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International Journal of Clinical Pharmacy

, Volume 35, Issue 6, pp 1161–1169 | Cite as

Issues potentially affecting quality of life arising from long-term medicines use: a qualitative study

  • Janet KrskaEmail author
  • Charles W. Morecroft
  • Helen Poole
  • Philip H. Rowe
Research Article

Abstract

Background Polypharmacy is increasing and managing large number of medicines may create a burden for patients. Many patients have negative views of medicines and their use can adversely affect quality of life. No studies have specifically explored the impact of general long-term medicines use on quality of life. Objective To determine the issues which patients taking long-term medicines consider affect their day-to-day lives, including quality of life. Setting Four primary care general practices in North West England Methods Face-to-face interviews with adults living at home, prescribed four or more regular medicines for at least 1 year. Interviewees were identified from primary care medical records and purposively selected to ensure different types of medicines use. Interviews were recorded, transcribed and analysed thematically. Results Twenty-one interviews were conducted and analysed. Patients used an average of 7.8 medicines, 51 % were preventive, 40 % for symptom relief and 9 % treatment. Eight themes emerged: relationships with health professionals, practicalities, information, efficacy, side effects, attitudes, impact and control. Ability to discuss medicines with health professionals varied and many views were coloured by negative experiences, mainly with doctors. All interviewees had developed routines for using multiple medicines, some requiring considerable effort. Few felt able to exert control over medicines routines specified by health professionals. Over half sought additional information about medicines whereas others avoided this, trusting in doctors to guide their medicines use. Patients recognised their inability to assess efficacy for many medicines, notably those used for prophylaxis. All were concerned about possible side effects and some had poor experiences of discussing concerns with doctors. Medicines led to restrictions on social activities and personal life to the extent that, for some, life can revolve around medicines. Conclusion There is a multiplicity and complexity of issues surrounding medicines use, which impact on day-to-day lives for patients with long-term conditions. While most patients adapt to long-term medicines use, others did so at some cost to their quality of life.

Keywords

England Medication management Patient-centred Pharmaceutical care Quality of life Qualitative research 

Notes

Acknowledgments

Authors are grateful to Helen Roberts who assisted in identifying patients and to Rosie Auckland who conducted the interviews.

Funding

The study was funded by Liverpool John Moores University.

Conflicts of interest

The authors have no conflicts of interest to declare.

