The journey to concordance for patients with hypertension: a qualitative study in primary care
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We aimed to explore, using qualitative methods, the perspectives of patients with hypertension on issues relating to concordance in prescribing.
This study took place in NHS general practices in Northern Ireland. A purposeful sample of patients who had been prescribed anti-hypertensive medication for at least one year were invited to participate in focus groups or semi-structured interviews; data were analysed using constant comparison.
Main outcome measures
The perspectives of patients with hypertension on issues relating to concordance in prescribing.
Twenty-five individuals participated in five focus groups; two participated in semi-structured interviews. Participants felt they could make valuable contributions to consultations regarding their management. They were prepared to negotiate with GPs regarding their medication, but most deferred to their doctor’s advice, perceiving doctors’ attitudes and time constraints as barriers to their greater involvement in concordant decision-making. They had concerns about taking anti-hypertensive drugs, were aware of lifestyle influences on hypertension and reported using personal strategies to facilitate adherence and reduce the need to take medication.
Participants indicated a willingness to be␣involved in concordance in prescribing anti- hypertensive medication but needed health professionals to address their concerns and confusion about the nature of hypertension. These findings suggest that there is a need for doctors and other healthcare professionals with responsibility for prescribing to develop skills specifically to explore the beliefs and views underlying an individual’s medication use. Such skills may need to be developed through specific training programmes at both undergraduate and postgraduate level.
KeywordsCommunication Compliance Concordance General practice Hypertension Primary care Qualitative research Northern Ireland Health beliefs
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The authors wish to thank the patients who participated in the focus groups. The authors also gratefully acknowledge the practice managers and GPs who helped with the logistical aspects of the study. Carmel Hughes is supported by a National Primary Care Career Scientist Award from the Research and Development Office, Northern Ireland. The study was funded under a School of Pharmacy PhD studentship to Catherine Bane. Conflicts of Interest: None declared.
- 1.Myers LB, Midence K. Concepts and issues in adherence. In: Myers LB, Midence K, editors. Adherence to treatment in medical conditions. Reading: Harwood Academic Publishers; 1998Google Scholar
- 2.WHO Report. Adherence to long-term therapies. Evidence for action. Switzerland: World Health Organisation; 2003Google Scholar
- 5.Horne R, Weinman J. Patients’ beliefs about prescribed medicines and their role in adherence to treatment in chronic physical illness. J Psychosom Res 1999; 47:557–567Google Scholar
- 6.From Compliance to Concordance. Achieving shared goals in medicine taking. London: Royal Pharmaceutical Society of Great Britain and Merck Sharp & Dohme; 1997Google Scholar
- 7.Charles C, Whelan T, Gafni A. What do we mean by partnership in making decisions about treatment? Br Med J 1999; 319:780–782Google Scholar
- 8.Pollock K. ‘I’ve not asked him, you see, and he’s not said’: understanding lay explanatory models of illness is a prerequisite for concordant consultations. Int J Pharm Pract 2001; 9:105–117Google Scholar
- 13.The National Office for Summative Asssessment. www.nosa.org.uk/information/video/cogped.guidelines.htm. Accessed 4 September 2004Google Scholar
- 19.Nair K, Dolovich L, Cassels A, McCormack J, Levine M, Gray J et al. What patients want to know about their medications: focus group study of patient and clinician perspectives. Can Fam Physician 2000; 48:104–110Google Scholar
- 20.Festinger L. A theory of cognitive dissonance. Stanford: Stanford University Press; 1957Google Scholar
- 24.Fallsberg M. Reflections on medicines and medication: a qualitative analysis among people on long-term drug regimens. Linkoping Studies in Education. Dissertations 31; 1991Google Scholar
- 27.Becker MH. The health belief model and sick role behaviour. Health Edu Monogr 1974; 2:409–419Google Scholar
- 28.Horne R, Weinman J. Predicting treatment adherence: an overview of theoretical models. In: Myers LB, Midence K, editors. Adherence to treatment in medical conditions. Reading: Harwood Academic Publishers; 1998Google Scholar
- 30.Ross S, Walker A, MacLeod MJ. Patient compliance in hypertension: role of illness perceptions and treatment beliefs. J Human Hypertension 2004; 18:607–613Google Scholar
- 31.Conner M, Norman P. The role of social cognition in health behaviours. In: Conner M, Norman P, editors. Predicting health behaviour. Buckingham: Open University PressGoogle Scholar