Patients' expectations of medicines – a review and qualitative synthesis

Dohnhammar, Ulrica; Reeve, Joanne; Walley, Tom

doi:10.1111/hex.12345

Cited by 14 publications

(19 citation statements)

References 34 publications

(128 reference statements)

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“…This is likely because they feared CVD even more than the side effects, or because they were not able to change their lifestyle. 14 …”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, patients and doctors balance risks and benefits of medication in a different way. For example, benefits in the short term are identified as more important to patients compared with doctors 14. Patients’ views on deprescribing their medication can thus be different than their physicians’ views, but patient viewpoints could influence the implementation of preventive CVD management.…”

Section: Introductionmentioning

confidence: 99%

“… 9 , 13 Patients’ expectations of the long-term medications they use play a role in their willingness to have their preventive medication deprescribed. Dohnhammar et al 14 reported that patients use medication to care for themselves above and beyond lifestyle changes alone and that they tend to overestimate the risk-lowering effects of preventive medication. Furthermore, patients and doctors balance risks and benefits of medication in a different way.…”

Section: Introductionmentioning

confidence: 99%

“…For example, benefits in the short term are identified as more important to patients compared with doctors. 14 Patients’ views on deprescribing their medication can thus be different than their physicians’ views, but patient viewpoints could influence the implementation of preventive CVD management. Therefore, our objective was to identify various viewpoints and beliefs in patients with low CVD risk using preventive cardiovascular medication concerning preventive CVD management.…”

Section: Introductionmentioning

confidence: 99%

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Understanding deprescribing of preventive cardiovascular medication: a Q-methodology study in patients

Luymes¹,

Boelhouwer²,

Poortvliet³

et al. 2017

PPA

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BackgroundPatients with low cardiovascular disease (CVD) risk potentially use preventive cardiovascular medication unnecessarily. Our aim was to identify various viewpoints and beliefs concerning the preventive CVD management of patients with low CVD risk using preventive cardiovascular medication. Furthermore, we investigated whether certain viewpoints were related to a preference for deprescription or the continuation of preventive cardiovascular medication.MethodsIn 2015, we purposively sampled patients from the intervention arm of the Evaluating Cessation of STatins and Antihypertensive Treatment In primary Care (ECSTATIC) trial in the Netherlands for this study. Participants made Q-sorts by ranking 43 statements concerning preventive CVD management from “totally disagree” to “totally agree”. These Q-sorts were analyzed using PQMethod 2.35 software. A varimax procedure presented the distinguishing viewpoints that were favored by our participants. We used group discussion quotations to underline our findings. For validation purposes, we asked participants how well each viewpoint fitted them.ResultsOf 291 invited patients, 33 participated. Thirty-one Q-sorts were analyzed. The following three viewpoints were found: 1) a controlling viewpoint, in which patients held the belief that monitoring blood pressure and cholesterol levels is important (n=13, of which seven had their medication deprescribed and six continued their medication); 2) an autonomous viewpoint, in which patients showed a dislike of medication (n=8, of which seven had their medication deprescribed and one had it continued); and 3) an afraid viewpoint, in which patients were fearful of developing CVD (n=8, of which two had their medication deprescribed and six had it continued). Seventy-four percent of the participants believed that the viewpoint to which they were assigned was a good fit.ConclusionThree well-discriminating viewpoints about preventive CVD management were determined. Knowing and recognizing these viewpoints is effective for general practitioners when discussing the deprescribing of preventive cardiovascular medications with patients and may be used to promote implementation of deprescription.

