Advertisement

Pharmacy World & Science

, Volume 30, Issue 6, pp 846–853 | Cite as

Concordance-based adherence support service delivery: consumer perspectives

  • Sophie Du Pasquier
  • Parisa Aslani
Research Article

Abstract

Objectives: To explore consumers’ attitudes towards, and expectations of, adherence support services in primary health care, specifically in community pharmacy; and to explore consumers’ attitudes towards the concept of concordance. Setting: An exploratory qualitative study conducted in Metropolitan Sydney, Australia. Method: Three focus group discussions with consumers on chronic therapy (n = 22) and two focus groups with consumer representatives (n = 15) were conducted in 2002. Consumer representatives were peer educators volunteering in an association which promotes quality use of medicines among elderly patients. All discussions were audio-taped, transcribed verbatim and thematically content analysed. Main outcome measures: Consumers’ experiences with adherence support services delivered by general practitioners and pharmacists, their expectations towards general practitioners’ and pharmacists’ role in adherence support; and attitudes towards concordance in consultations. Results: Participants expected an increased provision of medicine information and a reduction in the number of medications taken as the main strategies to promote adherence. They believed that once understandable information had been delivered, it was their responsibility to take their medications as prescribed. Yet participants frequently complained about the information received, especially from doctors. Only a subgroup of participants expected pharmacists to be involved in adherence support services. These participants generally relied on pharmacists for medicine information and were satisfied with the communication process when interacting with the pharmacists. All participants were positive about concordance, because they valued two-way communication and increased consideration of their needs and beliefs by healthcare professionals. However, they were hesitant about being involved in a shared treatment decision-making process. Many participants focused on concordance with doctors and identified barriers to the establishment of concordance: time pressures, financial constraints, the gap of competence and power between patients and doctors. Conclusions: Pharmacists should consider consumers’ needs for information and establishing concordance, as well as their expectations of the pharmacy profession, in delivering concordance based adherence support services. Given participants’ high demand for medicine information, an opportunity might exist for pharmacists to influence consumers’ expectations by offering information which is tailored towards their needs.

Keywords

Adherence Australia Cognitive pharmaceutical services Concordance Medicine information Patient centred care Pharmaceutical Care 

Notes

Acknowledgements

The authors would like to thank the participants for taking part in the focus group discussions, and the Combined Pensioners and Superannuants Association of New South Wales for assistance in identifying participants for the research study.

Funding

Ms. Sophie du Pasquier received a postgraduate scholarship from Merck, Sharp & Dohme and then the Pharmacy Research Trust of New South Wales whilst conducting this study.

Conflicts of interest

There are no conflicts of interest to declare by the authors.

