Primary care practitioners’ perspectives on medicine optimisation for older people from ethnic minorities with polypharmacy in primary care: a realist evaluation

Background Older people from ethnic minority communities are disproportionately affected by the risks of polypharmacy due to higher levels of multiple long-term conditions, unequal access to care, and communication barriers. Medicine optimisation is a key approach to improving prescribing and outcomes, but how it works for older people from ethnic minority communities in primary care remains poorly understood. Aim To explore how, why, and under what circumstances medicine optimisation works or does not work for older people from ethnic minority communities with polypharmacy, from the perspective of primary care practitioners. Design & setting A realist evaluation using semi-structured realist interviews with primary care practitioners in England and Wales. Method We conducted seventeen interviews with GPs, clinical pharmacists, community pharmacists, and practice nurses. We analysed the data using a realist approach to refine and extend an initial programme theory developed through a prior realist review. Results Seventeen primary care practitioners participated, representing diverse professional roles, ethnic backgrounds, and levels of experience. Analysis identified 18 context-mechanism-outcome configurations, organised into five areas: practitioner strategies, patient beliefs and stigma, communication and language support, informal carer involvement, and system constraints (especially time pressure and remote consultations). Medicine optimisation worked well when practitioners showed respect, adapted communication to cultural and language contexts, and negotiated family involvement. Barriers included stigma, deference to authority, reliance on herbal beliefs, language limitations, and informal carer burden. Conclusion Improving medicine optimisation for older people from ethnic minority communities requires relationship-based, context-sensitive care. These findings offer theory-based insights for UK primary care.