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Pharmacy World & Science

, Volume 29, Issue 5, pp 534–540 | Cite as

The journey to concordance for patients with hypertension: a qualitative study in primary care

  • Catherine Bane
  • Carmel M. Hughes
  • Margaret E. Cupples
  • James C. McElnay
Research Article

Abstract

Objective

We aimed to explore, using qualitative methods, the perspectives of patients with hypertension on issues relating to concordance in prescribing.

Method

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.

Results

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.

Conclusions

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.

Keywords

Communication Compliance Concordance General practice Hypertension Primary care Qualitative research Northern Ireland Health beliefs 

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Notes

Acknowledgements

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.

References

  1. 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. 2.
    WHO Report. Adherence to long-term therapies. Evidence for action. Switzerland: World Health Organisation; 2003Google Scholar
  3. 3.
    Osterberg L, Blaschke R. Adherence to medication. New Engl J Med 2005; 353:487–497PubMedCrossRefGoogle Scholar
  4. 4.
    Benson J, Britten N. Patients’ decisions about whether or not to take antihypertensive drugs: qualitative study. Br Med J 2002; 325:873–877CrossRefGoogle Scholar
  5. 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. 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. 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. 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
  9. 9.
    Svensson S, Kjellgren KI, Ahlner J, Saljo R. Reasons for adherence with antihypertensive medication. Int J Cardiol 2000; 76:157–163PubMedCrossRefGoogle Scholar
  10. 10.
    Dowell J, Jones A, Snadden D. Exploring medication use to seek concordance with non-adherent patients: a qualitative study. Br J Gen Pract 2002; 52:24–32PubMedGoogle Scholar
  11. 11.
    Elwyn G, Edwards A, Britten N. “Doing prescribing”: how doctors can be more effective. Br Med J 2003; 327:864–867CrossRefGoogle Scholar
  12. 12.
    Donovan J, Mills N, Smith M, Brindle L, Jacoby A, Peters T et al. Improving design and conduct of randomised trials by embedding them in qualitative research: ProtecT (prostate testing for cancer and treatment) study. Br Med J 2002; 325:766–770SCrossRefGoogle Scholar
  13. 13.
    The National Office for Summative Asssessment. www.nosa.org.uk/information/video/cogped.guidelines.htm. Accessed 4 September 2004Google Scholar
  14. 14.
    Miller NH. Compliance with treatment regimens in chronic asymptomatic diseases. Am J Med 1997; 102(2A Supplement):43–49PubMedCrossRefGoogle Scholar
  15. 15.
    Lisper L, Isacson D, Sjoden P-O, Bingefors K. Medicated hypertensive patients’ views and experience of information and communication concerning antihypertensive drugs. Pat Educ Couns 1997; 32:147–155CrossRefGoogle Scholar
  16. 16.
    Lahdenpera TS, Kyngas HA. Levels of compliance shown by hypertensive patients and their attitude toward their illness. J Adv Nursing 2001; 34:189–195CrossRefGoogle Scholar
  17. 17.
    Weiss MC, Montgomery AA, Fahey T, Peters TJ. Decision analysis for newly diagnosed hypertensive patients: a qualitative investigation. Pat Educ Couns 2004; 53:197–203CrossRefGoogle Scholar
  18. 18.
    Stevenson FA, Barry CA, Britten N, Barber N, Bradley CP. Doctor–patient communication about drugs: the evidence for shared decision making. Soc Sci Med 2000; 50:829–840PubMedCrossRefGoogle Scholar
  19. 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. 20.
    Festinger L. A theory of cognitive dissonance. Stanford: Stanford University Press; 1957Google Scholar
  21. 21.
    Stewart J, Brown K, Kendrick D, Dyas J. Understanding of␣blood pressure by people with type 2 diabetes: a primary␣care focus group study. Br J Gen Pract 2005; 55:298–304PubMedGoogle Scholar
  22. 22.
    Gascon JJ, Sanchez-Ortuno M, LLor B, Skidmore D, Saturno PJ. Why hypertensive patients do not comply with the treatment. Results from a qualitative study. Fam Pract 2004; 21:125–130PubMedCrossRefGoogle Scholar
  23. 23.
    Johnson MJ, Williams M, Marshall ES. Adherent and nonadherent medication-taking in elderly hypertensive patients. Clin Nursing Res 1999; 8:318–335CrossRefGoogle Scholar
  24. 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
  25. 25.
    Townsend A, Hunt K, Wyke S. Managing multiple morbidity in mid-life: a qualitative study of attitudes to drug use. Br Med J 2003; 327:837–942CrossRefGoogle Scholar
  26. 26.
    Lewis DK, Robinson J, Wilkinson E. Factors involved in deciding to start preventive treatment: qualitative study of clinicians’ and lay people’s attitudes. Br Med J 2003; 327:841–847CrossRefGoogle Scholar
  27. 27.
    Becker MH. The health belief model and sick role behaviour. Health Edu Monogr 1974; 2:409–419Google Scholar
  28. 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
  29. 29.
    Van Wissen K, Litchfield M, Maling T. Living with high blood pressure. J Adv Nursing 1998; 27:567–574CrossRefGoogle Scholar
  30. 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. 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
  32. 32.
    Jones G. Prescribing and taking medicines. Br Med J 2003; 327:819–820CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Catherine Bane
    • 1
  • Carmel M. Hughes
    • 2
  • Margaret E. Cupples
    • 3
  • James C. McElnay
    • 2
  1. 1.Research and Development OfficeBelfastNorthern Ireland, UK
  2. 2.School of PharmacyQueen’s University BelfastBelfastNorthern Ireland, UK
  3. 3.Department of General PracticeQueen’s UniversityBelfastUK

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