References

  1. 1.
    Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005;353:487–97.PubMedCrossRefGoogle Scholar
  2. 2.
    Kripalani S, Yao X, Haynes B. Interventions to enhance medication adherence in chronic medical conditions. Arch Intern Med. 2007;167:540–50.PubMedCrossRefGoogle Scholar
  3. 3.
    Haynes B, McKibbon A, Kanani R. Systematic review of randomized trials of interventions to assist patients to follow prescriptions for medications. Lancet. 1996;348:383–6.PubMedCrossRefGoogle Scholar
  4. 4.
    Horne R. Adherence to medication: a review of existing research. In: Myers L, Midence K, editors. Adherence to treatment in medical condition. Amsterdam: Harwood Academic Publishers; 1998. p. 285–311. ISBN 9057022656.Google Scholar
  5. 5.
    Royal Pharmaceutical Society of Great Britain, Merck Sharp and Dohme. From compliance to concordance: achieving sharegoals in medicine taking. 1997. http://www.concordance.org. Accessed Aug 2000.
  6. 6.
    Kjellgren K, Svensson S, Ahlner J, Saljo R. Antihypertensive treatment and patient autonomy—the follow-up appointment as a resource for care. Patient Educ Couns. 2000;40:39–49.PubMedCrossRefGoogle Scholar
  7. 7.
    Stevenson F, Barry A, Britten N, Barber N, Bradley CP. Doctor-patient communication about drugs: the evidence for shared decision making. Soc Sci Med. 2000;50:829–40.PubMedCrossRefGoogle Scholar
  8. 8.
    Thorne S, Ternulf N, Paterson B. Attitudes toward patient expertise in chronic illness. Int J Nurs Stud. 2000;37:303–11.PubMedCrossRefGoogle Scholar
  9. 9.
    Smith F, Francis S, Rowley E. Group interviews with people taking long-term medication: comparing the perspectives of people with arthritis, respiratory disease and mental health problems. Int J Pharm Pract. 2000;8:88–96.Google Scholar
  10. 10.
    Ortiz M. A survey of pharmacists’ perceptions of their professional role. Aust J Pharm. 1990;71:241–8.Google Scholar
  11. 11.
    Kansanaho H, Isonen-Sjolung N, Pietila K, Airaksinen M, Isonen T. Patient counselling profile in a Finnish pharmacy. Patient Educ Couns. 2002;47:77–82.PubMedCrossRefGoogle Scholar
  12. 12.
    Schommer J, Wiederholt J. A field investigation of participant and environment effects on pharmacist-patient communication in community pharmacies. Med Care. 1995;33(6):567–84.PubMedCrossRefGoogle Scholar
  13. 13.
    Schommer J, Wiederholt J. The association of prescription status, patient age, patient gender, and patient asking question behavior with the content of pharmacist-patient communication. Pharm Res. 1997;14(2):145–51.PubMedCrossRefGoogle Scholar
  14. 14.
    WHO. Adherence to long-term therapies—evidence for action. Geneva; 2003. ISBN 9241545992.Google Scholar
  15. 15.
    Raynor D, Nicolson M, Nunney J, Petty D, Vail A, Davies L. The development and evaluation of an extended adherence support programme by community pharmacists for elderly patients at home. Int J Pharm Pract. 2000;8:157–64.Google Scholar
  16. 16.
    Van Wijk B, Klungel O, Heerdink E, de Boer A. Effectiveness of interventions by community pharmacists to improve patient adherence to chronic medication: a systematic review. Ann Pharmacother. 2005;39:319–28.PubMedCrossRefGoogle Scholar
  17. 17.
    Denham M, Barnett N. Drug therapy and the older person—role of the pharmacist. Drug Saf. 1998;19(4):243–50.PubMedCrossRefGoogle Scholar
  18. 18.
    Raynor D. Patient compliance: the pharmacist’s role. Int J Pharm Pract. 1992;3:126–35.Google Scholar
  19. 19.
    Gibbs A. Social research update: issue 19: focus groups. Department of Sociology, University of Surrey. http://www.soc.surrey.ac.uk. Accessed Dec 2001.
  20. 20.
    Minichiello V, Aroni R, Hays T. In-depth interviewing: principles, techniques, analysis. Sydney: Pearson Education Australia; 2008. ISBN 978073398014.Google Scholar
  21. 21.
    Ritchie J, Spencer L. Qualitative data analysis for applied policy research. In: Bryman A, Burgess RG, editors. Analysing qualitative data. London: Routledge; 1994. ISBN 041506063X.Google Scholar
  22. 22.
    Pope C, Ziebland S, Mays N. Analysing qualitative data. In: Pope C, Mays N, editors. Qualitative research in health care. London: BMJ Publishing group; 2000. ISBN 0727913964.Google Scholar
  23. 23.
    Taylor S, Bogdan R. Introduction to qualitative research methods—a guidebook and resource. New York: Wiley; 1998. ISBN 0471168688.Google Scholar
  24. 24.
    Smith F. Focus groups and observation studies. Int J Pharm Pract. 1998;6:229–42.Google Scholar
  25. 25.
