Person-centred medicine in the care home setting: feasibility testing of a complex intervention.

Abstract

Background: Person-centred medicine in older patients requires medication decisions to be aligned with individual preferences, needs, and values. However, involvement of care home residents and their relatives in such decisions remains limited due to professional preferences and perceived barriers. This study investigates the feasibility of a newly developed intervention aiming to facilitate person-centred medicine through resident and relative involvement and interprofessional communication support.

Methods: The feasibility testing was conducted in two care homes from April to October 2022 in an urban Danish Municipality. The intervention consisted of two components: the PREparation of Patients for Active Involvement in medication Review for Care Home (PREPAIR-CH) and a medication communication template for healthcare professionals. A flexible three-stage workflow and a multifaceted implementation strategy facilitated implementation. Data was collected through observations and interviews with healthcare professionals (care home staff, GPs), residents, and relatives. Data analysis was guided by Normalization Process Theory.

Results: Ten residents participated in the intervention (four in the presence of relatives) and were subsequently interviewed. Additionally, five interviews with healthcare professionals were conducted. The intervention purpose was deemed relevant by residents, relatives, and healthcare professionals and aligned with individual values. The implementation strategy followed the intended delivery. Flexibility, coordination, and collaboration within the local team were key to facilitating intervention implementation. Challenges included selection of residents, involvement of relatives, and management of competing priorities. The intervention offered a structure for involvement and provided valuable insights for healthcare professionals into the patient perspective, thereby fostering reflection and dialogue and enhancing the residents' and relatives' perceived involvement. The medication communication template was considered relevant by staff, whereas GPs found it unnecessary.

Conclusions: The PREPAIR-CH was found acceptable and feasible by residents, relatives, and healthcare professionals, but care home staff and GPs disagreed on the relevance of the medication communication template. The findings suggest that the intervention may enhance resident and relative involvement to support person-centred medicine. Some uncertainties must be explored before a large-scale evaluation, including the applicability to different types of residents and how to support interprofessional communication about medicines, as the needs appear to differ between care home staff and GPs.