scholarly journals New Insights into Antihypertensive Adherence from Illness Perception and the Physician-Patient Relationship: A Mixed Methods Study

2021 ◽  
Author(s):  
Mohammad Reza Nikfarjam ◽  
Shahram Mohammadkhani ◽  
Ali Reza Moradi ◽  
Tahereh Davarpasand
Keyword(s):  
Mixed Methods ◽  
Lifestyle Modification ◽  
Illness Perception ◽  
Preliminary Evidence ◽  
Mixed Methods Study ◽  
Uncontrolled Hypertension ◽  
Patient Relationship ◽  
Physician Patient Relationship ◽  
Modifiable Factors ◽  
Physician Patient

Low treatment adherence is the most important cause of uncontrolled hypertension. Given the limited evidence in the literature, this study investigated how illness perception and the physician-patient relationship influence medication and lifestyle modification adherence in essential hypertension. In this explanatory mixed methods study, we collected and analyzed quantitative data from 112 patients, and then revealed qualitative themes from the collected data of 3 patients identified based on statistical results. Explaining quantitative results, mixed methods inferences provided preliminary evidence for professionals and future studies regarding the role of illness perception and the physician-patient relationship as modifiable factors in fearless behavior change intervention.

scholarly journals Assessment of patient and provider attitudes towards therapeutic drug monitoring to improve medication adherence in low-income patients with hypertension: a qualitative study

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e039940
Author(s):  
Kevin B Schesing ◽  
Ricardo Chia ◽  
Bryan Elwood ◽  
Ethan A Halm ◽  
Simon J Craddock Lee ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Therapeutic Drug Monitoring ◽  
Low Income ◽  
Drug Monitoring ◽  
Uncontrolled Hypertension ◽  
Secondary Outcome ◽  
Therapeutic Drug ◽  
Patient Relationship ◽  
Physician Patient Relationship ◽  
Physician Patient

ObjectivesPrevious studies have implicated therapeutic drug monitoring (TDM), by measuring serum or urine drug levels, as a highly reliable technique for detecting medication non-adherence but the attitudes of patients and physicians toward TDM have not been evaluated previously. Accordingly, we solicited input from patients with uncontrolled hypertension and their physicians about their views on TDM.DesignProspective analysis of responses to a set of questions during semistructured interviews.SettingOutpatient clinics in an integrated health system which provides care for a low-income, uninsured population.ParticipantsPatients with uncontrolled hypertension with either systolic blood pressure of at least 130 mm Hg or diastolic blood pressure of at least 80 mm Hg despite antihypertensive drugs and providers in the general cardiology and internal medicine clinics.Primary and secondary outcome measuresAttitudes towards TDM and the potential impact on physician–patient relationship.ResultsWe interviewed 11 patients and 10 providers and discussed the findings with 13 community advisory panel (CAP) members. Of the patients interviewed, 91% (10 of 11) and all 10 providers thought TDM was a good idea and should be used regularly to better understand the reasons for poorly controlled hypertension. However, 63% (7 of 11) of patients and 20% of providers expressed reservations that TDM could negatively impact the physician–patient relationship. Despite some concerns, the majority of patients, providers and CAP members believed that if test results are communicated without blaming patients, the potential benefits of TDM in identifying suboptimal adherence and eliciting barriers to adherence outweighed the risks.ConclusionThe idea of TDM is well accepted by patients and their providers. TDM information if delivered in a non-judgmental manner, to encourage an honest conversation between patients and physicians, has the potential to reduce patient–physician communication obstacles and to identify barriers to adherence which, when overcome, can improve health outcomes.