    Silverman D. Doing qualitative research, a practical handbook. London; Thousand Oaks: Sage Publishing Group; 2000. ISBN 0761958231.Google Scholar
  26. 26.
    Murphy E, Dingwall R, Greatbatch D, Parker S, Watson P. Qualitative research methods in health technology assessment: an overview. Health Technol Assess. 1998;2(16):1–13.Google Scholar
  27. 27.
    Mays N, Pope C. Quality in qualitative health research. In: Mays N, Pope C, editors. Qualitative research in health care. London: BMJ Publishing Group; 2000. ISBN 0727913964.Google Scholar
  28. 28.
    Hefferman F, Peterson G, Polack A. Public perceptions on aspects of community pharmacy practice. Aust Pharm. 1993;12:296–301.Google Scholar
  29. 29.
    Consumers’ Health Forum of Australia. Understanding consumer behaviour and experiences in relation to the use of medicines, literature review. Canberra; 1999. p. 1–64. Available at www.chf.org.au/publications/all_search3.asp?id=301.
  30. 30.
    Clark N, Gong M. Management of chronic disease by practitioners and patients: are we teaching the wrong things? BMJ. 2000;320:572–5.PubMedCrossRefGoogle Scholar
  31. 31.
    Kendrew P, Ward F, Buick D, Wright D, Horne R. Satisfaction with information and its relationship with adherence in patients with chronic pain. Int J Pharm Pract. 2001;9:R5.Google Scholar
  32. 32.
    Caress A, Luker K, Woodcock A, Beaver K. An exploratory study of priority information needs in adult asthma patients. Patient Educ Couns. 2002;47:319–27.PubMedCrossRefGoogle Scholar
  33. 33.
    Dowell J, Hudson H. A qualitative study of medication-taking behaviour in primary care. Fam Pract. 1997;14(5):369–75.PubMedCrossRefGoogle Scholar
  34. 34.
    Isacson D, Bingefors K. Attitudes towards drugs—a survey in the general population. Pharm World Sci. 2002;24(3):104–10.PubMedCrossRefGoogle Scholar
  35. 35.
    Traulsen Morgall J, Almarsdottir A, Bjornsdottir I. The lay user perspective on the quality of pharmaceuticals, drug therapy and pharmacy services—results of focus group discussions. Pharm World Sci. 2002;24(5):196–200.CrossRefGoogle Scholar
  36. 36.
    Abu-Omar S, Weiss M, Hassel K. Pharmacists and their customers; a personal or anonymous service? Int J Pharm Pract. 2000;8:135–43.Google Scholar
  37. 37.
    Schommer J. Pharmacist’s new communicative role: explaining illness and medicine to patients. In: Explaining illness: research, theory and strategies. Mahwah, NJ, US: Lawrence Erlbaum Associates; 2000. ISBN 0805831126.Google Scholar
  38. 38.
    Chewning B, Schommer J. Increasing clients’ knowledge of community pharmacists’ roles. Pharm Res. 1996;13(9):1299–304.PubMedCrossRefGoogle Scholar
  39. 39.
    Schommer J. Patients’ expectations and knowledge of patient counseling services that are available from pharmacists. Am J Pharm Educ. 1997;61:402–6.Google Scholar
  40. 40.
    Bell H, McElnay J, Hughes C. Societal perspectives on the role of the community pharmacist and community-based pharmaceutical services. J Soc Adm Pharm. 2000;17(2):119–28.Google Scholar
  41. 41.
    Schommer J, Sullivan C, Haugtbvedt C. Patients’ role orientation for pharmacist consultation. J Soc Adm Pharm. 1995;13(1):33–41.Google Scholar
  42. 42.
    Ende J, Kazis L, Ash A, Moskowitz A. Measuring patients’ desire for autonomy: decision making and information seeking preferences among medical patients. J Gen Intern Med. 1989;4:23–9.PubMedCrossRefGoogle Scholar
  43. 43.
    Edwards A, Elwyn G, Smith C, Williams S, Thornton H. Consumers’ views of quality in the consultation and their relevance to “shared decision-making” approaches. Health Expect. 2001;4:151–61.PubMedCrossRefGoogle Scholar
  44. 44.
    Vermeire E, Hearnshaw H, Van Royen P, Denekens J. Patient adherence to treatment: three decades of research: a comprehensive review. J Clin Pharm Ther. 2001;26:331–42.PubMedCrossRefGoogle Scholar
  45. 45.
    Campbell R, Pound P, Pope C, Britten N, Pill R, Morgan M, et al. Evaluating meta-ethnography: a synthesis of qualitative research on lay experiences of diabetes and diabetes care. Soc Sci Med. 2003;56:671–84.PubMedCrossRefGoogle Scholar
  46. 46.
    Trewin V. Patient sources of drug information and attitudes to their provision: a corticosteroid model. Pharm World Sci. 2003;25(5):191–6.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2008

Authors and Affiliations

  1. 1.Faculty of Pharmacy, Building A15The University of SydneySydneyAustralia
  2. 2.Pharmacy Practice Research Group, Department of Ambulatory Care and Community MedicineUniversity of LausanneLausanneSwitzerland

Personalised recommendations