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Vol. 54, No. 3, March 2008, pp.384 - 393 Copyright © 2008 by The College of Family Physicians of Canada
Do patients’ expectations influence their use of medications?Qualitative studyLisa Dolovich, PharmD MSc, Kalpana Nair, MEd MSc, Connie Sellors, Lynne Lohfeld, PhD, Annie Lee, MSc(T) and Mitchell Levine, MD MSc FRCPC FISPEDr Dolovich is a Scientist and Associate Director, Ms Nair is a doctoral student and Dr Levine is Director of the Centre for Evaluation of Medicines at St Joseph’s Healthcare in Hamilton, Ont. Ms Sellors is a pharmacist and a Lecturer in the Department of Family Medicine at McMaster University in Hamilton. Dr Lohfeld is an Assistant Professor in the Department of Clinical Epidemiology and Biostatistics at McMaster University. Ms Lee is a pharmacist and Structured Practical Experience Program Educational/Site Coordinator in the Leslie Dan Faculty of Pharmacy at the University of Toronto in Ontario Correspondence to: Dr Lisa Dolovich, Centre for Evaluation of Medicines, 105 Main St E, Level P1, Hamilton, ON L8N 1G6; telephone 905 522-1155, extension 33968; fax 905 528-7386; e-mailldolovic{at}mcmaster.ca OBJECTIVE To investigate whether patients’ expectations influence how they take their medications by looking at the expectations patients have of their medications and the factors that affect these expectations. DESIGN Qualitative study using in-depth interviews and a grounded-theory approach. SETTING A large city in Ontario. PARTICIPANTS A total of 18 community-dwelling adult patients taking medication for at least 6 months. METHOD Both purposive and convenience sampling techniques were used. The initial strategy comprised stratified, maximum variation, and typical case sampling. The research team developed a semistructured interview guide after a preliminary review of the literature. Individual, face-to-face, in-depth interviews were conducted and audiotaped. At the end of the interviews, basic demographic information was collected. Interviewers were debriefed following each interview and their comments on relevant contextual information, general impressions of the interview, and possible changes to the interview guide were audiotaped. Audiotapes of each interview, including the debriefing, were transcribed verbatim, cleaned, and given a unique identifying number. At least 2 team members participated in analyzing the data using an operational code book that was modified to accommodate emerging themes as analysis continued. MAIN FINDINGS Patients’ expectations were more realistic than idealistic. Many participants acted on their expectations by changing their medication regimens on their own or by seeking additional information on their medications. Expectations were affected by patients’ beliefs, past experiences with medications, relationships with their health care providers, other people’s beliefs, and the cost of medication. Patients actively engaged in strategies to confirm or modify their expectations of their medications. CONCLUSION A range of factors (most notably past experiences with medications and relationships with health care providers) influenced patients’ expectations of their medications. More comprehensive discussion between patients and their health care providers about these factors could affect whether medications are used optimally.
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