BMJ  2003;327:837 (11 October), doi:10.1136/bmj.327.7419.837

Paper

Managing multiple morbidity in mid-life: a qualitative study of attitudes to drug use

¹ MRC Social and Public Health Sciences Unit, University of Glasgow, Glasgow G12 8RZ, ² Scottish School for Primary Care, NHS Education for Scotland, The Lister, Edinburgh EH8 9DR

Objective To examine attitudes towards drug use among middle aged respondents with high levels of chronic morbidity.

Design Qualitative study with detailed interviews.

Setting West of Scotland.

Participants 23 men and women aged about 50 years with four or more chronic illnesses.

Main outcome measure Participants' feelings about long term use of drugs to manage chronic multiple morbidity.

Results Drugs occupied a central place in the way people managed their comorbidities. Respondents expressed an aversion to taking drugs, despite acknowledging that they depended on drugs to live as "normal" a life as possible. Respondents expressed ambivalence to their drugs in various ways. Firstly, they adopted both regular and more flexible regimens and might adhere to a regular regimen in treating one condition (such as hypertension) while adopting a flexible regimen in relation to others, in response to their experience of symptoms or varying demands of their daily life. Secondly, they expressed reluctance to take drugs, but an inability to be free of them. Thirdly, drugs both facilitated performance of social roles and served as evidence of an inability to perform such roles.

Conclusions Insight into the considerable tension experienced by people managing complex drug regimens to manage multiple chronic illness may help medical carers to support self care practices among patients and to optimise concordance in their use of prescribed drugs.

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