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Addressing the polypharmacy challenge in older people with multimorbidity (APOLLO-MM): study protocol for an in-depth ethnographic case study in primary care
  1. Deborah Swinglehurst,
  2. Nina Fudge
  1. Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
  1. Correspondence to Professor Deborah Swinglehurst; d.swinglehurst{at}


Introduction Polypharmacy is on the rise. It is burdensome for patients and is a common source of error and adverse drug reactions, especially among older adults. Health policy advises clinicians to practice medicines optimisation—a person-centred approach to safe, effective medicines use. There has been little research exploring older patients’ perspectives and priorities around medicines-taking or their actual practices of fitting medicines into their daily lives and how these are shaped by the wider context of healthcare.

Methods and analysis We will conduct an in-depth multisite ethnographic case study. The study is based in seven clinical sites (three general practices and four community pharmacies) and includes longitudinal ethnographic follow-up of older adults, organisational ethnography and participatory methods. Main data sources include field notes of observations in the home and clinical settings; interviews with patients and professionals; cultural probe activities; video recordings of clinical consultations and interprofessional talk; documents. Our analysis will illuminate the everyday practices of polypharmacy from a range of lay and professional perspectives; the institutional contexts within which these practices play out and the sense-making work that sustains—or challenges—these practices. Our research will adopt a ‘practice theory’ lens, drawing on the sociology of organisational routines and other relevant social theory guided by ongoing iterative data analysis.

Ethics approval The study has HRA approval and received a favourable ethical opinion from the Leeds West Research Ethics Committee (IRAS project ID: 205517; REC reference 16/YH/0462).

Dissemination Aside from academic outputs, our findings will inform the development of recommendations for practice and policy including an interactive e-learning resource. We will also work with service users to co-design patient/public engagement resources.

  • polypharmacy
  • multimorbidity
  • ethnography
  • primary care

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:

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  • Contributors DS designed the study and secured funding. DS and NF have both been involved in fieldwork and have both contributed to writing this paper.

  • Funding statement This article presents independent research funded by the National Institute for Health Research (NIHR) through a Clinician Scientist Award (DS). In addition NF was (in part) supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) North Thames at Bart’s Health NHS Trust. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

  • Competing interests None declared.

  • Patient consent for publication Not required.

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

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