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A qualitative study of cardiac rehabilitation patients' perspectives on taking medicines: implications for the 'medicines-resistance' model of medicine-taking.

White S, Bissell P, Anderson C - BMC Health Serv Res (2013)

Bottom Line: The findings suggest that the active/passive and accepter/modifier distinctions may not allow for clear determination of which profile a patient fits into at any given point, and that definitions such as 'accepter' and 'resistance' may be insufficiently discerning to categorise patients' use of medicines in practice.These problems appear to arise when the issue of patients' accounts about medicines adherence are considered, since patients may have concerns or disquiet about medicines whether or not they are adherent and the model does not consider disquiet in isolation from adherence.Practical application of the 'medicines resistance' model of medicine-taking may be problematic in this patient group.

View Article: PubMed Central - HTML - PubMed

Affiliation: School of Pharmacy, Keele University, Staffordshire ST5 5BG, UK. s.j.white@keele.ac.uk

ABSTRACT

Background: The appropriate use of medicines continues to be an important area of inter-disciplinary research activity both in the UK and beyond. Key qualitative work in this area in the last decade has included the 'medicines resistance' model of medicine-taking, which was based on a meta-ethnography of 37 qualitative studies. This model proposed that patients approach medicine-taking as 'passive accepters', 'active accepters', 'active modifiers' or 'complete rejecters', of which the latter two categories were considered to show 'resistance' to medicines. However, critical assessment of the model appears to be currently lacking, particularly in terms of its use in clinical practice. This paper seeks to contribute to the literature in this area by critically examining the practical application of the model in light of the findings from a qualitative, follow-up study of cardiac rehabilitation patients' perspectives and experiences of using medicines.

Methods: Following ethical approval, in-depth, audiotaped, qualitative interviews were conducted with fifteen patients who had completed a UK hospital-based cardiac rehabilitation programme. Participants were aged 42-65, white British and from a variety of socioeconomic backgrounds. Interview topics included perspectives on coronary heart disease, medicine-taking and lifestyle changes. Follow-up interviews with ten patients approximately nine months later explored whether their perspectives had changed.

Results: The findings suggest that the active/passive and accepter/modifier distinctions may not allow for clear determination of which profile a patient fits into at any given point, and that definitions such as 'accepter' and 'resistance' may be insufficiently discerning to categorise patients' use of medicines in practice. These problems appear to arise when the issue of patients' accounts about medicines adherence are considered, since patients may have concerns or disquiet about medicines whether or not they are adherent and the model does not consider disquiet in isolation from adherence.

Conclusions: Practical application of the 'medicines resistance' model of medicine-taking may be problematic in this patient group. Dissociation of disquiet about medicines from medicines adherence may allow for a focus on helping patients to resolve their disquiet, if possible, without this necessarily having to be viewed in terms of its potential effect on adherence.

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Pound et al’s ‘medicines resistance’ model of medicine-taking [[6].
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Figure 1: Pound et al’s ‘medicines resistance’ model of medicine-taking [[6].

Mentions: To understand this area in more depth, researchers have increasingly been drawn to qualitative approaches and one of the most interesting papers to have emerged in this field in recent years is that by Pound et al[6]. Their ‘medicines-resistance’ model of medicine-taking (Figure 1) was developed from a meta-ethnography[7] of 37 qualitative research studies published between 1992 and 2001 that primarily explored lay peoples’ views of medicine-taking. Their model placed peoples’ approaches to prescribed medicines into the four categories of ‘passive accepter’ (accepts medicines without question), ‘active accepter’ (accepts medicines after self-evaluation), ‘active modifier’ (modifies their medicines regimen after self-evaluation) and ‘complete rejecter’ (rejects taking medicines completely). Of these categories, the latter two were considered to show what they described as ‘medicines-resistance’. The ‘medicines-resistance’ model differed from Dowell and Hudson’s model of medicine-taking in that it included the category of ‘active accepter’ of medicines[8]. This is an important distinction because although Dowell and Hudson found that most patients evaluated medicines for themselves before accepting them, their model only categorised such acceptance as a passive process[8]. In contrast, the ‘medicines-resistance’ model recognised this as an active process, as is modification of the medication regimen after a process of self-evaluation.


