Original researchPatients' evaluation of the appropriateness of their hypertension management—A qualitative study
Section snippets
Background
Modernizing the United Kingdom's National Health Service to ensure patients receive the most effective care pathways, has in part involved a series of National Service Frameworks.1, 2 Most National Service Frameworks are based on evidence-based guidelines, which have been established from systematic reviews and meta-analyses of randomized, controlled clinical trial data. This ensures that the recommended treatments for specific medical conditions (for example, hypertension and asthma) are based
Methods
This study involved semistructured interviews with patients who had been diagnosed with hypertension. Ethical approval was obtained from the Local National Health Service Research Ethics Committee and the University's Committee on the Ethics of Research on Human Beings.
Participants' details
Of the 232 information packs posted to patients with hypertension or displayed in the waiting rooms of each medical center, 88 (38%) replies were received. Sixty-three (27%) indicated a willingness to participate in the study, and the remainder (11%) declined. Twenty-eight patients (12 females and 16 males) were purposively selected—their average age was 59 years (ranging from 20 to 78 years) and their average duration of treatment of hypertension was 10 years (ranging from 6 months to 30
Discussion
The findings indicate that patients may not be familiar with the concept of appropriateness in terms of their prescribed medication or medical care. All patients considered that this term referred to their prescribed medication being suitable. However, they did not consider themselves “medically knowledgeable” and consequently, any evaluation of prescribed medication and treatment was better determined by their GP. Clearly, this reflects the trust that patients have in their GP, as they are
Conclusion
Patients' evaluation of appropriateness may be constructed from both explicit and implicit attributes, which are made up of both medical and nonmedical criteria. Implicit attributes, those not consciously known to the patient still could be involved in the process of evaluating hypertension, its treatment, and care. Although the nonmedical attributes that are considered by patients can be categorized, it has to be remembered that it is the inherent meaning held by each individual patient that
Acknowledgments
The authors are grateful for the time given to the study by the interviewed patients and the anonymous reviewers for their comments and suggestions.
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