[Reasons for therapy non-compliance in older patients taking multiple medication]. / Motivos de incumplimiento terapéutico en pacientes mayores polimedicados, un estudio mediante grupos focales.

OBJECTIVE: To determine the prevalence of therapy non-compliance (TN) and the reasons for it in patients > or =65 taking multiple medication. DESIGN: Quantitative stage: TN prevalence by means of Morisky-Green test. Qualitative stage: 3 focus groups (FG). October 2005 to January 2006. SETTING: Primary care centre in Catalonia, Spain. PARTICIPANTS: Persons > or =65 years old taking 3 or more medicines. A total of 208 tests were administered at random and non-compliers were distributed by thumb into three FG. MEASUREMENTS AND MAIN RESULTS: Quantitative stage. Collection of variables: non-complier, gender, number of medicines, and age. SPSS analysis. Qualitative stage. Data collection through FG and analysis of content: text transcription and classification by theme and sub-theme lines. NC prevalence of 47.6%. In the consultation we found reasons relating to the doctor, the doctor-patient relationship and the context. At pharmacies, pharmacists acted as regulators of prescriptions. At home, patients' beliefs, life-style and the characteristics of the medicine affected compliance. Patients wanted to be sure that doctors understood their chronic medication and would guarantee there would be no interactions. They wanted pharmacists to back this guarantee up. They read the instructions leaflet and were frightened by the section on side-effects. CONCLUSIONS: Prescriptions can become trivial for doctors and extremely important for patients. We must understand reasons for NC and incorporate actions-recommendations to improve compliance, both in day-to-day practice and in the centre's organisation.

Motivos de incumplimiento terapéutico en pacientes mayores polimedicados, un estudio mediante grupos focales / Reasons for therapy non-compliance in older patients taking multiple medication

Objetivo. Determinar la prevalencia de incumplimiento terapéutico y sus motivos en pacientes de 65 años o mayores y polimedicados. Diseño. Fase cuantitativa: prevalencia de incumplimiento terapéutico mediante test de Morisky-Green. Fase cualitativa: 3 grupos focales. Desde octubre de 2005 a enero de 2006. Emplazamiento. Un centro de atención primaria de Cataluña. Participantes. Sujetos de 65 años o mayores que tomaban 3 o más fármacos. Se aplicaron aleatoriamente 208 tests y se distribuyó de forma facultativa a los incumplidores en 3 grupos focales. Mediciones y resultados principales. Fase cuantitativa, recogida de variables: incumplidor, sexo, número de fármacos y edad. Análisis con SPSS. Fase cualitativa, recogida de datos mediante grupos focales y análisis del contenido: transcripción textual y clasificación en líneas temáticas y subtemáticas. La prevalencia de incumplimiento terapéutico fue del 47,6%. En la consulta se detectan motivos relacionados con el médico, la relación médico-paciente y el entorno. En la farmacia el farmacéutico actúa como modulador de la prescripción. En la casa influyen creencias del paciente, hábitos de vida y características del fármaco. El paciente quiere estar seguro de que el médico conoce su medicación crónica y le asegure la inexistencia de interacciones, busca que el farmacéutico se la corrobore, lee el prospecto y se asusta con el apartado de efectos secundarios. Conclusiones. La prescripción puede llegar a ser trivial en el médico y trascendente para el paciente. Debemos conocer los motivos de incumplimiento terapéutico e incorporar acciones-recomendaciones para mejorarlo, tanto en la práctica diaria como en la organización del centro

Objective. To determine the prevalence of therapy non-compliance (TN) and the reasons for it in patients >=65 taking multiple medication. Design. Quantitative stage: TN prevalence by means of Morisky-Green test. Qualitative stage: 3 focus groups (FG). October 2005 to January 2006. Setting. Primary care centre in Catalonia, Spain. Participants. Persons >=65 years old taking 3 or more medicines. A total of 208 tests were administered at random and non-compliers were distributed by thumb into three FG. Measurements and main results. Quantitative stage. Collection of variables: non-complier, gender, number of medicines, and age. SPSS analysis. Qualitative stage. Data collection through FG and analysis of content: text transcription and classification by theme and sub-theme lines. NC prevalence of 47.6%. In the consultation we found reasons relating to the doctor, the doctor-patient relationship and the context. At pharmacies, pharmacists acted as regulators of prescriptions. At home, patients' beliefs, life-style and the characteristics of the medicine affected compliance. Patients wanted to be sure that doctors understood their chronic medication and would guarantee there would be no interactions. They wanted pharmacists to back this guarantee up. They read the instructions leaflet and were frightened by the section on side-effects. Conclusions. Prescriptions can become trivial for doctors and extremely important for patients. We must understand reasons for NC and incorporate actions-recommendations to improve compliance, both in day-to-day practice and in the centre's organisation