Antihypertensive treatment and patient autonomy - the follow-up appointment as a resource for care

Since hypertension is a chronic condition which generally requires long-ter m commitment to pharmacological therapy as well as alterations of patient l ifestyle, the patient-physician communication in the clinical setting is an important determinant of the quality of care and health outcome. The aim o f the present study was to explore the structure and content of the communi cation between the patient and the physician, and the process of decision-m aking at a routine follow-up appointment for hypertension. The study was ba sed 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 hyperte nsion. Patients' questions about medication mainly referred to unwanted eff ects of the drugs. Little time was invested in discussing risks related to hypertension. A collaborative shared decision-making was seldom observed in the consultations. (C) 2000 Elsevier Science Ireland Ltd. All rights reser ved.