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- Aminoff, Ulla Britt, et al.
(författare)
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The nurse--a resource in hypertension care.
- 2001
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Ingår i: Journal of advanced nursing. - : Wiley. - 0309-2402 .- 1365-2648. ; 35:4, s. 582-9
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Tidskriftsartikel (refereegranskat)abstract
- AIM OF THE STUDY: To explore the content and structure of communication between patient and nurse at follow-up appointments concerning hypertension. BACKGROUND: Hypertension is a chronic condition and calls for co-operation between health care providers and patients over a long period of time. One important purpose of the follow-up consultations is to transfer knowledge between patients and health care providers in order to empower patients. This is an important determinant of the quality of care. DESIGN/METHODS: The study was based on 20 audio-recordings of actual follow-up appointments and was approved by ethics committees. The consultations took place at four different health care units for hypertensive patients. FINDINGS: The average length of consultations was 18 minutes. In the consultations, patients initiated an average of eight new topics and nurses an average of 20. All nurses talked with patients about life style. Compared with previous studies of follow-ups with physicians, consultations with nurses addressed lifestyle factors and adherence to treatment to a higher degree. It was also observed that patients were more actively involved in interaction with nurses compared with the follow-ups with physicians. CONCLUSIONS: Active patient participation in care is a critical factor in improving adherence to treatment. It would be of value to develop and assess a more patient-centred organization of hypertension care and thereby more individualized hypertension treatment. Nurses may have a pivot role in such care.
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| 2. |
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| 3. |
- Hoffmann, M, et al.
(författare)
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Risk talk: rhetorical strategies in consultations on hormone replacement therapy
- 2003
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Ingår i: Health, Risk & Society. - 1369-8575. ; 5, s. 139-154
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Tidskriftsartikel (refereegranskat)abstract
- When analysing risk discussions in medical settings it is important to consider the specific activity type. In this qualitative study 20 first-time consultations by healthy women regarding hormone replacement therapy (HRT) in the menopause the risk discussion is asymmetrical with the doctors dominating. Despite being set up as a specific opportunity for women in the menopause to discuss problems and risks, it comes forth as a decision-making activity in a traditional medical setting. The consultations fulfil to a high extent the demands for informed decision making, but the risk discussions are recontextualised into a cost-benefit discourse with a typical implicit quantitative bias. The doctors use several different rhetorical strategies such as positive introduction of HRT, embedding drawbacks in positive introductions and/or exits thereby diminishing them. The word risk is avoided to a considerable extent and the term 'drawbacks' is used instead. The most obvious strategy is to move from the woman's symptoms to aspects of prevention, thus changing the discussion from the menopause and different strategies to cope with menopausal problems into a medically oriented discussion of pharmacological treatment alternatives. The 'change of life' in these talks is entirely conceptualised within a 'medical model'.
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| 4. |
- Kiessling, Tina, et al.
(författare)
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Patients´ experiences of participation in care
- 2004
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Ingår i: Vård i Norden. - 0107-4083 .- 1890-4238. ; 24, s. 31-37
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Tidskriftsartikel (refereegranskat)abstract
- Patients have a legal right to participate in their care and in the decision-making affecting their care in most Western countries. However, this is not only a matter of legal right. According to previous research, treatment outcome may be improved if patients experience greater participation. The aim of this Swedish study was to describe how patients experience their participation in the care, and factors that have an influence on their participation. A phenomenological approach was used and data was collected by interviews with eight inpatients at a surgical ward. The interviews were audio-taped and transcribed verbatim. Through analysis, meaning units were organized into themes and the essence was formulated. The experience of participation was expressed in following themes: a need of dialogue, continuity in contact with the staff and control. The essence of participation was the desire of a continuous dialogue with the caregiver, with the aim of exchanging information. Lack of time, as the patient experienced it, among the caregivers reduced the possibility to keep the dialogue. The need of control could force the patient to participate in the care situation.
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| 5. |
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| 6. |
- Kjellgren, Karin I, 1950, et al.
(författare)
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Antihypertensive treatment and patient autonomy--the follow-up appointment as a resource for care.
- 2000
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Ingår i: Patient education and counseling. - 0738-3991 .- 1873-5134. ; 40:1, s. 39-49
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Tidskriftsartikel (refereegranskat)abstract
- Since hypertension is a chronic condition which generally requires long-term commitment to pharmacological therapy as well as alterations of patient lifestyle, the patient-physician communication in the clinical setting is an important determinant of the quality of care and health outcome. The aim of the present study was to explore the structure and content of the communication between the patient and the physician, and the process of decision-making at a routine follow-up appointment for hypertension. The study was based on 51 audio-recordings of authentic consultations. Most patients had a passive role in the consultations, and initiated few topics of conversation. The few topics that the patients initiated were usually not about hypertension. Patients' questions about medication mainly referred to unwanted effects of the drugs. Little time was invested in discussing risks related to hypertension. A collaborative shared decision-making was seldom observed in the consultations.
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| 7. |
- Kjellgren, Karin I, 1950, et al.
(författare)
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To follow dermatological treatment regimens--patients' and providers' views.
