Article Text

Download PDFPDF

Physicians’ role in the development of inappropriate polypharmacy among older adults in Iran: a qualitative study
  1. Seyede Salehe Mortazavi1,
  2. Mohsen Shati2,
  3. Seyed Kazem Malakouti1,
  4. Hamid Reza Khankeh3,
  5. Shiva Mehravaran4,
  6. Fazlollah Ahmadi5
  1. 1 School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran
  2. 2 Mental Health Research Center, School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran
  3. 3 Department of Nursing, University of Social Welfare and Rehabilitation Sciences (USWR), Tehran, Iran
  4. 4 Department of Ophthalmology, Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, USA
  5. 5 Department of Nursing, Tarbiat Modares University, Tehran, Iran
  1. Correspondence to Dr Mohsen Shati; shati.m{at}iums.ac.ir

Abstract

Objectives The use of unnecessary or excessive medications (inappropriate polypharmacy) is a major health challenge among older adults which is driven by several factors. This study aims to provide in-depth descriptions of the physician’s role in the development of inappropriate polypharmacy among older adults in Iran.

Design Qualitative content analysis of interviews, field notes and other relevant documents available (eg, medical records). Data collection and analyses were done concurrently to guide the sampling process.

Setting Three purposively selected referral hospitals in Tehran, Iran.

Participants A total of 7 physicians, 10 older adults, 3 caregivers and 3 pharmacists with a median age of 54 (IQR 23) years were recruited through convenience sampling.

Results Emerged categories included misdiagnosis, inappropriate prescribing, insufficient patient education, poor communication, unprofessional behaviour and limited perspectives which highlight the role of physicians in the development of inappropriate polypharmacy among older adults in Iran under the main concept of poor medical practice.

Conclusion This study provides valuable insight on the role of physicians in the development of inappropriate polypharmacy among the elderly in the healthcare setting in Iran by exploring the viewpoints of physicians, patients, caregivers and pharmacists. Physicians can be an influential factor in tackling this challenge through proper diagnosis, prescription, patient education and follow-up. In Iran, physicians’ practice styles are affected by potentially adverse factors such as the novelty of geriatric medicine, lack of a referral system, patient unfamiliarity with the system and lack of a monitoring system for multiple prescriptions. Furthermore, clinics tend to be overcrowded and visit fees can be low; in this setting, lack of physician assistants leads to limited time allocation to each patient and physician dissatisfaction with their income.

  • polypharmacy
  • excessive drug use
  • unnecessary drug use
  • qualitative research
  • elderly
  • inappropriate prescribing

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

View Full Text

Statistics from Altmetric.com

Footnotes

  • Contributors SSM, MS and SKM contributed to design the study, conceptualisation, data collection, formal analysis, methodology, writing original draft, review and editing. HRK and FA: contributed to supervision, visualisation, methodology, validation, writing original draft, review and editing. ShM contributed to investigation, project administration, supervision, methodology, writing the original draft and review and editing of the manuscript.

  • Funding This work was financially sponsored by Iran University of Medical Sciences as a PhD studentship (grant no: 93-121-02-24651).

  • Competing interests None declared.

  • Ethics approval This study was approved as a minimal-risk research by the Ethics Committee of Iran University of Medical Sciences (approval reference number: IR.IUMS.REC.1393-02-121-24651).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The data that support the findings of this study are available on request from the first author, not including personal identifiers based on our informed consent.

  • Patient consent for publication Not required.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.