References

  1. 1.
    May M, Montori V, Mair F. We need minimally disruptive medicine. BMJ. 2009;339:485–7.CrossRefGoogle Scholar
  2. 2.
    Eton DT, se Oliveria DR, Egginton JS, Ridgeway JL, Odell L, May CR, Montori VM. Building a measurement framework of burden of treatment in complex patients with chronic conditions: a qualitative study. Patient Relat Outcome Meas. 2012;3:39–49.CrossRefPubMedGoogle Scholar
  3. 3.
    Campbell SE, Seymour DG, Primrose WR. A systematic literature review of factors affecting outcome in older medical patients admitted to hospital. Age Ageing. 2004;33:110–5.CrossRefPubMedGoogle Scholar
  4. 4.
    Fox C, Richardson K, Maidment ID, Savva GM, Matthew FE, Smithard D, Coulton S, Katona C, Boustani MA, Brayne C. Anticholinergic medication use in the older population: the MRC cognitive function and aging study. J Am Geriatr Soc. 2011;59:1477–83.CrossRefPubMedGoogle Scholar
  5. 5.
    Alic A, Pranjic N, Ramic E. Polypharmacy and decreased cognitive abilities in elderly patients. Med Arch. 2011;65(2):102–5.Google Scholar
  6. 6.
    NHS Information Centre. Prescriptions Dispensed in the community: statistics for 1999 to 2009. 2010. Available at: http://www.ic.nhs.uk/webfiles/publications/prescriptionsdispensed/Prescriptions_Dispensed_1999_2009%20.pdf.
  7. 7.
    Bowling A. Measuring health: a review of quality of life measurement scales. 2nd ed. Buckingham: Open University Press; 1997.Google Scholar
  8. 8.
    Pound P, Britten N, Morgan M, Yardley L, Pope C, Daker-White G, et al. Resisting medicines: a synthesis of qualitative studies of medicine taking. Soc Sci Med. 2005;61(1):133–55.CrossRefPubMedGoogle Scholar
  9. 9.
    Moen J, Bohm A, Tillenius T, Antonov K, Nilsson JLG, Ring L. I don’t know how many of these [medicines] are necessary. A focus group study among elderly users of multiple medicines. Patient Educ Couns. 2008;74:135–141.Google Scholar
  10. 10.
    Eastleigh Southern Parishes Older People’s Forum. Pills and Perils: Repeat Prescribing for Older patients. ESPOPF, 2008. Available at: www.espopf.org/research/PillsAndPerils.
  11. 11.
    Nunes V, Neilson J, O’Flynn N, Calvert N, Kuntze S, Smithson H, et al. Clinical guidelines and evidence review for medicines Adherence: involving patients in decisions about prescribed medicines and supporting adherence. London: National Collaborating Centre for Primary Care and Royal College of General Practitioners; 2009.Google Scholar
  12. 12.
    Boustani MA, Campbell N, Munger S, Maidment I, Fox C. Impact of anticholinergics on the aging brain: a review and practical application. Aging Health. 2008;4(3):311–20.CrossRefGoogle Scholar
  13. 13.
    Elliott RA, Marriott JL. Standardised assessment of patients’ capacity to manage medications: a systematic review of published instruments. BMC Geriatr. 2009;9:27.CrossRefPubMedGoogle Scholar
  14. 14.
    Atkinson MJ, Sinha A, Hass SL, Colman SS, Kumar RN, Brod M, Rowland CR. Validation of a general measure or treatment satisfaction, the treatment satisfaction questionnaire for medication (TSQM), using a national panel study of chronic disease. Health and Quality of Life Outcomes. 2004;2:12.CrossRefPubMedGoogle Scholar
  15. 15.
    Boyatzis RE. Transforming Qualitative Information: Thematic Analysis and Code Development. CA: Sage Publications; 1998.Google Scholar
  16. 16.
    Krska J, Morecroft CW, Poole H, Rowe PH. Developing a tool to measure medicines-related quality of life. Int J Pharm Pract. 2012;20(Suppl 1):12.Google Scholar
  17. 17.
    Royal Pharmaceutical Society and British Medical Association. British National Formulary 63, Pharmaceutical Press: London; 2012.Google Scholar
  18. 18.
    Williams S, Weinman J, Dale J. Doctor-patient communication and patient satisfaction: a review. Fam Pract. 1998;15:480–92.CrossRefPubMedGoogle Scholar
  19. 19.
