The Pharmaceutical Journal
Vol 273 No 7320 p525
9 October 2004

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Non-adherence with drugs more likely if patients’ beliefs are ignored

The 2004 British Pharmaceutical Conference and Exhibition “Medicines: from cell to society” took place at Manchester International Convention Centre from 27–29 September

BPC 2004 summary

Pharmacists should encourage patients to share their views on medicines and illness, Rob Horne, director of the Centre for Health Care Research, University of Brighton, told delegates.

He explained that patients’ non-adherence with medicines can be intentional and is related to their beliefs about medicines and illness. There are two factors that appear important when a patient makes decisions about whether or not to take their medicines: the extent to which they believe they need the medicine and how they balance this with their beliefs about the risks involved. “Typically, over 30 per cent of patients harbour strong concerns,” he said. “What is more, patients tend to have an exaggerated perception of risk.”

He explained that patients’ ideas about medicines tend to be derived from their ideas about illness. He cited the example of asthma, seen by clinicians as a chronic condition needing persistent treatment. Patients may doubt the need for daily inhaled corticosteroids because their view of the disease is centred around symptoms.

“ Pharmacists may make the assumption that the patient in front of them shares the same value system,” Professor Horne said. In reality there may be two sets of opposing beliefs. “Often it is difficult for patients to tell us [that they have a different view] so we get surreptitious non-adherence.”

Patients might think that their scepticism about a medicine will be interpreted as lack of confidence in the practitioner. However, beliefs need to be shared and declared if concordance is to be achieved. “We need to invite patients to give us their views and tell us frankly, without judgement, what they do with the treatment and why,” he commented.

Patients’ ideas about treatment and disease have an internal logic but there is evidence that patients’ beliefs are “not set in stone”. They may be changed through education and negotiation. “The future of pharmacy, in common with the future of medicine, lies beyond the medical model. This is a key challenge for the next decade,” Professor Horne concluded. “Taking account of psychological and social, as well as biomedical, factors will allow pharmacists to work in partnership with patients to get the best from medicines.”