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Using a problem detection study (PDS) to identify and compare health care provider and consumer views of antihypertensive therapy

Journal of Human Hypertension volume 17, pages 397–405 (2003)Cite this article

Abstract

The objectives of this study were to ascertain consumer knowledge and behaviour about hypertension and treatment and to compare these with health care providers' perceptions (of ‘most’ consumers). The design for the study was a problem detection study (PDS): focus groups and then survey. Focus groups and survey participants were convenience samples of consumers, doctors, nurses and pharmacists. The main outcome measures were agreement on a 5-point Likert scale with statements about consumers' knowledge and behaviour about high blood pressure and medication. The survey identified areas of consensus and disagreement between consumers and health providers. While general knowledge and concordance with antihypertensive therapy among consumers was good, consequences such as eye and kidney disease, interactions with herbal medicines, and how to deal with missing a dose were less well known. Side effects were a problem for over one-quarter of participants, and cost was a problem in continuing therapy. Half the consumers had not received sufficient written information. Providers overall disagreed that most consumers have an adequate understanding of the condition. They agreed that most consumers adhere to therapy and can manage medicines; and about their own profession's role in information provision and condition management. Consumers confirmed positive provider behaviour, suggesting opportunities for greater communication between providers about actions taken with their consumers. In conclusion, the PDS methodology was useful in identifying consumer opinions. Differences between consumer and provider responses were marked, with consumers generally rating their knowledge and behaviour above providers' ratings of ‘most’ consumers. There are clear gaps to be targeted to improve the outcomes of hypertension therapy.

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References

  1. Australian Pharmaceutical Advisory Council. National Medicines Policy. Commonwealth of Australia, Department of Health and Aged Care: Canberra, 2000.

  2. Roughead EE, Monteith GR, Harvey KJ, Tett SE . Evaluating Australia's National Medicines Policy using geographical mapping. Int Med J 2002; 32: 66–71.

    Article  CAS  Google Scholar 

  3. Ratanawijitrasin S, Soumerai SB, Weerasuriya K . Do national medicinal drug policies and essential drug programs improve drug use? A review of experiences in developing countries. Soc Sci Med 2001; 53: 831–844.

    Article  CAS  Google Scholar 

  4. Edmonds DJ et al. Development of an Australian drug utilisation database: a report from the Drug Utilization Subcommittee of the Pharmaceutical Benefits Advisory Committee. Pharmacoeconomics 1993; 3: 427–432.

    Article  CAS  Google Scholar 

  5. Cockburn J, Pit S . Prescribing behaviour in clinical practice: patients' expectations and doctors' perceptions of patients' expectations a questionnaire study. BMJ 1997; 315: 520–523.

    Article  CAS  Google Scholar 

  6. Davis JJ . Riskier than we think? The relationship between risk statement completeness and perceptions of direct to consumer advertised prescription drugs. J Health Commun 2000; 5: 349–369.

    Article  CAS  Google Scholar 

  7. Schommer JC, Doucette WR, Worley MM . Processing prescription drug information under different conditions of presentation. Patient Educ Couns 2001; 43: 49–59.

    Article  CAS  Google Scholar 

  8. Carter-Edwards L, Bynoe MJ, Svetkey LP . Knowledge of diet and blood pressure among African Americans: use of focus groups for questionnaire development. Ethnic Dis 1998; 8: 184–197.

    CAS  Google Scholar 

  9. Montgomery AA, Fahey T . How do patients' treatment preferences compare with those of clinicians?. Qual Health Care 2001; 10(Suppl 1): i39–i43.

    Article  Google Scholar 

  10. Hammarstrom B, Wessling A, Nilsson JL . Pharmaceutical care for patients with skin diseases: a campaign year at Swedish pharmacies. J Clin Pharm Ther 1995; 20: 327–334.

    Article  CAS  Google Scholar 

  11. Lisper B, Nilsson JLG . The asthma year in Swedish pharmacies. Ann Pharmacother 1996; 30: 455–459.

    Article  CAS  Google Scholar 

  12. Rosenqvist U, Hoglund A, Nilsson JLG . Diabetes mass education for patients, their educators and the general public by the pharmacies of Sweden. Drug Info J 1995; 29: 609–616.

    Article  Google Scholar 

  13. Consumer Focus Collaboration. Feedback, Participation and Consumer Diversity: A Literature Review. Canberra: Commonwealth Department of Health and Aged Care, 2000.