- 2004
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Ingår i: Acta dermato-venereologica. - : Medical Journals Sweden AB. - 0001-5555 .- 1651-2057. ; 84:6, s. 445-50
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Tidskriftsartikel (refereegranskat)abstract
- Adherence to long-term therapy for chronic illness is on average 50%. However, regarding adherence to dermatological treatment the existing literature is limited. The aim of the study was to acquire an understanding of issues associated with adherence to dermatological therapy. Focus group interviews were used in two types of fora: patients with chronic dermatological diseases and health care providers, including doctors, nurses and pharmacists working in dermatological care. Results reveal the providers' view of a suboptimal rate of adherence. According to both providers and patients, factors affecting adherence were patients' expectations and experiences of therapeutic effect, possibilities for the patient to take active part in treatment decisions, as well as mode of administration and type of medication. Suggested strategies for improvement are individualized patient education, continuous treatment support with assessment of medication-taking behaviour and enhanced communication skills among the providers.
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| 8. |
- Skoglund, Pär, et al.
(författare)
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Analgesic medication--communication at pharmacies.
- 2003
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Ingår i: Patient education and counseling. - 0738-3991. ; 51:2, s. 155-61
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Tidskriftsartikel (refereegranskat)abstract
- Treatment conducted in co-operation with the client is decisive for a successful result i.e. adherence to medication, satisfaction and improved health outcome. The aim of this study was to capture the communication between clients and pharmacists when dispensing prescriptions of analgesics in community pharmacies. The study was based on 42 authentic audio-recordings of clients' communication with pharmacists. Most clients had a passive role and the analysis testify to a short and asymmetric communication between the interlocutors. On average, the clients asked three questions. One-third of these questions were related to medication, i.e. dose, effect, written information, symptoms or disease. Of the questions asked by pharmacists, 2% were open in character. The study confirms previous research in other settings on caregiver dominance in consultations. Concordance in pharmaceutical care assumes a much more active client. Therefore facilitating a more active role for the clients at pharmacies is of the outmost importance.
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| 9. |
- Svensson, Staffan, 1972, et al.
(författare)
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Adverse events and patients' perceptions of antihypertensive drug effectiveness.
- 2003
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Ingår i: Journal of human hypertension. - : Springer Science and Business Media LLC. - 0950-9240 .- 1476-5527. ; 17:10, s. 671-5
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Tidskriftsartikel (refereegranskat)abstract
- Adverse events that patients attribute to their drug treatment are generally considered to reduce adherence to medication. However, some patients interpret such symptoms as indicating drug effectiveness. If perceivedly effective drugs are more likely to be taken then adverse events may increase adherence. The extent to which patients interpret adverse events as indicating drug effectiveness is not well known. We investigated this in a cross-sectional questionnaire study of 1013 drug-treated hypertensive patients from 55 primary health-care centres and 11 internal medicine clinics in Sweden. We hypothesized that estimates of future risk of complications of hypertension made by hypertensive patients who had adverse events would be lower than estimates made by patients who did not have adverse events, and that these estimates would only differ when patients were estimating their risks in a setting where they continued taking antihypertensive drugs. Patients' risk estimates were measured with visual analogue scales and adverse events were detected by an open question. Contrary to our hypothesis, patients with adverse events (25.7%) gave higher estimates of future risk in the continuing medication setting. This association persisted in a multivariate analysis, where a number of factors related to adverse events and risk were controlled for (OR 1.76 (95% CI, 1.26-2.45), P=0.001 for the most highly correlated risk measure), but risk estimates did not differ between patients with and without adverse events in the setting of not continuing medication. Possible explanations for these findings are pre-existing differences in attitude towards drugs and level of fear of complications.
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| 10. |
- Svensson, Staffan, 1972, et al.
(författare)
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Reasons for adherence with antihypertensive medication.
- 2000
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Ingår i: International journal of cardiology. - 0167-5273 .- 1874-1754. ; 76:2-3, s. 157-63
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Hypertension is often insufficiently controlled in clinical practice, a prominent reason for this being poor patient adherence with therapy. Little is known about the underlying reasons for poor adherence. We set out to investigate hypertensive patients' self-reported reasons for adhering to or ignoring medical advice regarding antihypertensive medication. METHODS: Qualitative analysis of semi-structured interviews with 33 hypertensive patients in a general-practice centre and a specialist hypertension unit in Southern Sweden. Blood-pressure measurements and laboratory measurements of antihypertensive medication were performed. RESULTS: Nineteen out of 33 patients were classified as adherent. Adherence was a function of faith in the physician, fear of complications of hypertension, and a desire to control blood pressure. Non-adherence was an active decision, partly based on misunderstandings of the condition and general disapproval of medication, but mostly taken in order to facilitate daily life or minimize adverse effects. Adherent patients gave less evidence of involvement in care than non-adherent patients. There was no obvious relation between reported adherence, laboratory markers of adherence and blood-pressure levels. CONCLUSIONS: The interview is a powerful tool for ascertaining patients' concepts and behaviour. To optimize treatment of hypertension, it is important to form a therapeutic alliance in which patients' doubts and difficulties with therapy can be detected and addressed. For this, effective patient-physician communication is of vital importance.
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