J Dowell1, H Hudson. 1. Tayside Centre for General Practice, University of Dundee, UK.
Abstract
BACKGROUND: Prescribed medication is a mainstay of primary care but it is clear that a large proportion of treatment is not taken correctly. Such 'non-compliance' is considered to be a major problem, but research to date has provided few solutions. There have been increasing calls for a change in approach in order to gain a deeper understanding of why the problem remains and new ways of addressing it. OBJECTIVES: We aimed to investigate how adult primary care patients perceived medication-taking using a Grounded Theory methodology. METHOD: Fifty general practice patients without major current mental health or recreational drug abuse problems were interviewed at home using a flexible interview schedule. Subjects' accounts of taking prescribed treatments were verified where possible by tablet counts or case-record review, six interviews being excluded as unreliable. Medication use was discussed for 159 prescribed treatments of which 34 were reportedly not taken as directed. RESULTS: The analysis is presented as a model of decision making which suggests that: (i) knowledge (about disease and treatment) combined with faith in the doctor produces the motivation to start using medicines; (ii) most patients test a medicine before accepting it fully; (iii) three types of medicine user exist: those who (a) passively accept treatment advice, i.e. try to take the medicine as they perceive the doctor wants them to, (b) actively use medicines, i.e. take it as they decide they want to, and (c) reject medication altogether; (iv) the process of accepting a treatment is closely linked to accepting the illness; and (v) practical problems are a late obstacle which only play a small part in the process. CONCLUSIONS: These concepts have been organized within a comprehensive model of the decision-making process, which is discussed with reference to other current theories of medication use. Researchers and clinicians must move beyond compliance when assessing or trying to improve medication use. Making the medication-testing process explicit is proposed as one way of assisting patients to use treatments better.
BACKGROUND: Prescribed medication is a mainstay of primary care but it is clear that a large proportion of treatment is not taken correctly. Such 'non-compliance' is considered to be a major problem, but research to date has provided few solutions. There have been increasing calls for a change in approach in order to gain a deeper understanding of why the problem remains and new ways of addressing it. OBJECTIVES: We aimed to investigate how adult primary care patients perceived medication-taking using a Grounded Theory methodology. METHOD: Fifty general practice patients without major current mental health or recreational drug abuse problems were interviewed at home using a flexible interview schedule. Subjects' accounts of taking prescribed treatments were verified where possible by tablet counts or case-record review, six interviews being excluded as unreliable. Medication use was discussed for 159 prescribed treatments of which 34 were reportedly not taken as directed. RESULTS: The analysis is presented as a model of decision making which suggests that: (i) knowledge (about disease and treatment) combined with faith in the doctor produces the motivation to start using medicines; (ii) most patients test a medicine before accepting it fully; (iii) three types of medicine user exist: those who (a) passively accept treatment advice, i.e. try to take the medicine as they perceive the doctor wants them to, (b) actively use medicines, i.e. take it as they decide they want to, and (c) reject medication altogether; (iv) the process of accepting a treatment is closely linked to accepting the illness; and (v) practical problems are a late obstacle which only play a small part in the process. CONCLUSIONS: These concepts have been organized within a comprehensive model of the decision-making process, which is discussed with reference to other current theories of medication use. Researchers and clinicians must move beyond compliance when assessing or trying to improve medication use. Making the medication-testing process explicit is proposed as one way of assisting patients to use treatments better.
Authors: Robert A Yood; Kathleen M Mazor; Susan E Andrade; Srinivas Emani; Wing Chan; Kristijan H Kahler Journal: J Gen Intern Med Date: 2008-09-12 Impact factor: 5.128