The Pharmaceutical Journal
Vol 275 No 7377 p656
26 November 2005

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Mismatch revealed between doctors’ and patients’ attitudes to self-injected therapy

Research into attitudes of doctors and patients towards self-administered injectable therapy suggests doctors are influenced more by misplaced perceptions of patient antipathy than by published guidelines. The study also found patients are much more willing to self-inject than doctors believe.

Robert Horne, a pharmacist and professor of psychology in health care at the University of Brighton, presented results of the “Open mind” study at the 10th European AIDS Conference held in Dublin last week. The study investigated why only 10 per cent of eligible patients requiring the injectable antiretroviral (ARV) therapy enfuvirtide (Fuzeon), because of resistance to other ARV drug classes, are receiving it. However, Professor Horne says his findings have wider relevance to all injectable therapies for serious medical conditions where patients’ outcomes could be seriously compromised by choosing non-injectable treatment options.

The study included 603 treatment-experienced HIV patients and 499 doctors with three years’ or more experience of treating HIV who had at least 15 per cent of patients with exposure to eight or more ARVs. It looked at practicalities as well as perceptions that serve as barriers or motivators to the delivery of optimal treatment.

Results showed 76 per cent of doctors agreed injectable therapy could offer a superior clinical outcome but almost half believed it would increase non-adherence and treatment refusal while 40 per cent thought patients would feel the drawbacks outweighed benefits. However, 72 per cent of patients said they had never been given the opportunity to discuss injectable therapy as a treatment option. Over three quarters said they would be likely to accept injectable therapy if it were offered by their doctors and 60 per cent thought that they could cope confidently with self-injecting and were motivated to accept treatment as directed.

“ This does not call for doctor-bashing,” said Professor Horne. “Doctors have good intentions in limiting patient access to injectable ARVs but they may be depriving the patients most likely to benefit,” he commented. “Misplaced beliefs may be influencing prescribing more than published guidelines. The study will help us in designing intelligent, streetwise interventions to address the problem.”