A QUALITATIVE STUDY OF MEDICATION-TAKING BEHAVIOR IN PRIMARY-CARE

Background. Prescribed medication is a mainstay of primary care but it is clear that a large proportion of treatment is not taken correctly. Such 'non-compliance' is considered to be a major problem, but resear ch to date has provided few solutions. There have been increasing call s for a change in approach in order to gain a deeper understanding of why the problem remains and new ways of addressing it. Objectives. We aimed to investigate how adult primary care patients perceived medicat ion-taking using a Grounded Theory methodology. Method. Fifty general practice patients without major current mental health or recreational drug abuse problems were interviewed at home using a flexible intervie w schedule. Subjects' accounts of taking prescribed treatments were ve rified where possible by tablet counts or case-record review, six inte rviews being excluded as unreliable. Medication use was discussed for 159 prescribed treatments of which 34 were reportedly not taken as dir ected. Results. The analysis is presented as a model of decision makin g which suggests that: (i) knowledge (about disease and treatment) com bined with faith in the doctor produces the motivation to start using medicines; (ii) most patients test a medicine before accepting it full y; (iii) three types of medicine user exist: those who (a) passively a ccept treatment advice, i.e. try to take the medicine as they perceive the doctor wants them to, (b) actively use medicines, i.e. take it as they decide they want to, and (c) reject medication altogether; (iv) the process of accepting a treatment is closely linked to accepting th e illness; and (v) practical problems are a late obstacle which only p lay a small part in the process. Conclusions. These concepts have been organized within a comprehensive model of the decision-making process , which is discussed with reference to other current theories of medic ation use. Researchers and clinicians must move beyond compliance when assessing or trying to improve medication use. Making the medication- testing process explicit is proposed as one way of assisting patients to use treatments better.