Justification of medication management resource allocation among older people living in their own homes: a qualitative study

Abstract Background In Norway, older individuals living at home who can no longer manage their own medication have the right to apply for assistance from municipal home health services. Allocation of these services is documented in individual decision letters, detailing the specific services to be provided at home. The decision should be based on each patient’s needs and the criteria for service allocation. This study explores the justification for allocating medication management resources to older people living in their own homes. It aims to identify the various justifications presented in decision letters, together with those given by patients and healthcare personnel working in municipal home healthcare. Methods This case study employed inductive qualitative content analysis of research interviews with nine patients who had recently been allocated medication management assistance, four service providers, and two purchasers, along with analysis of eight decision letters. Results The analysis revealed an overarching theme for the study— resource allocation for safe medication management —with three distinct categories: “getting a foot in the door”, “keeping the home care service afloat”, and “mastering one’s health at home”. Justifications for medication management resource allocation were described in more objective terms in decision letters than in the information gained through the interviews. Conclusion The justification for medication management resource allocation indicates greater use of implicit than explicit criteria. The allocation of medication management assistance is used to gain early access to patients’ homes for follow-up and monitoring. It is seen as a low-cost measure which helps patients stay at home for as long as possible, even if municipal resources are limited. While this approach aligns with government priorities, justifications for resource allocation are not transparent or standardised, as they should be according to current guidelines.