Practitioners’ Perspectives on Medicine Optimisation for Older People from Ethnic Minority Communities with Polypharmacy in Primary Care

Practitioners’ Perspectives on Medicine Optimisation for Older People from Ethnic Minority Communities with Polypharmacy in Primary Care: A Realist evaluation

Introduction

Medicine optimisation (MO) is a person-centred approach to support the safe, effective, and appropriate use of medications, aligned with patients’ preferences and needs. MO in older people, particularly those from ethnic minority communities (EMCs), can be challenging due to cultural, communication, and systemic factors. These challenges are increased by polypharmacy, the use of multiple medications to manage multimorbidity, when medication errors, non-adherence, and adverse drug interactions are more likely.

This evaluation builds on a prior realist review that highlighted the complexities of MO for older people from EMCs. By exploring the perspectives of practitioners, this research aims to understand what works, for whom, why, and under what circumstances.

Methods

A realist evaluation was conducted using middle-range context-mechanism-outcome configurations (CMOCs) developed from a prior review. Semi-structured interviews were carried out with 15 purposively sampled primary care practitioners, including GPs and pharmacists. Interviews were audio-recorded, transcribed, and analysed using a realist framework.

Result

The earlier analysis revealed that older people from EMCs often faced barriers such as varying levels of health knowledge, language differences, and cultural stigmas, which limited their understanding of treatments and engagement in MO. These contexts triggered mechanisms of mistrust and disengagement.

However, when older people from EMCs encountered practitioners who demonstrated cultural understanding and adapted communication to their needs, mechanisms such as trust, understanding, sense of empowerment, and active participation were activated. This improved their confidence and adherence to medications. Systemic constraints, such as short consultation and reliance on remote tools, often disrupted continuity of care, leaving older people feeling unsupported.

The involvement of family members and interpreters helped bridge communication gaps, but inconsistencies in understanding or engagement sometimes introduced confusion, undermining trust, and clarity.

Conclusion

MO works best when tailored to the contexts of older people from EMCs, activating mechanisms such as trust, understanding, and empowerment.