  14. Draper MaHS . The Role of Patient Satisfaction Surveys in a National Approach to Hospital Quality Management. Australian Government Publishing Service Canberra, 1995, p. 102.

    Google Scholar 

  15. Kirscht JP, Roesenstock IM . Patient adherence to antihypertensive medical regimens. J Commun Health 1977; 3: 115–124.

    Article  CAS  Google Scholar 

  16. Sackett DL, et al. Randomised clinical trial of strategies for improving medication compliance in primary hypertension. Lancet 1975; 31 May: 1205–1207.

  17. Devine E, Reifschneider E . A meta-analysis of the effects of psycho-educational care in adults with hypertension. Nurs Res 1995; 44: 237–243.

    Article  CAS  Google Scholar 

  18. Glanz K, Kirscht JP, Rosenstock IM . Linking research and practice in patient education for hypertension. Med Care 1981; 19: 141–152.

    Article  CAS  Google Scholar 

  19. Simpson SH, Farris KB, Johnson JA, Tsuyuki RT . Using focus groups to identify barriers to drug use in patients with congestive heart failure. Pharmacotherapy 2000; 20: 823–829.

    Article  CAS  Google Scholar 

  20. Bennett SA, Magnus P . Trends in cardiovascular risk factors in Australia: Results from the National Heart Foundation's risk factor prevalence study. Med J Aust 1994; 161: 519–527.

    Article  CAS  Google Scholar 

  21. National Health Priority Areas Report. Cardiovascular health. A report on heart, stroke and vascular disease. Summary 1998. Commonwealth Department of Health and Aged Care and Australian Institute of Health and Welfare: Canberra, 1999, Report No.: AIHW Cat. No. PHE 12.

  22. Australian Bureau of Statistics. Cause of Death in Australia 1999. Canberra: Australian Bureau of Statistics; 2000. Report No.: Catalogue Number: 3303.0.

  23. Australian Institute of Health and Welfare. Cardio-vascular Health. AIHW: Canberra; 2001.

  24. Britt H, Miller GC, Charles J . General practitioner activity in Australia 1999–2000. General Practitioner Statistics and Classification Unit, Australian Institute for Health and Welfare: Canberra; 2001.

    Google Scholar 

  25. Stanton AL . Determinants of adherence to medical regimens by hypertensive patients. J Behav Med 1987; 10: 377–394.

    Article  CAS  Google Scholar 

  26. Hays RD et al. The impact of patient adherence on health outcomes for patients with chronic disease in the Medical Outcomes Study. J Behav Med 1994; 17: 347–360.

    Article  CAS  Google Scholar 

  27. Steel N . Thresholds for taking antihypertensive drugs in different professional and lay groups: questionnaire survey. BMJ 2000; 7247: 1446–1447.

    Article  Google Scholar 

  28. Horne R, Weinman J . Patients' beliefs about prescribed medicines and their role in adherence to treatment in chronic physical illness. J Psychosom Res 1999; 47: 555–567.

    Article  CAS  Google Scholar 

  29. Morisky DE, Bowler MH, Finlay JS . An educational and behavioural approach toward increasing patient activation in hypertension management. J Commun Health 1982; 7: 171–182.

    Article  CAS  Google Scholar 

  30. Kawachi I, Wilson N . The evolution of anti-hypertensive therapy. Soc Sci Med 1990; 31: 1239–1243.

    Article  CAS  Google Scholar 

  31. Sclar DA et al. Effect of health education in promoting prescription refill compliance among patients with hypertension. Clin Ther 1991; 13: 489–495.

    CAS  PubMed  Google Scholar 

  32. Harris L, Carruthers-Czyzewski P . The pharmacist's role in controlling hypertension. Can Pharma J 1981; 114: 46–48.

    CAS  Google Scholar 

  33. Garrity TF, Garrity AR . The nature and efficacy of intervention studies in the National High Blood Pressure Education Research Program. J Hypertens Suppl 1985; 3: S91–S95.

    CAS  PubMed  Google Scholar 

  34. Gardner SF, Schneider EF . 24-Hour ambulatory blood pressure monitoring in primary care. J Am Board Fam Pract 2001; 14: 166–171.

