Realist review: understanding the challenges of medicine optimisation among older people from ethnic minority communities with polypharmacy in primary care

Abstract

INTRODUCTION: Polypharmacy is growing among older people from ethnic minority communities in the United Kingdom, due to a higher prevalence of chronic conditions like diabetes and cardiovascular diseases. Health disparities and unequal access to healthcare services further complicate treatment. Medicine optimisation aims to identify suboptimal medication use, reduce unnecessary medications, and improve adherence. However, medicine optimisation within ethnic minority communities presents challenges because of cultural differences, language barriers, and systemic issues. AIMS AND OBJECTIVES: To understand how Medicine optimisation works (or does not work) for older people from ethnic minority communities within primary care, identifying what works, for whom, and under what circumstances. METHODS: We conducted a realist review following Pawson's five-step framework: we developed initial programme theories, conducted systematic searches, selected and appraised studies, and synthesised the data. The review adhered to the Realist and Meta-Narrative Evidence Syntheses: Evolving Standards (RAMESES) guidelines. RESULT/DISCUSSION: Our programme theory is supported by 11 context-mechanism-outcome configurations that outline key contextual factors and mechanisms influencing the outcomes of Medicine optimisation. Cultural competence among practitioners is essential for building trust. Cultural norms and stigmas significantly influence how medications are perceived and adhered to, while language barriers hinder effective communication and understanding between older people and practitioners. Additionally, religious beliefs shape health behaviours and can impact adherence. CONCLUSION: Medicine optimisation for older people from ethnic minority communities is complex, due to the layered context in which Medicine optimisation occurs. Our review suggests that one-size-fits-all approaches to Medicine optimisation are inadequate. Significant gaps remain in understanding the contexts and mechanisms affecting Medicine optimisation in these groups, requiring further research across.