Simulation-Based Training of Communication and Emotional Competence for the Improvement of Physician-Patient Relationship

2006 ◽  
Author(s):  
Luigi Anolli ◽  
Fabrizia Mantovani ◽  
Alessia Agliati ◽  
Olivia Realdon ◽  
Valentino Zurloni ◽  
...  
Keyword(s):  
Emotional Competence ◽  
Patient Relationship ◽  
Physician Patient Relationship ◽  
Simulation Based ◽  
Physician Patient

Crisis and Informed Consent: Analysis of a Law-Medicine Malocclusion

1987 ◽  
Vol 12 (1) ◽  
pp. 55-97 ◽  
Author(s):  
Fran Carnerie
Keyword(s):  
Informed Consent ◽  
Medical Treatment ◽  
Clinical Setting ◽  
Patient Relationship ◽  
Physician Patient Relationship ◽  
Catastrophic Illness ◽  
Physician Patient ◽  
Emotional Impairment

AbstractMany individuals develop a temporary state of cognitive and emotional impairment after being diagnosed with catastrophic illness. Thus, when crucial decisions about medical treatment are required, they are unable to assimilate information; or worse, the legal need to be informed can rival a psychological desire to not be informed. The Canadian informed consent doctrine is unresponsive to crisis and clinically impracticable, and so paradoxically compromises the integrity and autonomy it was designed to protect. Many aspects of the physician-patient relationship and clinical setting also undermine the philosophical values enshrined in this doctrine. This further jeopardizes the individual's integrity. The Article explores proposals for change such as delaying the informing and consenting, improving the concept of consent, and improving the role of the physician.

scholarly journals Physicians’ views on the usefulness and feasibility of identifying and disclosing patients’ last phase of life: a focus group study

2021 ◽  
pp. bmjspcare-2020-002764
Author(s):  
Catherine Owusuaa ◽  
Irene van Beelen ◽  
Agnes van der Heide ◽  
Carin C D van der Rijt
Keyword(s):  
Palliative Care ◽  
Organ Failure ◽  
Care Quality ◽  
Patient Relationship ◽  
Physician Patient Relationship ◽  
Focus Group Study ◽  
Timely Initiation ◽  
Care Services ◽  
Palliative Care Services ◽  
Physician Patient

ObjectivesAccurate assessment that a patient is in the last phase of life is a prerequisite for timely initiation of palliative care in patients with a life-limiting disease, such as advanced cancer or advanced organ failure. Several palliative care quality standards recommend the surprise question (SQ) to identify those patients. Little is known about physicians’ views on identifying and disclosing the last phase of life of patients with different illness trajectories.MethodsData from two focus groups were analysed using thematic analysis with a phenomenological approach.ResultsFifteen medical specialists and general practitioners participated. Participants thought prediction of patients’ last phase of life, i.e. expected death within 1 year, is important. They seemed to find that prediction is more difficult in patients with advanced organ failure compared with cancer. The SQ was considered a useful prognostic tool; its use is facilitated by its simplicity but hampered by its subjective character. The medical specialist was considered mainly responsible for prognosticating and gradually disclosing the last phase. Participants’ reluctance to such disclosure was related to uncertainty around prognostication, concerns about depriving patients of hope, affecting the physician–patient relationship, or a lack of time or availability of palliative care services.ConclusionsPhysicians consider the assessment of patients’ last phase of life important and support use of the SQ in patients with different illness trajectories. However, barriers in disclosing expected death are prognostic uncertainty, possible deprivation of hope, physician–patient relationship, and lack of time or palliative care services. Future studies should examine patients’ preferences for those discussions.

Ethics of Drug Giving and Drug Taking

1988 ◽  
Vol 18 (2) ◽  
pp. 195-200 ◽  
Author(s):  
Albert R. Jonsen
Keyword(s):  
Ethical Principles ◽  
Patient Relationship ◽  
Physician Patient Relationship ◽  
Ancient Greek ◽  
Therapeutic Application ◽  
Therapeutic Drugs ◽  
Physician Patient ◽  
Technical Terms

The activity of prescribing therapeutic drugs is one of the most significant features of the physician-patient relationship. This activity must be understood in moral, as well as technical terms. The ancient Greek word for drug had three meanings, providing the outline for an ethics of medication: remedy, poison and magical charm. Corresponding to these three meanings are three ethical principles: competence in therapeutic application, avoidance of harm and honesty.

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