Reasons for medication non-initiation: A qualitative exploration of the patients' perspective.

BACKGROUND: Non-initiation occurs when the doctor prescribes a new pharmacological treatment to a patient who does not fill the prescription. Non-initiation prevalence estimates range between 6% and 28% in Primary Care (PC) and it is associated with poorer clinical outcomes, more sick-leave days and higher costs. To date, the reasons for non-initiation have not been explored using a qualitative framework. OBJECTIVE: The aim of the present study was to identify reasons for medication non-initiation among PC patients with distinct treatment profiles (acute, chronic symptomatic and asymptomatic, and mental disorders). METHODS: An exploratory, explanatory qualitative study based on Grounded Theory. We conducted individual semi-structured interviews with 30 PC patients. A constant comparative method of analysis was performed. RESULTS: The results were similar for all therapeutic groups. The decision to initiate treatment is multifactorial. Users make a risk-benefit assessment which is influenced by their beliefs about the pathology and the medication, their emotional reaction, health literacy and cultural factors. The patients' context and relationship with the health system influence decision-making. CONCLUSIONS: The decision to initiate a treatment is strongly influenced by factors that health professionals can discuss with patients. Health professionals should explore patients' beliefs about benefits and risks to help them make informed decisions and promote shared decision-making. General practitioners should ensure that patients understand the benefits and risks of disease and treatment, while explaining alternative treatments, encouraging patients to ask questions and supporting their treatment decisions.

Importância da ecocardiografia bidimensional na detecçäo e avaliaçäo dos derrames pericárdicos / The importance of two-dimensional echocardiography in the detection and evaluation of pericardial effusion

Os derrames pericárdicos, principalmente septados, podem apresentar sérias dificuldades para sua detecçäo e quantificaçäo pela ecocardiografia convencional. A ecocardiografia bidimensional, em auxílio a modalidade M, permite a detecçäo mais correta dos derrames generalizados, pela regiäo apical e subxifóide. Foram estudados 22 pacientes portadores de derrame pericárdico, dos quais quatro eram septados e oito eram pós-operatórios. Estabeleceram-se as diferenças ecocardiográficas entre os diversos tipos e, em 10 casos, relacionou-se com o aspecto radiológico e com o volume de líquido extraído pela punçäo pericárdica ou pela pericariotomia, mostrando uma razoável correlaçäo (r = 0,76). Conclui-se que a ecocarddiografia bidimensional permite a detecçäo de derrames pericárdicos, especialmente os septados situados fora do alcance do sistema convencional, assim como a sua quantificaçäo, com boa confiabilidade