Concordance-based adherence support service delivery: consumer perspectives
- 286 Downloads
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.
KeywordsAdherence Australia Cognitive pharmaceutical services Concordance Medicine information Patient centred care Pharmaceutical Care
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.
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.
- 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.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.
- 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.Ortiz M. A survey of pharmacists’ perceptions of their professional role. Aust J Pharm. 1990;71:241–8.Google Scholar
- 14.WHO. Adherence to long-term therapies—evidence for action. Geneva; 2003. ISBN 9241545992.Google Scholar
- 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
- 18.Raynor D. Patient compliance: the pharmacist’s role. Int J Pharm Pract. 1992;3:126–35.Google Scholar
- 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.Minichiello V, Aroni R, Hays T. In-depth interviewing: principles, techniques, analysis. Sydney: Pearson Education Australia; 2008. ISBN 978073398014.Google Scholar
- 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.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.Taylor S, Bogdan R. Introduction to qualitative research methods—a guidebook and resource. New York: Wiley; 1998. ISBN 0471168688.Google Scholar
- 24.Smith F. Focus groups and observation studies. Int J Pharm Pract. 1998;6:229–42.Google Scholar
- 25.Silverman D. Doing qualitative research, a practical handbook. London; Thousand Oaks: Sage Publishing Group; 2000. ISBN 0761958231.Google Scholar
- 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.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.Hefferman F, Peterson G, Polack A. Public perceptions on aspects of community pharmacy practice. Aust Pharm. 1993;12:296–301.Google Scholar
- 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.
- 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
- 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.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
- 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.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.Schommer J, Sullivan C, Haugtbvedt C. Patients’ role orientation for pharmacist consultation. J Soc Adm Pharm. 1995;13(1):33–41.Google Scholar