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Background: Tackling problematic polypharmacy is a global health safety priority and is likely to require a multifaceted approach. UK health policy hinges around the potential of medication reviews, but deprescribing in medication reviews is uncommon and evidence on how to harness their potential is sparse. Methods: Storytelling Group, a design-led methodology, was used to invite experts-by-experience ('story-creators') to re-imagine the medication review. We facilitated three 2-h workshops with seven story-creators, aged 65+ with experience of polypharmacy and an interest in identifying ways of safely reducing medications. Participants collaboratively built fictive scenarios, creating characters, chronology, contexts and plots, identifying touchpoints and incorporating personal experience. Provocative prompts ('What ifs?') aided story development. Results: Participants created five rich fictional narratives, featuring protagonists affected by polypharmacy and medication reviews involving new and different professionals, roles and contexts. Storytelling Group enabled experts-by-experience to use their knowledge of current medication review practices as their motivation to inspire novel imagined arrangements. This speculative exercise, deliberately crafted to distance participants from current realities, enabled them to share insights and propose new possibilities to address polypharmacy. The process revealed a range of tacit assumptions regarding the roles of healthcare professionals, patients, medications, the health system, and their inter-relationships. Only two of the five narratives they co-constructed involved deprescribing, neither in conventional clinical settings. We then curated a prototype collection of seven fictional short stories ('Let's Talk Differently About Medicines') which we refined through user-experience testing. Conclusions: Our study is an empirical exploration of a design-led methodology which may be adapted for application in healthcare improvement when the phenomenon being addressed is sufficiently complex as to escape easy articulation or resolution. [ABSTRACT FROM AUTHOR]

Contemporary health services are primarily designed around single diseases. People with multimorbidity (multiple long‐term health conditions) often become burdened by accumulated treatments. Through multimodal fieldwork in a socially disadvantaged London borough, we explore how people living with multimorbidity navigate conditions of 'chronic crisis', encompassing ill‐health, overmedicalisation, polypharmacy and social exclusion. Participants in our study frequently experience 'existential stuckness', exacerbated by processes of social exclusion. We argue that diagnoses and treatments should account for people's unique aetiologies, and prioritise the notion of 'flourishing' over 'cure' as the absence of disease is not always achievable. To foster this emphasis on flourishing, we advocate for a dialogical turn in diagnostic processes that better support patients' existential needs in the context of long‐term illness. [ABSTRACT FROM AUTHOR]

Background: Health inequalities in the UK are widening, particularly since the COVID-19 pandemic. Community pharmacies are the most visited healthcare provider in England and are ideally placed to provide and facilitate access to care for those most disadvantaged. Aim: To explore the experiences and needs of community pharmacy teams in providing care for marginalised groups and how this has changed since the COVID-19 pandemic. Design and setting: A qualitative study in community pharmacy and across primary care. Method: Semi-structured interviews were undertaken with members of community pharmacy teams, primary care network (PCN) pharmacists, GPs, and nurses in the North of England. Results: In total, 31 individuals participated in an interview (26 pharmacy staff, three GPs, and two nurses). Most participants acknowledged that their pharmacy had become busier since COVID-19 because of increased footfall compounded by patient difficulties in navigating remote digital systems. Few participants had received any formal training on working with marginalised communities; however, organisational barriers (such as lack of access to translation facilities) combined with interorganisational barriers (such as lack of integrated care) made it more difficult to provide care for some marginalised groups. Despite this, the continuity of care provided by many pharmacies was viewed as an important factor in enabling marginalised groups to access and receive care. Conclusion: There are opportunities to better utilise the skills of community pharmacy teams. Resources, such as access to translation services, and interventions to enable better communication between community pharmacy teams and other primary care services, such as general practice, are essential. [ABSTRACT FROM AUTHOR]

