemberg (Germany) for Sciences, Research and Arts, during the conduct of the study; non-financial support from VKliPha; AkdÄ; GSASA, APS e.V., NHS, ESCP, BAK, ÄZQ, SFPC, Dosing GmbH, Karolinska Institutet, University of Bonn, University Hospital Hamburg, personal fees from Universitätsklinikum Heidelberg IMBI, Govi Verlag, Deutscher Apotheker Verlag, Wissenschaftliche Verlagsgesellschaft Stuttgart, Bundesgesundheitsblatt, personal fees, non-financial support from ADKA e.V.; EAHP; Chamber of Pharmacists, Hessen; Chamber of Pharmacists, Baden-Württemberg, Chamber of Pharmacists, Westfalen-Lippe, Chamber of Pharmacists Nordrhein, Chamber of Pharmacists Bavaria, DPhG, AD REM TEAM München, ABDA - Bundesvereinigung Deutscher Apotheker e.V., Omnicell, Chamber of Pharmacists Niedersachsen, Chamber of Pharmacists Thüringen, grants from Chambers of Pharmacists Baden-Württemberg, Nordrhein, Hessen and Niedersachsen, Klaus Tschira Stiftung gGmbH, Dosing GmbH, ABDA - Bundesvereinigung Deutscher Apotheker e.V., g-BA, BMBF, European Commission Horizon 2020, outside the submitted work.
Prof. Dr. Walter E. Haefeli reports grants from the State Ministry of Baden-Wuerttemberg (Germany) for Sciences, Research and Arts, during the conduct of the study; grants from ADIR, travel expenses from AID Berlin, grants from AOK BW, personal fees from Apoth.kammer Schlesw., grants from Basilea Ltd., grants from Bayer AG, speaker fees and traveling expenses from Berlin-Chemie AG, grants from BMBF, speaker fees and traveling expenses from Boehringer GmbH, grants, speaker fees and traveling expenses from Bristol-Myers Squibb, grants from Chiesi GmbH, personal fees from COCS/DGD, grants, personal fees from Daiichi-Sankyo, grants from DFG No. 79, personal fees from DiakonissenKH MA, research funding from DKFZ, he is a shareholder of Dosing GmbH and his wife an employee of Dosing GmbH, personal fees from ESA Köln, grants from EU Projects, traveling expenses from Fresenius, research funding from Gem.Bundesausschuss, personal fees from GenPlus GmbH, personal fees, speaker fees and traveling expenses from Grünenthal GmbH, grants from GSK, grants from HDIT, grants from Hepatera Ltd., grants from IPMB, grants from Janssen GmbH, consultancy services and traveling expenses from LAK BW, personal fees from Ligatur Verlag, grants from MWK, grants from MYR GmbH, speaker fees and traveling expenses from Novartis, traveling expenses from Orphix Consulting, grants from PCI, speaker fees and traveling expenses from Pfizer, consultancy services and traveling expenses from PIQUR Basel, grants from QPS Netherlands B.V., grants from SFB 1389/1 TP C1.2, grants from Smooth Clin. Trial, grants from Sumaya Biotec, grants from K. Tschira Stiftung, consultancy and traveling expenses from Stiftung Warentest, personal fees from Thieme Verlag, traveling expenses from Uni Saarbrücken, grants from Vaximm GmbH, outside the submitted work.
Prof. Dr. Jürgen M. Bauer reports grants from the Ministry for Research, Baden-Württemberg, Germany, during the conduct of the study; personal fees from Nestlé, personal fees from Nutricia, personal fees from Novartis, personal fees from Fresenius, personal fees from Daiichi Sankyo, personal fees from Bayer, outside the submitted work.
The authors report no other conflicts of interest in this work.