The Pharmaceutical Journal
Vol 274 No 7337 p215
19 February 2005

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Who decides? UK public perception of decisions about care and medicines

Caroline Kelham, Geraldine Mynors and Joanne Shaw, of the Medicines Partnership, look at the results of a commissioned MORI poll

Surveys of public opinion by Medicines Partnership clearly show that people want to be involved in decisions about treatment, but still lack the information they need. The results come from an annual MORI poll commissioned by Medicines Partnership.

Polling took place in the run-up to the “Ask about medicines week” campaigns in 2003 and 2004 and aimed to test how far people want to be involved in decisions about treatment and whether they have the information they need to make decisions.

The survey asked people whether they generally prefer to make up their own mind about what treatment is right for them, to decide together with the doctor, or for the doctor to decide for them. In both 2003 and 2004, 24 per cent said they prefer to make up their own mind after the doctor had explained the options, 40 per cent prefer to decide in partnership with the doctor, and 32 per cent prefer the doctor to make the decision. In other words, nearly two thirds of patients want to be involved to some extent in decisions about their treatment.

Not surprisingly, these figures vary according to age, gender, geography and social class. But in every category, at least half of people prefer patient-centred decision-making to a traditional, paternalistic model where their doctor decides for them. For example, half of the over 65s, and 54 per cent of people from social classes D and E want some say in decisions. More women than men want to be actively involved in choice of treatment, but 58 per cent of men still want to have some level of engagement. And while people in some parts of the North of England leaned more strongly towards “doctor knows best” than in the Midlands and South, at least 53 per cent of patients in these areas wanted a partnership approach.

The goal is not to involve every patient in the decision about their medicines, but to make sure that everyone has the chance to be involved to the extent that they want. There is still a long way to go: in last year’s Healthcare Commission survey, 40 per cent of patients did not think they were involved as much as they wanted to be in decisions about medicines, and 30 per cent wanted to be more involved in decisions about care and treatment.¹

The stereotype of patients who want to take an active role in decisions may conjure up an image of young, middle-class professionals in the South East. But it is a mistake to assume that older patients or people from less advantaged backgrounds do not want to have their say. More than anything, these data remind us that one size does not fit all.

Not getting the right information

If patients are to participate in treatment decisions in a meaningful way, they need information. Our surveys showed that many people think they do not have enough information about the options open to them, or the pros and cons of particular treatments. In 2004, 44 per cent of people who had been prescribed a new medicine over the previous year believed they did not know enough about other possible medicines or treatments. One in five thought they did not know enough about potential side effects, and one in three said there is not enough information available about the risks and benefits of medicines.

This is backed up by evidence from a recent international study where half of UK patients said that their doctor told them about treatment choices and asked for their ideas and opinions only occasionally or not at all.² And in the 2004 Healthcare Commission patient survey nearly 40 per cent of hospital inpatients and 60 per cent of patients in primary care believed they were not given enough information about side effects.

The MORI survey confirmed that health professionals are still the main source for medicines information, with over half the members of the public surveyed finding pharmacists a useful information source.

More can be done to give patients access to high quality, reliable, patient-friendly medicines information so that they can participate in decisions about their own treatment and understand their medicines better. Pharmacists can help prepare patients for partnership by delivering and signposting information and encouraging people to think through their questions and priorities.

The new community pharmacy contract should help move this forward. Giving advice about medicines is a key component of essential services such as dispensing and repeat dispensing. There are further opportunities to promote patient information and shared decision-making through signposting and public health interventions. Medicines use review and enhanced medicines management services will also be a path to identifying and addressing patients’ information needs and involving them in a discussion about issues and concerns with treatment.

The transition from secondary to primary care is a key step, with many patients now leaving hospital with unanswered questions about how to make best use of their medicines. Increasing automation in hospital pharmacies is freeing hospital pharmacist time to engage with patients and help them to understand their medicines better.

References

1. Healthcare Commission. Patient survey report 2004: primary care

2. Schoen C, Osborn R, Huynh PT, Doty M, Davis K, Zapert K et al. Primary care and health system performance: adults’ experiences in five countries. Health Affairs 2004;23:119–35