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- Kjellgren, Karin I, 1950, et al.
(författare)
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Antihypertensive medication in clinical encounters.
- 1998
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Ingår i: International journal of cardiology. - 0167-5273. ; 64:2, s. 161-9
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Tidskriftsartikel (refereegranskat)abstract
- In managing hypertension, patient participation and understanding of the nature and significance of treatment are decisive. We analysed the communication between patient and physician with respect to antihypertensive medication at a follow-up appointment, and assessed patients' knowledge of their medication. The empirical data consist of audio-recordings from 51 hypertensive patients' follow-up appointment with their physicians. Thirty-three of these patients were interviewed in depth immediately after the appointment. The study was performed in primary health care centres and at a specialist clinic for hypertension. When discussing medications, patients mainly talked about experiences of being on medication, whereas physicians generally focused on the pharmacological effect and dosage of the drug. Physicians routinely asked about compliance with drug regimen, but seldom in any depth. Little effort was invested into discussing the effect and goal of therapy. The main finding was that patients had a very fragmentary understanding of the functional nature of their antihypertensive medication. This is unsatisfactory both from the point of view of treatment efficacy and also when considering the legal requirements of involving the patient in the decision making. The follow-up appointments studied gave few possibilities for the patient to learn about their antihypertensive medication.
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- Kjellgren, Karin I, 1950, et al.
(författare)
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Hypertensive patients' knowledge of high blood pressure.
- 1997
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Ingår i: Scandinavian journal of primary health care. - 0281-3432. ; 15:4, s. 188-92
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To investigate hypertensive patients' understanding of the circulatory system, in particular high blood pressure. DESIGN: Semi-structured audio-taped interviews of patients immediately after a regular follow-up appointment with their physician. SETTING: A primary health care centre and a specialist clinic (hypertension unit) in southern Sweden. PATIENTS: 33 hypertensive patients, consecutively selected. MAIN OUTCOME MEASURE: Focus was set on the exploration of patients' understanding/knowledge. RESULTS: In spite of a long history of hypertensive care, on average ten years, patients had a less than satisfactory understanding of their condition. Most patients knew their blood pressure values, but very few were able to give an account of what high blood pressure implies in functional terms. Knowledge of high blood pressure seems mainly to be derived from sources other than the health care system, in particular from the mass media. Knowledge of the risks associated with hypertension was quite good, as was the insight into how these risks could be managed. CONCLUSION: An assessment of patient knowledge of high blood pressure ought to be a starting point for educational strategies that aim to deepen patients' understanding of their state of health.
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- Kjellgren, Karin I, 1950, et al.
(författare)
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Patients' and physicians' assessment of risks associated with hypertension and benefits from treatment.
- 1998
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Ingår i: Journal of cardiovascular risk. - 1350-6277. ; 5:3, s. 161-6
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Perceptions of effects of a medical regimen may affect patients' adherence to therapy. OBJECTIVE: To assess concordance between patients' and physicians' estimations of the risks of hypertension and benefits of treatment during a regular follow-up appointment. DESIGN: A population-based Swedish multicentre study. Patients were included consecutively from a randomized selection of centres (55 primary health care centres and 11 clinics of internal medicine). METHODS: A questionnaire was given to 1013 patients undergoing their individually prescribed antihypertensive therapy and 212 physicians who were caring for these patients. RESULTS: Without therapy, patients perceived the risks of cardiovascular complications to be higher than did their physicians. Patients were not aware that an increasing number of risk factors has an impact on the risk of complications. Patients furthermore rated the benefits of treatment higher than did their physicians (P<0.001). Of the patients, 14% had blood pressures < or = 140/90 mmHg. Most of the patients (61%) were not aware of their target blood pressure. However, when the target pressure was communicated to patients by the physician, patients remembered it accurately. The patients were generally not willing to trade even minor side effects from antihypertensive therapy for benefits of treatment. CONCLUSIONS: There was a high degree of inconsistency between patients' and physicians' estimations of risks of hypertension. Patients estimated the effects of treatment to be more beneficial than did their physicians.
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- Kjellgren, Karin I, 1950, et al.
(författare)
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Perceived symptoms amongst hypertensive patients in routine clinical practice- a population-based study.