    Ong L. Doctor-patient communication: a review of the literature. Soc Sci Med. 1995;40(7):903–18.CrossRefPubMedGoogle Scholar
  20. 20.
    Mead N, Bower P. Patient-centred consultations and outcomes in primary care: a review of the literature. Patient Educ Counsel. 2002;48(1):51–61.CrossRefGoogle Scholar
  21. 21.
    Guthrie B, Saultz JW, Freeman GK, Haggerty JL. Continuity of care matters. BMJ. 2008;337:a867.CrossRefPubMedGoogle Scholar
  22. 22.
    Saultz JW, Albedaiwi W. Interpersonal continuity of care and patient satisfaction: a critical review. Ann Fam Med. 2004;2:445–51.CrossRefPubMedGoogle Scholar
  23. 23.
    Adler R, Vasiliadis A, Bickell N. The relationship between continuity and patient satisfaction: a systematic review. Fam Pract. 2010;27(2):171–8.CrossRefPubMedGoogle Scholar
  24. 24.
    Salisbury C, Johnson L, Purgy S, Valderas JM, Montgomery AA. Epidemiology and impact of multimorbidity in primary care. A retrospective cohort study. Br J Gen Pract. 2011;61(582):e12–21.CrossRefPubMedGoogle Scholar
  25. 25.
    Kripalani S, LeFevre F, Phillips CO, Williams MV, Basaviah P, Baker DW. Deficits in communication and information transfer between hospital-based and primary care physicians: implications for patient safety and continuity of care. JAMA. 2007;297(8):831–41.CrossRefPubMedGoogle Scholar
  26. 26.
    Krska J, Morecroft CW. Views of the general public on the role of pharmacy in public health. J Pharm Health Serv Res. 2010;1(1):33–8.Google Scholar
  27. 27.
    Saramunee K, Krska J, Mackridge AJ, Richards J, Suttajit S, Philips-Howard P. How to enhance the uptake of public health services in community pharmacy? A qualitative study. Res Soc Admin Pharm 2012. Published on-line doi:  10.1016/j.sapharm.2012.05.006.
  28. 28.
    Anderson C, Blenkinsopp A, Armstrong M. Feedback from community pharmacy users on the contribution of community pharmacy to improving the public’s health: a systematic review of the peer reviewed and non-peer reviewed literature 1990–2002. Health Expect. 2004;7:191–202.CrossRefPubMedGoogle Scholar
  29. 29.
    Eades CE, Ferguson JS, O’Carroll RE. Public health in community pharmacy: a systematic review of community pharmacist and consumer views. BMC Public Health. 2011;11(582):1–45.Google Scholar
  30. 30.
    Eton DT, Oliveira DR, Egginton JS, Ridgeway JL, Odell L, May CR, Montori VM. Building a measurement framework of burden of treatment in complex patients with chronic conditions: a qualitative study. Patient Relat Outcome Meas. 2012;3:39–49.CrossRefPubMedGoogle Scholar
  31. 31.
    Kairuz T, Bye L, Birdsall R, et al. Identifying compliance issues with prescription medicines among older people: a pilot study. Drugs Aging. 2008;25(2):153–62.CrossRefPubMedGoogle Scholar
  32. 32.
    Medicines Use Review service http://www.psnc.org.uk/pages/mur.html (Accessed 23/07/13).
  33. 33.
    New Medicines Service. Pharmaceutical Services Negotiating Committee. NMS. 2011. Available from : http://www.psnc.org.uk/pages/nms.html. Accessed 23 July 2013.
  34. 34.
    Pharmacy Guild of Australia. Home medicines review service. Available from: http://www.guild.org.au/services-programs/medication-management/home-medicines-reviews. Accessed 23 July 2013.
  35. 35.
    American Pharmacists Association and National Association of Chain Drug Stores Foundation. Medication therapy management in pharmacy practice. 2008 Available at: http://www.pharmacist.com/sites/default/files/files/core_elements_of_an_mtm_practice.pdf (Accessed 23 July 2013.
  36. 36.
    Krska J, Morecroft CW. Patients’ use of information about medicine side effects in relation to experiences of suspected adverse drug reactions. Drug Saf. 2012 Published early on-line May 2013 DOI  10.1007/s40264-013-0065-3.
  37. 37.
    Berry DC, Michas IC, Gillie T, Forster M. What do patients want to know about their medicines and what do doctors want to tell them? A comparative study. Psychol Health. 1997;12:467–80.CrossRefGoogle Scholar
