Triadic Primary Care Encounters Managing Medications among Individuals with Mild Cognitive Impairment and Dementia: Patient, Caregiver and Clinician Perspectives.

Background and objective: Individuals with mild cognitive impairment (MCI) or dementia work with family caregivers and clinicians to manage multidrug regimens; however, problems with medication management are common and contribute to avoidable hospitalizations among individuals with dementia. We sought to describe the initiation of these triadic clinical encounters and medication management to identify opportunities to enhance them.

Research design and methods: We conducted semi-structured qualitative interviews among individuals with MCI or dementia, their family caregivers and primary care clinicians. Clinicians were not required to provide care for enrolled patients. Interview guides were informed by the Triadic Dementia Care Framework. Transcripts were analyzed following the Framework Method.

Results: We enrolled 32 patients, 32 caregivers, and 25 clinicians. Patients, caregivers and clinicians all prioritized patient-focused clinical encounters, and noted transitions in medication management responsibilities typically occur after observing reduced patient capacity. During these transitions, clinicians noted they do not routinely provide an overview of their patients' medications to caregivers, yet caregivers expressed desire for this. Three cross-cutting themes also emerged: 1) balancing patient cognitive impairment limitations and retention of patient autonomy is important to all members of the triad; 2) historical relationship dynamics inform current clinical encounters and medication management; 3) additional time is needed to manage patients with multiple conditions and medications.

Discussion and implications: Opportunities exist to utilize a multidisciplinary care team to initiate thoughtful early planning for transitions in medication management responsibilities and provide supplemental counseling and materials that reiterate the value of triadic relationships, and detail patient-medication guidance.