Dementia researchers have persuasively argued for using flexible and creative methods with people with dementia, to ensure their historically marginalised voices are now heard. This article builds on that work, using examples from a study of medicines practices of people with dementia and their informal carers. We have two aims: firstly, we show the ways in which two methods – linguistic ethnography and diary-interview method – can support the inclusion and participation of people with dementia. Secondly, we examine the methodological insights and the dilemmas created by using these methods. Our focus on supporting all means of communication (verbal, non-verbal, drawing, photography and writing) underpinned our choice of methods, which in turn facilitated inclusion and participation. Using a linguistic ethnographic approach supported participants to use material objects to tell their stories; video-recording interactions encompassed non-verbal communication; creative diary-methods made non-linguistic means of knowledge production possible. Moving around the home and neighbourhood and using familiar objects enabled people with dementia to explain their medicines in the context of their lives. Paying attention to sensory data created new insights into the skills and knowledge that family members develop and employ when they provide informal care. The methods were not without challenges. Participants experienced a tension in balancing opportunities for self-expression with the time and effort involved in participatory activities. For the researcher, prioritising the affective quality of respectful research relationships whilst not straying into 'faked friendship' created situated ethical dilemmas. [ABSTRACT FROM AUTHOR]

Background Polypharmacy is an important safety concern. Medication reviews are recommended for patients affected by polypharmacy, but little is known about how they are conducted, nor how clinicians make sense of them. We used video-reflexive ethnography (VRE) to: illuminate how reviews are conducted; elicit professional dialogue and concerns about polypharmacy; invite new transferable understandings of polypharmacy and its management. Methods We conducted 422 hours of fieldwork (participant observation), filmed 18 consultations between clinicians and patients receiving 10 or more regular items of medication (so-called 'higher risk' polypharmacy) and played short clips of film footage to 34 participants (general practitioners, nurses, clinical pharmacists, practice managers) in seven audio-recorded reflexive workshops. Our analysis focused on 'moments of potentiation' and traced clinicians' shifting understandings of their practices. Results Participants rarely referenced biomedical aspects of prescribing (eg, drug- drug interactions, 'Numbers Needed to Treat/Harm') focussing instead on polypharmacy as an emotional and relational challenge. Clinicians initially denigrated their medication review work as mundane. Through VRE they reframed their work as complex, identifying polypharmacy as a delicate matter to negotiate. In patients with multimorbidity and polypharmacy it was difficult to disentangle medication review from other aspects of patients' medical care. Such conditions of complexity presented clinicians with competing professional obligations which were difficult to reconcile. Medication review was identified as an ongoing process, rather than a discrete 'one-off' activity. Meaningful progress towards tackling polypharmacy was only possible through small, incremental, carefully supported changes in which both patient and clinician negotiated a sharing of responsibility, best supported by continuity of care. Conclusions Supporting acceptable, feasible and meaningful progress towards addressing problematic polypharmacy may require shifts in how medication reviews are conceptualised. Responsible decision-making under conditions of such complexity and uncertainty depends crucially on the affective or emotional quality of the clinician-patient relationship. [ABSTRACT FROM AUTHOR]

Within the European Commission-supported thematic network project AIRNET, a stakeholder survey was performed to identify key questions and issues of concern for end users regarding air pollution and health information. On the whole, survey respondents typically asked general questions concerning air pollution and health (i.e., regarding the type of pollutant, emission sources, monitoring, and health impact). Furthermore, an overwhelming response across all stakeholder categories was not the unavailability of information sources to inform policy, but the lack of time available to read and absorb all the information. Overall, the respondents expressed their preference for information that is (1) presented as short and clear overviews, (2) ready for policy use by including a practical linkage between the research findings and implementation of public protection, and (3) in a format easily passed on to others. [ABSTRACT FROM AUTHOR]

Despite the promise of a new streamlined process for gaining research ethics and governance approval, Nina Fudge, Judith Redfern, Charles Wolfe, and Christopher McKevitt argue that the process is still dogged by delay and arbitrary decisions.