    CAS  PubMed  Google Scholar 

  35. McKenney JM, Brown ED, Necsary R, Reavis L . Effect of pharmacist drug monitoring and patient education on hypertensive patients. Contemp Pharm Pract 1978; 1: 50–56.

    Google Scholar 

  36. Erickson SR, Slaughter MS, Halapy H . Pharmacists' ability to influence outcomes of hypertension therapy. Pharmacotherapy 1997; 17: 140–147.

    CAS  PubMed  Google Scholar 

  37. Mehos BM, Saseen JJ, MacLaughlin EJ . Effect of pharmacist intervention and initiation of home blood pressure monitoring in patients with uncontrolled hypertension. Pharmacotherapy 2000; 20: 1384–1389.

    Article  CAS  Google Scholar 

  38. Berger BA et al. Effectiveness of an educational program to teach pharmacists to counsel hypertensive patients and influence treatment adherence. J Pharma Market Manage 1990; 5: 27–41.

    Article  Google Scholar 

  39. Soghikian K . The role of nurse practioners in hypertension care. Clin Sci Mol Med 1978; 55: 345s–348s.

    Google Scholar 

  40. Eaton LE, Buck EA, Cantanzaro JE . The nurse's role in facilitating compliance in clients with hypertension. Medsurg Nurs 1996; 5: 339–345.

    CAS  PubMed  Google Scholar 

  41. Cummings KM, Kirscht JP, Binder LR, Godley AJ . Determinants of drug treatment maintenance among hypertensive persons in inner city Detroit. Public Health Rep 1982; 97: 99–106.

    CAS  PubMed  PubMed Central  Google Scholar 

  42. Levine DM et al. The physician's role in improving patient outcome in high blood pressure control. Md State Med J 1983; 32: 291–293.

    CAS  PubMed  Google Scholar 

  43. Morisky DE et al. Five-year blood pressure control and mortality following health education. Am J Public Health 1983; 73: 153–162.

    Article  CAS  Google Scholar 

  44. Kirscht JP, Kirscht JL, Rosenstock IM . A test of interventions to increase adherence to hypertensive medical regimens. Health Educ Q 1981; 8: 261–272.

    Article  CAS  Google Scholar 

  45. Earp JL, Ory MG, Strogatz DS . The effects of family involvement and practitioner home visits on the control of hypertension. Am J Public Health 1982; 72: 1147–1153.

    Article  Google Scholar 

  46. Fishman T . The 90-second intervention: a patient compliance mediated technique to improve and control hypertension. Public Health Rep 1995; 110: 173–178.

    CAS  PubMed  PubMed Central  Google Scholar 

  47. Rimer BK, Glanz K, Lerman C . Contributions of public health to patient compliance. J Commun Health 1991; 16: 225–240.

    Article  CAS  Google Scholar 

  48. Rudd P . Clinicians and patients with hypertension: unsettled issues about compliance. Am Heart J 1995; 130: 572–579.

    Article  CAS  Google Scholar 

  49. Doherty WJ, Schrott HG, Metcalf L, Iasiello-Vailas L . Effect of spouse support and health beliefs on medication adherence. J Fam Pract 1983; 17: 837–841.

    CAS  PubMed  Google Scholar 

  50. Robbins J . What can physicians do to improve patient compliance. Med Interface 1994; 7: 63–65.

    CAS  PubMed  Google Scholar 

  51. Garfield FB, Caro JJ . Compliance and hypertension. Curr Hypertens Rep 1999; 1: 502–506.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We thank the consumers and health professionals who participated in the Advisory Panel and contributed to the Focus Groups. The financial assistance of a grant (AUD$ 30,000) from Queensland Health (Public Health Services) for this Quality Use of Medicines project is also appreciated.

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Authors and Affiliations

  1. Australia's Health Pty Ltd, Lyneham, ACT, Australia

    A H Wade & D N Weir

  2. School of Pharmacy, The University of Queensland, Brisbane, QLD, Australia

    A H Wade, A P Cameron & S E Tett

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  1. A H Wade
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  2. D N Weir
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  3. A P Cameron
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  4. S E Tett
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Correspondence to S E Tett.

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Wade, A., Weir, D., Cameron, A. et al. Using a problem detection study (PDS) to identify and compare health care provider and consumer views of antihypertensive therapy. J Hum Hypertens 17, 397–405 (2003). https://doi.org/10.1038/sj.jhh.1001565

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