  38. 38.
    Stevenson F. The strategies used by general practitioners when providing information about medicines. Patient Educ Couns. 2001;43(1):97–104.CrossRefPubMedGoogle Scholar
  39. 39.
    Elliott RA, Ross DD, Adams AS, Safran DG, Soumerai SB. Strategies for coping in a complex world: adherence behavior among older adults with chronic illness. J Gen Intern Med. 2007;22(6):805–10.CrossRefPubMedGoogle Scholar
  40. 40.
    Britten N, Stevenson FA, Barry CA, Barber N, Bradley CP. Misunderstandings in prescribing decisions in general practice: a qualitative study. BMJ. 2000;320:484–8.CrossRefPubMedGoogle Scholar
  41. 41.
    Horne R, Weinman J, Hankins M. The beliefs about medicines questionnaire: the development and evaluation of a new method for assessing the cognitive representation of medication. Psychol Health. 1999;14:1–24.CrossRefGoogle Scholar
  42. 42.
    Golomb BA, McGraw JJ, Evans MA, Dimsdale JE. Physician response to patient reports of adverse drug effects. Drug Saf. 2007;30:669–75.CrossRefPubMedGoogle Scholar
  43. 43.
    Anderson CA, Krska J, Murphy E, Avery AJ. On behalf of the yellow card study collaboration. The importance of direct patient reporting of ADRs: a patient perspective. Br J Clin Pharmacol. 2011;72(5):806–22.CrossRefPubMedGoogle Scholar
  44. 44.
    Krska J, Anderson CA, Murphy E, Avery AJ. On behalf of the yellow card study collaboration. how patient reporters identify adverse drug reactions: a qualitative study of reporting via the UK yellow card scheme. Drug Saf. 2011;34(5):429–36.CrossRefPubMedGoogle Scholar
  45. 45.
    Weingart SN, Gandhi TK, Seger AC, Seger DL, Borus J, Burdick E, Leape LL, Bates DW. Patient-reported medication symptoms in primary care. Arch Intern Med. 2005;165:234–40.CrossRefPubMedGoogle Scholar
  46. 46.
    Krska J, Jones L, McKinney J, Wilson C. Medicines safety: experiences and perceptions of the general public in Liverpool. Pharmacoepidemiol Drug Saf. 2011;20(10):1098–103.CrossRefPubMedGoogle Scholar
  47. 47.
    Rochon PA, Gurwitz JH. Optimising drug treatment for elderly people: the prescribing cascade. BMJ. 1997;315:1096–9.CrossRefPubMedGoogle Scholar
  48. 48.
    Duerden MG, Hughes DA. Generic and therapeutic substitutions in the UK: are they a good thing? Br J Clin Pharmacol. 2010;70:335–41.CrossRefPubMedGoogle Scholar
  49. 49.
    Krska J, Allison K, Delargy M, Murray L, Smith H. Implementing a statin switching programme in primary care: patients’ views and experiences. Br J Clin Pharmacol. 2012;74:147–53.CrossRefPubMedGoogle Scholar
  50. 50.
    Thompson A, Green S, Dubois S, et al. Evaluation of patient satisfaction with switching medication. Prescriber. 2006;17:27–35.CrossRefGoogle Scholar
  51. 51.
    Hassali MA, Shafie AA, Jamshed A, Ibrahim M, Awaisu A. Consumers’ views on generic medicine: a review of literature. Int J Pharm Pract. 2009;17:79–88.PubMedGoogle Scholar
  52. 52.
    Richards C, Coulter A. Is the NHS becoming more patient centred? Trends from the national surveys of NHS patients in England, 2002–2007. 2007. Picker Institute.Google Scholar
  53. 53.
    Cox K, Britten N, Hooper R, White P. Patients’ involvement in decisions about medicines: GPs’ perceptions of their preferences. Br J Gen Pract. 2007;57:777–84.PubMedGoogle Scholar

Copyright information

© Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie 2013

Authors and Affiliations

  • Janet Krska
    • 1
    Email author
  • Charles W. Morecroft
    • 2
  • Helen Poole
    • 3
  • Philip H. Rowe
    • 2
  1. 1.School of PharmacyUniversities of Greenwich and KentKentUK
  2. 2.School of Pharmacy and Biomolecular SciencesLiverpool John Moores UniversityLiverpoolUK
  3. 3.School of Natural Sciences and PsychologyLiverpool John Moores UniversityLiverpoolUK

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