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“…This is likely because they feared CVD even more than the side effects, or because they were not able to change their lifestyle. 14 …”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Understanding deprescribing of preventive cardiovascular medication: a Q-methodology study in patients

Luymes¹,

Boelhouwer²,

Poortvliet³

et al. 2017

PPA

View full text Add to dashboard Cite

show abstract

“…In light of the growing evidence suggesting patients experience significant problems taking medicines [27], concerns over medicine wastage, and adverse effects due to inappropriate polypharmacy [28], the United Kingdom (UK) Department of Health commissioned a national ‘Medicine Use Review’ (MUR) service in 2005. This was to be delivered from pharmacies as an optional ‘advanced service’ to support patient understanding and adherence to therapy [29].…”

Section: Introductionmentioning

confidence: 99%

Towards equity: a qualitative exploration of the implementation and impact of a digital educational intervention for pharmacy professionals in England

Latif

Waring

Pollock

et al. 2019

Int J Equity Health

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Background Patients belonging to marginalised (medically under-served) groups experience problems with medicines (i.e. non-adherence, side effects) and poorer health outcomes largely due to inequitable access to healthcare (arising from poor governance, cultural exclusion etc.). In order to promote service equity and outcomes for patients, the focus of this paper is to explore the implementation and impact of a new co-produced digital educational intervention on one National Health Service (NHS) funded community pharmacy medicines management service. Methods Semi-structured interviews with a total of 32 participants. This included a purposive sample of 22 community pharmacy professionals, (16 pharmacists and 6 pharmacy support staff) all who offered the medicine management service. In order to obtain a fuller picture of the barriers to learning, five professionals who were unable to complete the learning were also included. Ten patients (from a marginalised group) who had received the service (as a result of the digital educational intervention) were also interviewed. Drawing on an interpretative analysis, Normalisation Process Theory (NPT) was used as a theoretical framework. Results Three themes are explored. The first is how the digital learning intervention was implemented and applied. Despite being well received, pharmacists found it challenging completing and cascading the learning due to organisational constraints (e.g. lack of time, workload). Using the four NPT constructs (coherence, cognitive participation, collective action and reflexive monitoring) the second theme exposes the impact of the learning and the organisational process of ‘normalisation’. Professional reflective accounts revealed instances where inequitable access to health services were evident. Those completing the intervention felt more aware, capable and better equipped to engage with the needs of patients who were from a marginalised group. Operationally there was minimal structural change in service delivery constraining translation of learning to practice. The impact on patients, explored in our final theme, revealed that they experience significant disadvantage and problems with their medicines. The medication review was welcomed and the discussion with the pharmacist was helpful in addressing their medicine-related concerns. Conclusions The co-produced digital educational intervention increases pharmacy professionals’ awareness and motivation to engage with marginalised groups. However structural barriers often hindered translation into practice. Patients reported significant health and medicine challenges that were going unnoticed. They welcomed the additional support the medication review offered. Policy makers and employers should better enable and facilitate ways for pharmacy professionals to better engage with marginalised groups. The impact of the educational intervention on patients’ health and medicines management could be substantial if supported and promoted effectively.

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Meta-synthesis of qualitative research: the challenges and opportunities

2016

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Synthesis of qualitative studies is an emerging area that has been gaining more interest as an important source of evidence for improving health care policy and practice. In the last decade there have been numerous attempts to develop methods of aggregating and synthesizing qualitative data. Although numerous empirical qualitative studies have been published about different aspects of health care research, to date, the aggregation and syntheses of these data has not been commonly reported, particularly in pharmacy practice related research. This paper describes different methods of conducting meta-synthesis and provides an overview of selected common methods. The paper also emphasizes the challenges and opportunities associated with conducting meta-synthesis and highlights the importance of meta-synthesis in informing practice, policy and research.

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Patients' expectations of medicines – a review and qualitative synthesis

Cited by 14 publications

References 34 publications

Understanding deprescribing of preventive cardiovascular medication: a Q-methodology study in patients

Understanding deprescribing of preventive cardiovascular medication: a Q-methodology study in patients

Towards equity: a qualitative exploration of the implementation and impact of a digital educational intervention for pharmacy professionals in England

Meta-synthesis of qualitative research: the challenges and opportunities

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