- 1998
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Ingår i: Journal of internal medicine. - : Wiley. - 0954-6820 .- 1365-2796. ; 244:4, s. 325-32
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To compare perceived symptoms between patients undergoing antihypertensive therapy and hypertensive patients without drug treatment, and to assess reasons for change of antihypertensive medication in routine clinical practice. DESIGN: Population-based multicentre study. Consecutive patients from a randomized sample of centres were given a standardized questionnaire to assess symptoms as well as opinions about their antihypertensive drugs. SETTING: Fifty-five Swedish primary health care centres and 11 clinics of internal medicine. PATIENTS: One thousand and thirteen hypertensive patients on their individually prescribed antihypertensive medication and 13 5 without antihypertensive therapy. MAIN OUTCOME MEASURES: Prevalence and perception of symptoms with and without antihypertensive drug therapy, changes of medication and reasons for this. RESULTS: Amongst the group of patients on antihypertensive medication, 57% spontaneously reported having had symptoms of high blood pressure before they started their drug therapy. Amongst the patients without antihypertensive drugs, 52% reported having such symptoms. When answering direct questions about different symptoms related to current drug treatment or increased blood pressure, patients with and without medication reported symptoms to a similar extent: 80 and 85%, respectively. A majority of patients (64%) had changed their medication during the course of treatment (range 0-61 years). The mean number of changes was 2.4 times over 12 years. The most common reported cause for changing drug treatment was side-effects (42%). CONCLUSIONS: The study shows that patients in general perceive symptoms from hypertension. Antihypertensive medication decreases the frequency and intensity of symptoms that might be related to high blood pressure but adds other symptoms linked to the medication. Changes in medication were mostly related to side-effects. The follow-up should pay attention to patients' experience of treatment. A sign of a well-managed hypertension population would be a decrease of symptoms over time.
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- Kjellgren, Karin I, 1950, et al.
(författare)
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Taking antihypertensive medication--controlling or co-operating with patients?
- 1995
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Ingår i: International journal of cardiology. - 0167-5273. ; 47:3, s. 257-68
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Tidskriftsartikel (refereegranskat)abstract
- Low compliance with antihypertensive drug regimens has been a well documented reason for inadequate control of hypertension. We assessed recent literature regarding compliance from different disciplines to clarify the nature of reported problems on low compliance to prescribed antihypertensive medication. Much research focuses on primary factors for compliance, methods to monitor and measure individual rates and patterns of compliance. From a behavioural oriented point of view, the focus is on understanding why patients act as they do. This review indicates that there is an almost complete lack of knowledge about how the decision making in the clinical practice is organized when prescribing antihypertensive medication and/or when following up treatment from patients already taking such drugs. Since the concrete communication and collaboration between patient and physician in the clinical setting are of prime significance for patient adherence to drug regimens, it is important to shed light on what happens in this critical situation.
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- Kronstrand, Robert, et al.
(författare)
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Codeine Concentration in Hair after Oral Administration Is Dependent on Melanin Content
- 1999
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Ingår i: Clinical Chemistry. - 0009-9147 .- 1530-8561. ; 45:9, s. 1485-1494
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Tidskriftsartikel (refereegranskat)abstract
- Background: Analysis of drugs in hair has been used on a qualitative basis to estimate earlier exposure to drugs. Clinical applications are rare because of the lack of dose–response relationships in the studies performed to date, and questions remain regarding the mechanisms of drug incorporation into hair. Several human studies have shown differences in drug accumulation between pigmented and nonpigmented hair. However, the melanin concentration in hair was not determined and correlated to the amount of drug incorporated.Methods: Nine human subjects were given codeine as a single oral dose, and plasma codeine concentrations were determined for 24 h, using gas chromatography–mass spectrometry. Hair samples were obtained weekly for a month. Total melanin, eumelanin, and codeine were measured quantitatively in hair samples by spectrophotometry, HPLC, and gas chromatography–mass spectrometry, respectively.Results: There was an exponential relationship between codeine and melanin concentrations in hair, (r2 = 0.95 with total melanin and r2 = 0.83 with eumelanin). After normalizing the results by the area under the curve for codeine in plasma, we obtained r2 = 0.86 for codeine vs total melanin and r2 = 0.90 vs eumelanin.Conclusions: Our results stress the importance of melanin determination when measuring drugs in hair. We postulate that analysis of drug concentration in hair may be worthwhile in the monitoring of drug compliance if the results are normalized for melanin content.
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