A qualitative study of cardiac rehabilitation patients' perspectives on taking medicines: implications for the 'medicines-resistance' model of medicine-taking.

White S, Bissell P, Anderson C - BMC Health Serv Res (2013)

Pound et al’s ‘medicines resistance’ model of medicine-taking [[6].
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3750914&req=5

Figure 1: Pound et al’s ‘medicines resistance’ model of medicine-taking [[6].
Mentions: To understand this area in more depth, researchers have increasingly been drawn to qualitative approaches and one of the most interesting papers to have emerged in this field in recent years is that by Pound et al[6]. Their ‘medicines-resistance’ model of medicine-taking (Figure 1) was developed from a meta-ethnography[7] of 37 qualitative research studies published between 1992 and 2001 that primarily explored lay peoples’ views of medicine-taking. Their model placed peoples’ approaches to prescribed medicines into the four categories of ‘passive accepter’ (accepts medicines without question), ‘active accepter’ (accepts medicines after self-evaluation), ‘active modifier’ (modifies their medicines regimen after self-evaluation) and ‘complete rejecter’ (rejects taking medicines completely). Of these categories, the latter two were considered to show what they described as ‘medicines-resistance’. The ‘medicines-resistance’ model differed from Dowell and Hudson’s model of medicine-taking in that it included the category of ‘active accepter’ of medicines[8]. This is an important distinction because although Dowell and Hudson found that most patients evaluated medicines for themselves before accepting them, their model only categorised such acceptance as a passive process[8]. In contrast, the ‘medicines-resistance’ model recognised this as an active process, as is modification of the medication regimen after a process of self-evaluation.

Bottom Line: The findings suggest that the active/passive and accepter/modifier distinctions may not allow for clear determination of which profile a patient fits into at any given point, and that definitions such as 'accepter' and 'resistance' may be insufficiently discerning to categorise patients' use of medicines in practice.These problems appear to arise when the issue of patients' accounts about medicines adherence are considered, since patients may have concerns or disquiet about medicines whether or not they are adherent and the model does not consider disquiet in isolation from adherence.Practical application of the 'medicines resistance' model of medicine-taking may be problematic in this patient group.

View Article: PubMed Central - HTML - PubMed

Affiliation: School of Pharmacy, Keele University, Staffordshire ST5 5BG, UK. s.j.white@keele.ac.uk

ABSTRACT

Background: The appropriate use of medicines continues to be an important area of inter-disciplinary research activity both in the UK and beyond. Key qualitative work in this area in the last decade has included the 'medicines resistance' model of medicine-taking, which was based on a meta-ethnography of 37 qualitative studies. This model proposed that patients approach medicine-taking as 'passive accepters', 'active accepters', 'active modifiers' or 'complete rejecters', of which the latter two categories were considered to show 'resistance' to medicines. However, critical assessment of the model appears to be currently lacking, particularly in terms of its use in clinical practice. This paper seeks to contribute to the literature in this area by critically examining the practical application of the model in light of the findings from a qualitative, follow-up study of cardiac rehabilitation patients' perspectives and experiences of using medicines.

Methods: Following ethical approval, in-depth, audiotaped, qualitative interviews were conducted with fifteen patients who had completed a UK hospital-based cardiac rehabilitation programme. Participants were aged 42-65, white British and from a variety of socioeconomic backgrounds. Interview topics included perspectives on coronary heart disease, medicine-taking and lifestyle changes. Follow-up interviews with ten patients approximately nine months later explored whether their perspectives had changed.

Results: The findings suggest that the active/passive and accepter/modifier distinctions may not allow for clear determination of which profile a patient fits into at any given point, and that definitions such as 'accepter' and 'resistance' may be insufficiently discerning to categorise patients' use of medicines in practice. These problems appear to arise when the issue of patients' accounts about medicines adherence are considered, since patients may have concerns or disquiet about medicines whether or not they are adherent and the model does not consider disquiet in isolation from adherence.

Conclusions: Practical application of the 'medicines resistance' model of medicine-taking may be problematic in this patient group. Dissociation of disquiet about medicines from medicines adherence may allow for a focus on helping patients to resolve their disquiet, if possible, without this necessarily having to be viewed in terms of its potential effect on adherence.

Show MeSH
Related in: MedlinePlus