Original research
Patients' evaluation of the appropriateness of their hypertension management—A qualitative study

https://doi.org/10.1016/j.sapharm.2006.02.006Get rights and content

Abstract

Background

The existing appropriateness measures for prescribing used in the United States and the United Kingdom use clinical attributes. Treatment and care from a patient's perspective need to be evaluated in terms of whether they are more likely to lead to an outcome of a life worth living, in social, psychological, and physical terms. However, it is unclear whether patients specifically evaluate their prescribed medication and treatment. If so, do they use only clinical attributes or a combination of clinical and nonclinical attributes?

Objectives

The aim of this study was to explore if patients evaluated their hypertension management, and if they did, investigate what attributes were involved in the evaluation.

Methods

Semistructured interviews, which focused on personal experiences of hypertension and its management were undertaken with patients (n = 28). The aim of the interviews was to obtain, in a narrative format, the experiences, beliefs, and information that patients considered important when discussing the management of hypertension. Data analysis used a constant comparative method.

Results

All patients considered their hypertension management regimen appropriate, but were able to mention only 2 categories of attributes to justify their decision (the relationship with their General Practitioner and lowering of their blood pressure). Further series attributes were mentioned by the patient during the course of their interview; these attributes were considered to be involved in their evaluation. These implicit attributes were categorized as anxieties and concerns regarding treatment and diagnosis, explanation of the consequences of treatment, choice of antihypertensives, and the side effects experienced.

Conclusions

Patient's evaluation of appropriateness was constructed from both explicit and implicit attributes. 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 involved when an evaluation is made.

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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